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JOGC

Hormone Therapy Use Among Young Patients with Cervical Cancer in Southern Saskatchewan

Published:April 25, 2022DOI:https://doi.org/10.1016/j.jogc.2022.03.016

      Abstract

      Objective

      Treatment for cervical cancer can cause cessation of ovarian function in young patients. Physician counselling practices related to premature menopause and hormonal therapy (HT) for young cervical cancer patients is not well known. The primary objective of this study was to assess the frequency of HT counselling and usage among young cervical cancer patients. The secondary objective was to assess clinical and demographic factors associated with HT use.

      Methods

      This retrospective review included adult women younger than age 50 years who received treatment for cervical cancer between 2007 and 2017. Patient and disease characteristics, disease outcome, and documentation of HT and bone health counselling were collected from electronic records. Descriptive statistical analysis was performed for the primary objective, and independent t tests and χ2 tests were used for secondary objective data analysis.

      Results

      In this study, 67 premenopausal women with cervical cancer (stages I–III) lost ovarian function from cancer treatment, of whom 52% had received counselling on HT from their oncologists. Thirty-nine percent of patients were using HT at the time of their last review. Younger women were more likely than older women to receive HT counselling (mean age 37.3 ± 6.6 y vs. 42.4 ± 6.0 y; P = 0.001). Counselling frequency and usage of HT were not affected by cancer stage, body mass index, or smoking status.

      Conclusion

      Young asymptomatic patients should receive HT if not contraindicated, yet half of qualified cervical cancer patients in this study received counselling on premature menopause and HT. Structured counselling on HT should be implemented as an integral part of cervical cancer care.

      Résumé

      Objectif

      Le traitement du cancer du col de l’utérus peut entraîner l’arrêt de la fonction ovarienne chez les patientes jeunes. Les pratiques de consultation des médecins ne sont pas bien connues en ce qui concerne la ménopause prématurée et l’hormonothérapie (HT) chez les patientes jeunes atteintes d’un cancer du col. L’objectif principal de cette étude était d’évaluer la fréquence des consultations et l’utilisation de l’HT chez les patientes jeunes atteintes d’un cancer du col. L’objectif secondaire était d’évaluer les facteurs cliniques et démographiques associés à l’utilisation de l’HT.

      Méthodologie

      Cette analyse rétrospective portait sur des femmes adultes de moins de 50 ans ayant reçu un traitement contre le cancer du col de l’utérus entre 2007 et 2017. Les caractéristiques de la patiente et de la maladie, l’issue de la maladie ainsi que l’utilisation de l’HT et les conseils en santé osseuse sont tirés de dossiers électroniques. Une analyse statistique descriptive a été effectuée pour l’objectif principal, et des tests de Student et de χ2 indépendants ont été utilisés pour l’analyse des données pour l’objectif secondaire.

      Résultats

      Dans cette étude, 67 femmes non ménopausées atteintes d’un cancer du col de l’utérus (stades I-III) ont perdu la fonction ovarienne en raison du traitement de leur cancer, dont 52 % avaient reçu des conseils sur l’HT par leur oncologue. Au moment de leur dernière évaluation, 39 % des patientes utilisaient l’HT. Les femmes plus jeunes étaient plus susceptibles que les femmes plus âgées de recevoir des conseils sur l’HT (âge moyen de 37,3 ± 6,6 ans p/r à 42,4 ± 6,0 ans; p = 0,001). Le stade du cancer, l’indice de masse corporelle et le tabagisme n’ont eu aucune incidence sur la fréquence des consultations et l’utilisation de l’HT.

      Conclusion

      Les patientes jeunes asymptomatiques devraient prendre une HT si elle n’est pas contre-indiquée, mais seulement la moitié des patientes admissibles atteintes d’un cancer du col de l’utérus ont reçu des conseils sur la ménopause prématurée et l’HT. Il y a lieu d’intégrer des conseils structurés sur l’HT dans le cadre des soins contre le cancer du col de l’utérus.

      Keywords

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      References

      1. Cancer Today – International Agency for Research on Cancer. WHO.
        (Available at:) (Accessed on January 27, 2022)
      2. Canadian Cancer Statistics Advisory Committee in collaboration with the Canadian Cancer Society, Statistics Canada and the Public Health Agency of Canada. Canadian cancer statistics 2021.
        (Available at:) (Accessed on January 26, 2022)
        • National Cancer Institute
        SEER, cancer stat facts: cervix uteri cancer.
        (Available at:) (Accessed on November 10, 2019)
        • Koh W.-J.
        • Abu-Rustum N.R.
        • Bean S.
        • et al.
        Cervical cancer, version 3.2019, NCCN Clinical Practice Guidelines in Oncology.
        J Natl Compr Cancer Netw. 2019; 17: 64-84
        • Viswanathan A.N.
        • Lee L.J.
        • Eswara J.R.
        • et al.
        Complications of pelvic radiation in patients treated for gynecologic malignancies.
        Cancer. 2014; 120: 3870-3883
        • Faubion S.S.
        • Kuhle C.L.
        • Shuster L.T.
        • et al.
        Long-term health consequences of premature or early menopause and considerations for management.
        Climacteric J Int Menopause Soc. 2015; 18: 483-491
        • Sullivan S.D.
        • Sarrel P.M.
        • Nelson L.M.
        Hormone replacement therapy in young women with primary ovarian insufficiency and early menopause.
        Fertil Steril. 2016; 106: 1588-1599
        • Yuksel N.
        • Evaniuk D.
        • Huang L.
        • et al.
        SOGC clinical practice guideline No. 422a: menopause: vasomotor symptoms, prescription therapeutic agents, complementary and alternative medicine, nutrition, and lifestyle.
        J Obstet Gynaecol Can. 2021; 43: 1188-1204
        • Berman T.A.
        • Schiller J.T.
        Human papillomavirus in cervical cancer and oropharyngeal cancer: one cause, two diseases.
        Cancer. 2017; 123: 2219-2229
        • Deli T.
        • Orosz M.
        • Jakab A.
        Hormone replacement therapy in cancer survivors - review of the literature.
        Pathol Oncol Res. 2020; 26: 63-78
        • Stewart C.J.R.
        • Crum C.P.
        • McGluggage W.G.
        • et al.
        Guidelines to aid in the distinction of endometrial and endocervical carcinomas, and the distinction of independent primary carcinomas of the endometrium and adnexa from metastatic spread between these and other sites.
        Int J Gyn Pathol. 2018; 38: S75-S92
        • Ploch E.
        Hormonal replacement therapy in patients after cervical cancer treatment.
        Gynecol Oncol. 1987; 26: 169-177
        • Vargiu V.
        • Amar I.D.
        • Rosati A.
        • et al.
        Hormone replacement therapy and cervical cancer: a systematic review of the literature.
        Climacteric. 2021; 24: 120-127
        • Rauh L.A.
        • Pannone A.F.
        • Cantrell L.A.
        Hormone replacement therapy after treatment for cervical cancer: are we adhering to standard of care?.
        Gynecol Oncol. 2017; 147: 597-600
        • Everhov Å.H.
        • Nyberg T.
        • Bergmark K.
        • et al.
        Hormone therapy after uterine cervical cancer treatment: a Swedish population-based study.
        Menopause N Y N. 2015; 22: 633-639
        • Read M.D.
        • Edey K.A.
        • Hapeshi J.
        • et al.
        Compliance with estrogen hormone replacement therapy after oophorectomy: a prospective study.
        Menopause Int. 2010; 16: 60-64
        • Froment M.-A.
        • Gomez S.L.
        • Roux A.
        • et al.
        Impact of socioeconomic status and ethnic enclave on cervical cancer incidence among Hispanics and Asians in California.
        Gynecol Oncol. 2014; 133: 409-415
        • Chlebowski R.T.
        • Anderson G.L.
        • Aragaki A.K.
        • et al.
        Association of menopausal hormone therapy with breast cancer incidence and mortality during long-term follow-up of the Women’s Health Initiative randomized clinical trials.
        JAMA. 2020; 324: 369-380
        • Moss E.L.
        • Taneja S.
        • Munir F.
        • et al.
        Iatrogenic menopause after treatment for cervical cancer.
        Clin Oncol R Coll Radiol G B. 2016; 28: 766-775
        • Hinds L.
        • Price J.
        Menopause, hormone replacement and gynaecological cancers.
        Menopause Int. 2010; 16: 89-93
        • Smit S.G.
        • Heyns C.F.
        Management of radiation cystitis.
        Nat Rev Urol. 2010; 7: 206-214
        • Liu Y.K.
        • Harty J.I.
        • Steinbock G.S.
        • et al.
        Treatment of radiation or cyclophosphamide induced hemorrhagic cystitis using conjugated estrogen.
        J Urol. 1990; 144: 41-43
        • Buonomo B.
        • Multinu F.
        • Casarin J.
        • et al.
        Ovarian transposition in patients with cervical cancer prior to pelvic radiotherapy: a systematic review.
        Int J Gynecol Cancer. 2021; 31: 360-370
      3. The 2017 hormone therapy position statement of the North American Menopause Society.
        Menopause. 2018; 25: 1362-1387
        • Baber R.J.
        • Panay N.
        • Fenton A.
        • et al.
        2016 IMS recommendations on women's midlife health and menopause hormone therapy.
        Climacteric. 2016; 19: 109-150