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Yeo W, Pang E, Liem GS, Suen JJS, Ng RYW, Yip CCH, Li L, Yip CHW, Mo FKF. Menopausal symptoms in relationship to breast cancer-specific quality of life after adjuvant cytotoxic treatment in young breast cancer survivors. Health Qual Life Outcomes 2020; 18:24. [PMID: 32041627 PMCID: PMC7011454 DOI: 10.1186/s12955-020-1283-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 02/05/2020] [Indexed: 11/10/2022] Open
Abstract
Introductions For young premenopausal breast cancer patients, adjuvant chemotherapy may cause menstrual disruptions and premature menopause, which may in turn impair their quality of life (QoL). In this study among young breast cancer survivors who have undergone adjuvant chemotherapy, the objectives were to assess post-treatment menopausal symptoms and their associated factors, and to correlate these symptoms with breast cancer-specific QoL. Methods The study population included premenopausal young Chinese women with early-stage breast cancer who had undergone adjuvant chemotherapy between 3 and 10 years prior to enrolling into this study. At study entry, patients’ characteristics and clinical features were collected; each patient had detail menstrual history collected and each filled in MENQOL and FACT-B + 4 questionnaires. Results Two hundred eighty eligible patients were recruited. For adjuvant chemotherapy, 92% received anthracyclines and 28% received taxanes; 76% received adjuvant tamoxifen. At a median of 5.0 years from initial cancer diagnosis, 49 and 11% had become post- and peri-menopausal respectively. MENQOL at study entry revealed that physical domain score was worse in overweight/obese patients (mean scores for underweight/normal vs overweight/obese: 2.65 vs 2.97, p = 0.0162). Vasomotor domain score was worse in those who received taxanes or tamoxifen (taxane vs non-taxane: 2.91 vs. 2.35, p = 0.0140; tamoxifen vs no tamoxifen: 2.75 vs. 2.34, p = 0.0479). Sexual domain score was worse among those who had become peri/post-menopausal (peri/postmenopausal vs premenopausal: 2.82 vs. 2.29, p = 0.0229). On the other hand, patients who utilized traditional Chinese medicine had significantly worse scores for vasomotor, psychosocial and physical domains. Further, there was a significant association between MENQOL scores and FACT-B + 4 scores; less severe symptoms in the MENQOL domains were associated with better QoL scores in FACT-B + 4 physical, functional, psychosocial and emotional well-being, Breast Cancer Subscale, Arm Subscale and FACT-B total score. Conclusion Among premenopausal breast cancer women who had undergone adjuvant chemotherapy, those who had received taxanes or tamoxifen, were overweight/obese and utilized traditional Chinese medicine had more severe menopausal symptoms. Patients who experienced worse menopausal symptoms were found to have worse breast cancer-specific QoL. Interventional studies with an aim to alleviate menopausal symptoms are warranted to assess if overall QoL of these patients could be improved. Trial registration Not applicable.
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Affiliation(s)
- Winnie Yeo
- Department of Clinical Oncology, Prince of Wales Hospital, Sir YK Pao Centre for Cancer, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, NT, Hong Kong, Hong Kong Special Administrative Region, China. .,Hong Kong Cancer Institute, State Key Laboratory of Translational Oncology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong Special Administrative Region, China.
| | - Elizabeth Pang
- Department of Clinical Oncology, Prince of Wales Hospital, Sir YK Pao Centre for Cancer, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, NT, Hong Kong, Hong Kong Special Administrative Region, China.,Hong Kong Cancer Institute, State Key Laboratory of Translational Oncology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong Special Administrative Region, China
| | - Giok S Liem
- Department of Clinical Oncology, Prince of Wales Hospital, Sir YK Pao Centre for Cancer, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, NT, Hong Kong, Hong Kong Special Administrative Region, China
| | - Joyce J S Suen
- Department of Clinical Oncology, Prince of Wales Hospital, Sir YK Pao Centre for Cancer, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, NT, Hong Kong, Hong Kong Special Administrative Region, China
| | - Rita Y W Ng
- Department of Clinical Oncology, Prince of Wales Hospital, Sir YK Pao Centre for Cancer, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, NT, Hong Kong, Hong Kong Special Administrative Region, China
| | - Christopher C H Yip
- Department of Clinical Oncology, Prince of Wales Hospital, Sir YK Pao Centre for Cancer, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, NT, Hong Kong, Hong Kong Special Administrative Region, China
| | - Leung Li
- Department of Clinical Oncology, Prince of Wales Hospital, Sir YK Pao Centre for Cancer, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, NT, Hong Kong, Hong Kong Special Administrative Region, China
| | - Claudia H W Yip
- Department of Clinical Oncology, Prince of Wales Hospital, Sir YK Pao Centre for Cancer, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, NT, Hong Kong, Hong Kong Special Administrative Region, China
| | - Frankie K F Mo
- Department of Clinical Oncology, Prince of Wales Hospital, Sir YK Pao Centre for Cancer, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, NT, Hong Kong, Hong Kong Special Administrative Region, China.,Hong Kong Cancer Institute, State Key Laboratory of Translational Oncology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong Special Administrative Region, China
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Yeo W, Mo FKF, Pang E, Suen JJS, Koh J, Loong HHF, Yip CCH, Ng RYW, Yip CHW, Tang NLS, Liem GS. Profiles of lipids, blood pressure and weight changes among premenopausal Chinese breast cancer patients after adjuvant chemotherapy. BMC Womens Health 2017; 17:55. [PMID: 28750616 PMCID: PMC5532788 DOI: 10.1186/s12905-017-0409-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 07/19/2017] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Adjuvant chemotherapy improves outcome of patients with early breast cancer. However, chemotherapy may be associated with long term toxicities. In this retrospective cohort study, the objectives were to determine body weight, body mass index (BMI), blood pressure and fasting lipids levels of young premenopausal Chinese breast cancer patients after adjuvant chemotherapy. Potential factors associated with these parameters were identified. METHODS Eligibility criteria include premenopausal Chinese patients who were diagnosed to have stage I-III breast cancer within 3-10 years, age < 45 and having received adjuvant chemotherapy at the time of breast cancer diagnosis. Information at initial breast cancer diagnosis were retrieved from patients' medical records and include age at diagnosis, tumor characteristics, anti-cancer treatments, blood pressure and body weight and height. At study entry, all patients had additional background demographics collected, as well as blood pressure, body weight and fasting serum lipid profiles measured. Incidence of chemotherapy-related amenorrhoea (CRA) and menopause were determined. Factors associated with weight gain, hypertension and dyslipidaemias were analyzed. RESULTS Two hundred and eighty patients were studied. The median age at breast cancer diagnosis was 41 years (range: 24-45). The median time from breast cancer diagnosis to study entry was 5.0 years. The median age at study entry was 46.5 years (range: 28-54). 91.1% developed CRA; 48.9% had become menopausal and 10% were peri-menopausal. Between initial breast cancer diagnosis and the time of study entry, the median weight gain was 1.8 kg; 63.2% gained weight by >2%; 52.1% were overweight/obese; 30.7% had hypertension. Abnormal total-cholesterol and LDL-cholesterol occurred in 34.3% and 56.1% respectively. On multivariate analyses, older age was associated with reduced risk while occurrence of CRA and having received taxane-containing regimens were associated with increased risk of weight gain. Oestrogen-receptor positivity was associated with reduced risk while overweight/obese statuses were associated with increased risk of hypertension. Use of tamoxifen was associated with reduced risk of abnormal LDL-cholesterol. Weight gain, overweight/obese, older age, progression to post/peri-menopausal status at study entry, having received corticosteroid premedication before adjuvant chemotherapy and having received taxane-containing adjuvant chemotherapy were associated with increased risk of dyslipidaemias. CONCLUSION Among young premenopausal Chinese breast cancer patients who had received adjuvant chemotherapy, the current study has revealed that although there was only a median weight gain of 1.8 kg, there was a nearly 60% increase in abnormal BMI. Further, a significant proportion of patients were detected to have hypertension and dyslipidaemias. Interventional studies with lifestyle modifications are warranted.
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Affiliation(s)
- Winnie Yeo
- Department of Clinical Oncology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, New Territories Hong Kong SAR
- State Key Laboratory in Oncology in South China, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, New Territories Hong Kong SAR
| | - Frankie K. F. Mo
- Department of Clinical Oncology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, New Territories Hong Kong SAR
- State Key Laboratory in Oncology in South China, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, New Territories Hong Kong SAR
| | - Elizabeth Pang
- Department of Clinical Oncology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, New Territories Hong Kong SAR
- State Key Laboratory in Oncology in South China, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, New Territories Hong Kong SAR
| | - Joyce J. S. Suen
- Department of Clinical Oncology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, New Territories Hong Kong SAR
| | - Jane Koh
- Department of Clinical Oncology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, New Territories Hong Kong SAR
- State Key Laboratory in Oncology in South China, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, New Territories Hong Kong SAR
| | - Herbert H. F. Loong
- Department of Clinical Oncology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, New Territories Hong Kong SAR
- State Key Laboratory in Oncology in South China, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, New Territories Hong Kong SAR
| | - Christopher C. H. Yip
- Department of Clinical Oncology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, New Territories Hong Kong SAR
| | - Rita Y. W. Ng
- Department of Clinical Oncology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, New Territories Hong Kong SAR
| | - Claudia H. W. Yip
- Department of Clinical Oncology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, New Territories Hong Kong SAR
| | - Nelson L. S. Tang
- Department of Chemical Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, New Territories Hong Kong SAR
- Li Ka Shing Institute of Health Sciences, Faculty of Medicine, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, New Territories Hong Kong SAR
| | - Giok S. Liem
- Department of Clinical Oncology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, New Territories Hong Kong SAR
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