2022-RA-723-ESGO Hormone replacement therapy in gynecological cancer survivors and BRCA mutation carriers: a MITO group survey

Abstract

<h3>Introduction/Background</h3> Early menopause in gynecological cancer survivors and BRCA mutation carriers is a major health concern as it is associated with both increased long-term multiorgan morbidity and all-cause mortality. Hormone replacement therapy (HRT) is the most effective remedy but, despite reassuring data on its oncological safety (with due exceptions), it remains underutilized in clinical practice. The Multicenter Italian Trials in Ovarian cancer and gynecologic malignancies (MITO) group promoted a national survey to investigate the knowledge and attitudes of healthcare professionals on prescribing HRT. <h3>Methodology</h3> The survey consisted of a self-administered multiple-choice online questionnaire, sent via email to all MITO members on January 3, 2022 and available for one month. <h3>Results</h3> Overall, 61 participants completed the questionnaire. Most respondents (73.8%) were female and 52.5% were gynecologists. Over 80% of specialists usually discuss HRT with patients, especially gynecologists (91%). The percentage of respondents in favor of prescribing HRT was 65% for ovarian cancer, 82% for cervical cancer and 41% for endometrial cancer patients. Around 70% of respondents recommend HRT after prophylactic surgery in BRCA-mutated patients. The main reasons for not prescribing HRT are oncological safety concerns and the failure of women to request it. Less than a half of patients usually ask the specialist for an opinion on HRT. Over 70% of respondents prescribe systemic HRT, while 24% prefer only local HRT. The vast majority of patients generally use HRT for up to 5 years. The major reasons for interrupting HRT are concerns about both oncological and other medical risks. <h3>Conclusion</h3> Real-world data suggests that many healthcare professionals, especially non-gynecologist oncologists, still do not adequately prescribe HRT for gynecological cancer survivors and healthy BRCA mutation carriers. International guidelines should be implemented to further stress the benefits and safety of HRT and support both specialists in recommending HRT and patients in accepting it.