Abstract
BackgroundMany women have discontinued hormone replacement therapy (HRT) in view of recent findings. The goal of this study was to determine if HRT discontinuation is associated with changes in health-related quality of life (HRQOL) in elderly women.MethodsWe studied women enrolled in Pennsylvania's Pharmaceutical Assistance Contract for the Elderly (PACE) program, linking prescription claims with data from a longitudinal mail survey. HRQOL measures included the number of days out of the last 30 that physical health was not good and analogous measures for mental health, pain, and interference with activities, as well as a composite "healthy days" measure developed by CDC. Longitudinal analyses focused on 2,357 women who completed surveys in both 2002 and 2003, and who used HRT at baseline (mean age = 75.5, range = 65–102). Propensity scores were used to match HRT continuers and discontinuers according to HRT type, demographics, and baseline HRQOL. Analysis of covariance was used to compare HRQOL change in continuers and discontinuers.ResultsBetween 2002 and 2003, 43% of HRT users discontinued therapy. Analysis of covariance to examine HRQOL change revealed complex interactions with age. Discontinuers aged 65–74 reported greater increases in days in which mental health was not good (p < .05), fewer "healthy days" (p < .05), more days in which health interfered with activities (p < .01), and more days with pain (p < .01). Among women aged 75–84, HRT discontinuers reported more days in which physical health was not good (p < .01); no other significant effects were observed in this group. Relative to HRT continuers, discontinuers aged 85 and older experienced apparent HRQOL improvements following cessation, with fewer days in which physical health was not good (p < .01), fewer days of poor mental health (p < .05), and more "healthy days" (p < .01).ConclusionsThese results suggest that there are substantial age differences in response to HRT discontinuation. While women aged 65–74 experienced apparent declines in HRQOL following HRT cessation, women aged 85 and older experienced relative improvements. The HRQOL declines observed among younger women underscore the importance of communication between clinicians and patients throughout the discontinuation process. These results also demonstrate the value of HRQOL surveillance as a component of health program administration.
Highlights
Many women have discontinued hormone replacement therapy (HRT) in view of recent findings
Women who had any baseline use of cardiovascular drugs were significantly more likely than nonusers to discontinue HRT (O.R. = 1.25, p = .0471), as were women who had any baseline use of medications used to treat osteoporosis (O.R. = 1.36, p = .0146)
Impact of discontinuation on health-related quality of life (HRQOL) As discussed above, HRT continuers and discontinuers were matched on the basis of the following factors: 1) the propensity scores obtained from the multivariate logistic regression, 2) the first principal component scores for the combined baseline HRQOL measures, 3) age group, and 4) type of HRT used at baseline
Summary
Many women have discontinued hormone replacement therapy (HRT) in view of recent findings. The well-publicized halting of the WHI combination therapy trial, along with emerging evidence from other studies, sparked intense debate and led to an important paradigm shift with respect to HRT. Guidelines such as those released in 2002 by the U.S Preventive Services Task Force stress that the harmful effects of HRT related to breast cancer and cardiovascular risk outweigh potential benefits such as increased bone density, and that HRT should not be used for the prevention of chronic conditions in postmenopausal women [6]. The recent shifts in guidelines and practice have presented a dilemma for clinicians and patients, and many women have opted to discontinue HRT [7]
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