Survey shows ongoing misconceptions about hormone therapy safety in cancer survivors

Despite evidence suggesting the safety of hormone therapy for patients with a history of low-grade endometrial or epithelial ovarian cancer, a new survey shows that many gynecologists and some gynecologic oncologists are still uncomfortable prescribing the therapy for this patient population. This indicates a need for more clinician education to help overcome lingering misconceptions. Results of the survey are published online today in Menopause, the journal of The Menopause Society.

Although most patients with gynecologic cancers are postmenopausal, it is estimated that 40% of these patients are premenopausal or perimenopausal at the time of diagnosis. Many patients undergoing surgery for a gynecologic malignancy will require a bilateral oophorectomy as part of their treatment. In addition, both chemotherapy and radiotherapy put women at risk of decreased ovarian function.

Thanks to improvements in cancer therapies, it is important to consider the long-term effects of primary ovarian insufficiency and hormone deprivation in premenopausal patients with gynecologic cancer. Estrogen therapy, however, has historically been underused in this population because of provider concerns primarily regarding cancer recurrence.

In 2020, the Society of Gynecologic Oncology (SGO) released a statement that was affirmed by The Menopause Society to help guide the use of hormone therapy in patients with gynecologic cancer. Since that time, there is no known publication of statistics relative to the effect on the frequency of practitioners prescribing hormones for this population.

That's why this new web-based survey of 293 members of the SGO and the American College of Obstetricians and Gynecologists was undertaken to explore and define the use of estrogen therapy in women with a history of gynecologic cancer. Some of the highlighted results of the survey include

• 63.82% of respondents prescribe estrogen therapy to patients with endometrial cancer
• 65.19% of respondents feel comfortable prescribing estrogen to patients with epithelial ovarian cancer
• 96.8% of respondents are comfortable prescribing estrogen for patients with cervical cancer

Prescribing patterns differed significantly based on sex, job title, and years in practice. The data suggest that benign gynecology care professionals and those with less clinical experience are more likely to hold misconceptions around hormone safety.

The respondents were also asked about their preferred estrogen therapy alternatives. Selective serotonin reuptake inhibitors were the most frequently selected (88.4%), followed by gabapentin (58%), and neurokinin-3 antagonists (46.4%).

Studies demonstrate that hormone therapy is a highly effective and safe (for most women) treatment to manage bothersome menopause symptoms that can greatly affect a woman's quality of life. The most common reason for not prescribing estrogen therapy in patients with a history of gynecologic cancer was the belief that the risks outweighed the benefits. Although this may be true for certain cancers, it is not for all.

Survey results are published in the article "Estrogen therapy in patients with gynecologic cancer: a survey of gynecologists and oncologists in the United States."

Treatment for gynecologic cancers often accelerates the onset of menopause and contributes to more severe symptoms in this population. Hormone therapy is the most effective treatment for the management of vasomotor symptoms and genitourinary syndrome of menopause. Recognizing when hormone therapy can be safely used will have a beneficial effect on overall well-being and health."

Dr. Monica Christmas, associate medical director for The Menopause Society