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Bounous VE, Cipullo I, D'Alonzo M, Martella S, Franchi D, Villa P, Biglia N, Ferrero A. A prospective, multicenter, randomized, double-blind placebo-controlled trial on purified and specific Cytoplasmic pollen extract for hot flashes in breast cancer survivors. Gynecol Endocrinol 2024; 40:2334796. [PMID: 38760920 DOI: 10.1080/09513590.2024.2334796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 03/11/2024] [Indexed: 05/20/2024] Open
Abstract
OBJECTIVE evaluate the efficacy and tolerability of PureCyTonin against hot flashes (HF) in breast cancer survivors (BCS). METHODS a prospective, multicenter, randomized, double-blind placebo-controlled trial was conducted in Italy. INTERVENTIONS administration of PureCyTonin or placebo, for 3 months. Effectiveness was investigated through the compilation of a daily diary for HF and of validated questionnaires (Menopause Rating Scale (MRS), Pittsburgh Sleep Quality Index (PSQI), Visual Analogical Scales (VAS) for HF, sweating, irritability, fatigue, sleep, quality of life), carried out before starting the treatment (T0), after 1 month (T1) and after 3 months (T2). Any side effects and HF diary were recorded at each visit. RESULTS 19 women were randomized to receive PureCyTonin and 20 to placebo. At T2 compared to T0, in the PureCyTonin group, we found a reduction in the number of HF (p = 0.02) measured by daily diary. An improvement in the subjective perception of women regarding HF intensity (p = 0.04), sweat nuisance (p = 0.02), irritability (p = 0.03) and fatigue (p = 0.04) was observed through VAS scale measurement at T2 compared to T0.The total MRS score was significantly better in the PureCyTonin group at T1 (p = 0.03) compared to T0. CONCLUSIONS PureCyTonin significantly reduces HF number after 3 months of therapy in BCS and it is well-tolerated.
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Affiliation(s)
- Valentina Elisabetta Bounous
- Gynecology and Obstetrics Unit, Umberto I Hospital of Turin, Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Isabella Cipullo
- Gynecology and Obstetrics Unit, Umberto I Hospital of Turin, Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Marta D'Alonzo
- Gynecology and Obstetrics Unit, Umberto I Hospital of Turin, Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Silvia Martella
- Unit of Preventive Gynecology, IRCCS European Institute of Oncology, Milan, Italy
| | - Dorella Franchi
- Unit of Preventive Gynecology, IRCCS European Institute of Oncology, Milan, Italy
| | - Paola Villa
- Department of Woman and Child Health and Public Health, Child Health Area, Sacred Heart Catholic University, Rome, Italy
| | - Nicoletta Biglia
- Gynecology and Obstetrics Unit, Umberto I Hospital of Turin, Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Annamaria Ferrero
- Gynecology and Obstetrics Unit, Umberto I Hospital of Turin, Department of Surgical Sciences, University of Turin, Turin, Italy
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Gudenkauf LM, Gray S, Gonzalez BD, Sachdeva A, Autio K. Balancing Hormone Therapy: Mitigating Adverse Effects of Androgen-Deprivation Therapy and Exploring Alternatives in Prostate Cancer Management. Am Soc Clin Oncol Educ Book 2024; 44:e433126. [PMID: 38788186 DOI: 10.1200/edbk_433126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2024]
Abstract
Androgen-deprivation therapy (ADT) is well established as the standard of care in metastatic prostate cancer (PCa) management; however, ADT has significant adverse effects (AEs) that must be addressed. This review aims to highlight opportunities to mitigate AEs of ADT and explore alternatives in PCa management. Specifically, we discuss behavioral and pharmacologic strategies for mitigating ADT AEs as well as ADT-sparing approaches for hormone-sensitive and castration-resistant PCa. Equipped with effective mitigation strategies and possible alternatives, clinicians and researchers can optimize health-related quality of life for patients currently receiving ADT for PCa and consider treatments that spare patients from AEs of ADT.
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Affiliation(s)
- Lisa M Gudenkauf
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL
| | - Struan Gray
- Salford Royal and The Christie NHS Foundation Trusts, Manchester, United Kingdom
- Genito-urinary Cancer Research Group, Division of Cancer Sciences, The University of Manchester, Manchester, United Kingdom
| | - Brian D Gonzalez
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL
| | - Ashwin Sachdeva
- Genito-urinary Cancer Research Group, Division of Cancer Sciences, The University of Manchester, Manchester, United Kingdom
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Karen Autio
- Department of Genitourinary Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
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Peterson DE, Koyfman SA, Yarom N, Lynggaard CD, Ismaila N, Forner LE, Fuller CD, Mowery YM, Murphy BA, Watson E, Yang DH, Alajbeg I, Bossi P, Fritz M, Futran ND, Gelblum DY, King E, Ruggiero S, Smith DK, Villa A, Wu JS, Saunders D. Prevention and Management of Osteoradionecrosis in Patients With Head and Neck Cancer Treated With Radiation Therapy: ISOO-MASCC-ASCO Guideline. J Clin Oncol 2024; 42:1975-1996. [PMID: 38691821 DOI: 10.1200/jco.23.02750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 01/22/2024] [Indexed: 05/03/2024] Open
Abstract
PURPOSE To provide evidence-based recommendations for prevention and management of osteoradionecrosis (ORN) of the jaw secondary to head and neck radiation therapy in patients with cancer. METHODS The International Society of Oral Oncology-Multinational Association for Supportive Care in Cancer (ISOO-MASCC) and ASCO convened a multidisciplinary Expert Panel to evaluate the evidence and formulate recommendations. PubMed, EMBASE, and Cochrane Library databases were searched for randomized controlled trials and observational studies, published between January 1, 2009, and December 1, 2023. The guideline also incorporated systematic reviews conducted by ISOO-MASCC, which included studies published from January 1, 1990, through December 31, 2008. RESULTS A total of 1,539 publications were initially identified. There were 487 duplicate publications, resulting in 1,052 studies screened by abstract, 104 screened by full text, and 80 included for systematic review evaluation. RECOMMENDATIONS Due to limitations of available evidence, the guideline relied on informal consensus for some recommendations. Recommendations that were deemed evidence-based with strong evidence by the Expert Panel were those pertaining to best practices in prevention of ORN and surgical management. No recommendation was possible for the utilization of leukocyte- and platelet-rich fibrin or photobiomodulation for prevention of ORN. The use of hyperbaric oxygen in prevention and management of ORN remains largely unjustified, with limited evidence to support its practice.Additional information is available at www.asco.org/head-neck-cancer-guidelines.
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Affiliation(s)
| | | | - Noam Yarom
- Sheba Medical Center, Tel Hashomer, Israel
- Tel Aviv University, Tel Aviv, Israel
| | - Charlotte Duch Lynggaard
- Department of Otolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Lone E Forner
- Department of Oral and Maxillofacial Surgery, Zealand University Hospital, Køge, Denmark
| | | | - Yvonne M Mowery
- UPMC Hillman Cancer Center, Pittsburgh, PA
- University of Pittsburgh, Pittsburgh, PA
| | | | - Erin Watson
- Department of Dental Oncology, Princess Margaret Cancer Center/Faculty of Dentistry, University of Toronto, Toronto, Canada
| | - David H Yang
- BC Cancer/University of British Columbia, Vancouver, Canada
| | - Ivan Alajbeg
- University of Zagreb School of Dental Medicine, Zagreb, Croatia
| | - Paolo Bossi
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- IRCCS Humanitas Research Hospital, Milan, Italy
| | | | - Neal D Futran
- University of Washington School of Medicine, Seattle, WA
| | | | - Edward King
- Northern Colorado Head and Neck Cancer Support Group, Windsor, CO
| | - Salvatore Ruggiero
- New York Center for Orthognathic and Maxillofacial Surgery, New York, NY
| | | | | | - Jonn S Wu
- BC Cancer/University of British Columbia, Vancouver, Canada
| | - Deborah Saunders
- Health Sciences North Research Institute, Northern Ontario School of Medicine, Health Sciences North, Sudbury, Ontario, Canada
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Panwar A, Lydiatt W, Osazuwa-Peters N. Genetic Depression Risk for Head and Neck Cancer Survivors-Fait Accompli? JAMA Otolaryngol Head Neck Surg 2024:2819422. [PMID: 38814662 DOI: 10.1001/jamaoto.2024.0377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2024]
Affiliation(s)
- Aru Panwar
- Head and Neck Surgical Oncology, Methodist Estabrook Cancer Center, Nebraska Methodist Hospital, Omaha, Nebraska
- Department of Surgery, Creighton University School of Medicine, Omaha, Nebraska
| | - William Lydiatt
- Head and Neck Surgical Oncology, Methodist Estabrook Cancer Center, Nebraska Methodist Hospital, Omaha, Nebraska
- Department of Surgery, Creighton University School of Medicine, Omaha, Nebraska
| | - Nosayaba Osazuwa-Peters
- Department of Head and Neck Surgery and Communication Sciences, Duke University School of Medicine, Durham, North Carolina
- Deputy Editor, Diversity, Equity, and Inclusion, JAMA Otolaryngology-Head & Neck Surgery
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Adhikari B, Shrestha N, Bhatt VR. A real-world study of the quality of Outpatient Pain Management in patients with Cancer. J Cancer Surviv 2024:10.1007/s11764-024-01621-3. [PMID: 38795285 DOI: 10.1007/s11764-024-01621-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 05/21/2024] [Indexed: 05/27/2024]
Abstract
PURPOSE Up to 40% patients with cancer reporting pain may not receive optimal analgesia indicating inadequate treatment of pain. We examined the patterns of outpatient pain management in patients with cancer who reported pain. METHODS We used the National Ambulatory Medical Care Survey data for outpatient visits from 2006 to 2018 for patients with any cancer and reporting pain. The primary outcome was prescription of pain medications among these patients. We performed multinomial logistic regression to identify factors associated with analgesic prescriptions among patients with cancer who reported pain. RESULTS We captured an estimated total of 412 million outpatient visits of which 22 million visits dealt with patients with cancer reporting pain. An estimated total of 13.8 million (61.33%) patient visits had pain reported but were not prescribed any pain medications. 5.5 million (24.44%) patient visits had non-opioid analgesic prescription while opioid analgesics were prescribed during 3.2 million (14.22%) visits. Patients who were black, aged 45-64 years, residing in rural geographical areas, visiting medical subspecialty practices, and having cancers of the respiratory and digestive systems had higher odds of receiving opioid prescription. CONCLUSIONS As one of the largest pain management studies among patients with cancer in the outpatient setting, covering 412 million patient visits, our study shows that a significant proportion of patients with cancer who reported pain did not receive a prescription for analgesics suggesting a possibility of undertreatment of pain. IMPLICATIONS FOR CANCER SURVIVORS Undertreatment of pain continues to remain a major unmet need in patients with cancer.
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Affiliation(s)
- Biplov Adhikari
- Medstar Health Internal Medicine Residency Program, 201 E University Pkwy, Baltimore, MD, USA.
| | - Nistha Shrestha
- Department of Outcomes and Translational Sciences, College of Pharmacy, The Ohio State University, Columbus, OH, USA
| | - Vijaya Raj Bhatt
- Division of Hematology-Oncology, The Fred & Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE, USA
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Gudenkauf LM, Fox RS, Gonzalez BD, Jim HSL, Salsman JM, Victorson DE, Sanford SD, Oswald LB. Need for Behavioral Interventions for Young Adults Living with Advanced Cancer in the U.S. Cancers (Basel) 2024; 16:1910. [PMID: 38791988 PMCID: PMC11120301 DOI: 10.3390/cancers16101910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 05/10/2024] [Accepted: 05/15/2024] [Indexed: 05/26/2024] Open
Abstract
The population of young adults (YAs) aged 18-39 living with advanced cancer is growing and faces a compounded set of challenges at the intersection of age and disease. Despite these substantial challenges, behavioral interventions tailored to YAs living with advanced cancer remain scarce. This commentary aims to (1) discuss the unmet psychological, social, and behavioral needs of YAs living with advanced cancer; (2) highlight the paucity of behavioral interventions tailored to this growing population; (3) offer recommendations for the development of behavioral interventions targeting the unique needs of YAs living with advanced cancer; and (4) describe potential far-reaching public health benefits of these targeted behavioral interventions.
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Affiliation(s)
- Lisa M. Gudenkauf
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL 33216, USA
| | - Rina S. Fox
- Division of Advanced Nursing Practice and Science, University of Arizona College of Nursing, Tucson, AZ 85721, USA
- Cancer Prevention and Control Program, University of Arizona Cancer Center, Tucson, AZ 85719, USA
| | - Brian D. Gonzalez
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL 33216, USA
| | - Heather S. L. Jim
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL 33216, USA
| | - John M. Salsman
- Department of Social Sciences and Health Policy, Division of Public Health Sciences, Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA
| | - David E. Victorson
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
- Cancer Control and Survivorship Program, Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL 60611, USA
| | - Stacy D. Sanford
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
- Cancer Control and Survivorship Program, Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL 60611, USA
| | - Laura B. Oswald
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL 33216, USA
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Mollica MA, McWhirter G, Tonorezos E, Fenderson J, Freyer DR, Jefford M, Luevano CJ, Mullett T, Nasso SF, Schilling E, Passero VA. Developing national cancer survivorship standards to inform quality of care in the United States using a consensus approach. J Cancer Surviv 2024:10.1007/s11764-024-01602-6. [PMID: 38739299 DOI: 10.1007/s11764-024-01602-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Accepted: 04/11/2024] [Indexed: 05/14/2024]
Abstract
PURPOSE To develop United States (US) standards for survivorship care that informs (1) essential health system policy and process components and (2) evaluation of the quality of survivorship care. METHODS The National Cancer Institute and the Department of Veterans Affairs led a review to identify indicators of quality cancer survivorship care in the domains of health system policy, process, and evaluation/assessment. A series of three virtual consensus meetings with survivorship care and research experts and advocates was conducted to rate the importance of the indicators and refine the top indicators. The final set of standards was developed, including ten indicators in each domain. RESULTS Prioritized items were survivor-focused, including processes to both assess and manage physical, psychological, and social issues, and evaluation of patient outcomes and experiences. Specific indicators focused on developing a business model for sustaining survivorship care and collecting relevant business metrics (e.g., healthcare utilization, downstream revenue) to show value of survivorship care to health systems. CONCLUSIONS The National Standards for Cancer Survivorship Care can be used by health systems to guide development of new survivorship care programs or services or to assess alignment and enhance services in existing survivorship programs. Given the variety of settings providing care to survivors, it is necessary for health systems to adapt these standards based on factors including age-specific needs, cancer types, treatments received, and health system resources. IMPLICATIONS FOR CANCER SURVIVORS With over 18 million cancer survivors in the United States, many of whom experience varied symptoms and unmet needs, it is essential for health systems to have a comprehensive strategy to provide ongoing care. The US National Standards for Survivorship Care should serve as a blueprint for what survivors and their families can anticipate after a cancer diagnosis to address their needs.
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Affiliation(s)
- Michelle A Mollica
- Division of Cancer Control and Population Sciences, National Cancer Institute, 9609 Medical Center Drive, MSC 9712, Room 3E440, Bethesda, MD, 20892-9762, USA.
| | - Gina McWhirter
- Department of Veterans Affairs, National Oncology Program, Washington, DC, USA
| | - Emily Tonorezos
- Division of Cancer Control and Population Sciences, National Cancer Institute, 9609 Medical Center Drive, MSC 9712, Room 3E440, Bethesda, MD, 20892-9762, USA
| | - Joshua Fenderson
- Hematology/Oncology Service, Brooke Army Medical Center, Defense Health Agency, San Antonio, TX, USA
- Uniformed Services University of Health Sciences, Bethesda, MD, USA
| | - David R Freyer
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Children's Hospital Los Angeles and USC Norris Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Michael Jefford
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Australian Cancer Survivorship Centre, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia
| | - Christopher J Luevano
- Office of The Assistant Secretary of Defense for Health Affairs, Department of Defense, Washington, DC, USA
| | - Timothy Mullett
- Department of Surgery, College of Medicine, University of Kentucky, Lexington, KY, USA
| | | | - Ethan Schilling
- Cancer Survivorship Advocate, Carolina Pediatric Therapy, Asheville, NC, USA
| | - Vida Almario Passero
- Division of Hematology/Oncology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Section of Hematology/Oncology, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
- VA National TeleOncology, Durham, NC, USA
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Ioffe D, Bhatia-Patel SC, Gandhi S, Hamad EA, Dotan E. Cardiovascular Concerns, Cancer Treatment, and Biological and Chronological Aging in Cancer: JACC Family Series. JACC CardioOncol 2024; 6:143-158. [PMID: 38774000 PMCID: PMC11103051 DOI: 10.1016/j.jaccao.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 02/08/2024] [Accepted: 02/12/2024] [Indexed: 05/24/2024] Open
Abstract
Cardiovascular disease (CVD) and cancer are leading causes of death globally, particularly among the rapidly growing population of older adults (OAs). CVD is a leading cause of mortality among cancer survivors, often accelerated by cancer treatments associated with short- or long-term cardiotoxicity. Moreover, there is a dynamic relationship among CVD, cancer, and aging, characterized by shared risk factors and biological hallmarks, that plays an important role in caring for OAs, optimizing treatment approaches, and developing preventive strategies. Assessment of geriatric domains (eg, functional status, comorbidities, cognition, polypharmacy, nutritional status, social support, psychological well-being) is critical to individualizing treatment of OAs with cancer. The authors discuss considerations in caring for an aging population with cancer, including methods for the assessment of OAs with CVD and/or cardiovascular risk factors planned for cancer therapy. Multidisciplinary care is critical in optimizing patient outcomes and maintaining quality of life in this growing vulnerable population.
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Affiliation(s)
- Dina Ioffe
- Department of Medical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
| | | | - Sakshi Gandhi
- Department of Medicine, Temple University Hospital, Philadelphia, Pennsylvania, USA
| | - Eman A. Hamad
- Department of Medicine, Temple University Hospital, Philadelphia, Pennsylvania, USA
| | - Efrat Dotan
- Department of Medical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
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Valente S, Roesch E. Breast cancer survivorship. J Surg Oncol 2024. [PMID: 38534002 DOI: 10.1002/jso.27627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 03/11/2024] [Indexed: 03/28/2024]
Abstract
Breast cancer survivorship care transitions from active treatment to focus on surveillance and health maintenance. This review article discusses the crucial aspects of breast cancer survivorship, which include cancer surveillance, management of treatment side effects, implementation of a healthy lifestyle, and psychosocial support.
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Affiliation(s)
| | - Erin Roesch
- Hematology/Medical Oncology, Cleveland Clinic, Cleveland, Ohio, USA
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Villa P, Bounous VE, Amar ID, Bernardini F, Giorgi M, Attianese D, Ferrero A, D’Oria M, Scambia G. Hormone Replacement Therapy in Post-Menopause Hormone-Dependent Gynecological Cancer Patients: A Narrative Review. J Clin Med 2024; 13:1443. [PMID: 38592285 PMCID: PMC10932409 DOI: 10.3390/jcm13051443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 02/21/2024] [Accepted: 02/22/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND Advances in the treatment of gynecological cancer have led to improvements in survival but also an increase in menopausal symptoms, especially in young women with premature iatrogenic menopause. METHODS A narrative review was performed to clarify the possibility of prescribing hormone replacement therapy (HRT) after hormone-dependent gynecological cancers (ovarian cancer [OC], cervical adenocarcinoma [AC], and endometrial cancer [EC]). RESULTS HRT can be prescribed to patients with early-stage, grade I-II OC who experience bothersome menopausal symptoms non-responsive to alternative non-hormone therapy after optimal surgery. Caution should be exercised in administering HRT after serous borderline tumors and endometrioid OC, and HRT is not recommended in low-grade serous OC. HRT is not contraindicated in AC survivors. After surgery for EC, HRT can be prescribed in women with early-stage low-grade EC. There is not enough data to give indications to patients with advanced EC. CONCLUSIONS HRT can be discussed with patients, evaluating the risks and benefits of hormone-dependent gynecological cancer. Counseling should be performed by gynecologic oncologists experienced in the management of these patients.
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Affiliation(s)
- Paola Villa
- Department of Women and Child’s Health Sciences and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (P.V.); (I.D.A.); (F.B.)
| | - Valentina Elisabetta Bounous
- Gynecology and Obstetrics Unit, Mauriziano Umberto I Hospital, Department of Surgical Sciences, University of Turin, 10128 Turin, Italy; (M.G.); (D.A.); (A.F.)
| | - Inbal Dona Amar
- Department of Women and Child’s Health Sciences and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (P.V.); (I.D.A.); (F.B.)
| | - Federica Bernardini
- Department of Women and Child’s Health Sciences and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (P.V.); (I.D.A.); (F.B.)
| | - Margherita Giorgi
- Gynecology and Obstetrics Unit, Mauriziano Umberto I Hospital, Department of Surgical Sciences, University of Turin, 10128 Turin, Italy; (M.G.); (D.A.); (A.F.)
| | - Daniela Attianese
- Gynecology and Obstetrics Unit, Mauriziano Umberto I Hospital, Department of Surgical Sciences, University of Turin, 10128 Turin, Italy; (M.G.); (D.A.); (A.F.)
| | - Annamaria Ferrero
- Gynecology and Obstetrics Unit, Mauriziano Umberto I Hospital, Department of Surgical Sciences, University of Turin, 10128 Turin, Italy; (M.G.); (D.A.); (A.F.)
| | | | - Giovanni Scambia
- Department of Women and Child’s Health Sciences and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (P.V.); (I.D.A.); (F.B.)
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Brauer ER, Petersen L, Ganz PA. Survivorship care in breast cancer: understanding implementation barriers through the lens of the Theoretical Domains Framework. JNCI Cancer Spectr 2024; 8:pkad108. [PMID: 38128018 PMCID: PMC10868380 DOI: 10.1093/jncics/pkad108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 12/06/2023] [Accepted: 12/18/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Breast cancer survivorship guidelines with specific recommendations on managing long-term effects are available, but uptake in clinical practice remains low. Using the lens of the Theoretical Domains Framework, we aimed to understand key factors in guideline-concordant management of long-term effects to inform future implementation efforts in clinical practice contexts. METHODS As part of a broader survey of oncologists, a theory-guided questionnaire was developed. Oncologists were asked to report level of agreement with Theoretical Domains Framework-based statements, current usage and perceived value of survivorship resources, and frequency of managing long-term effects in routine care. Data analyses included psychometric assessment of the questionnaire, descriptive summaries of theoretical domains and survivorship resources, and multivariable logistic regression models. RESULTS In total, 217 oncologists completed the Theoretical Domains Framework-based questionnaire; 54% of oncologists reported "always or almost always" evaluating physical effects at routine survivorship appointments, while 34% did so for psychosocial effects. In regression models, Environmental Context and Resources was the only theoretical domain found to be statistically significantly associated with "always or almost always" evaluating both physical (odds ratio = 0.29, 95% confidence interval = 0.09 to 0.80) and psychosocial (odds ratio = 0.09, 95% confidence interval = 0.02 to 0.35) effects. CONCLUSIONS Findings support application of the Theoretical Domains Framework in understanding oncologists' behaviors and perceived barriers in managing long-term effects in breast cancer survivors. In future implementation efforts, this theory-informed approach can be used to target relevant domains and strategies focused on embedding guideline recommendations in the clinical context through structured resources and environmental supports.
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Affiliation(s)
- Eden R Brauer
- School of Nursing, University of California Los Angeles, Los Angeles, CA, USA
- Center for Cancer Prevention and Control Research, Jonsson Comprehensive Cancer Center, University of California Los Angeles, Los Angeles, CA, USA
| | - Laura Petersen
- Center for Cancer Prevention and Control Research, Jonsson Comprehensive Cancer Center, University of California Los Angeles, Los Angeles, CA, USA
| | - Patricia A Ganz
- Center for Cancer Prevention and Control Research, Jonsson Comprehensive Cancer Center, University of California Los Angeles, Los Angeles, CA, USA
- Division of Hematology-Oncology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
- Department of Health Policy and Management, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, USA
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