Menopausal symptoms, sexual dysfunction, and hormone therapy use in young cervical cancer patients undergoing definitive treatment at a single institution

Abstract

<h3>Objectives:</h3> To evaluate the incidence of menopausal symptoms, sexual dysfunction, and hormone therapy (HT) use in cervical cancer patients at a single public hospital. <h3>Methods:</h3> This is a retrospective cohort study evaluating all patients under the age of 55 with stage IA1-IVA squamous cell carcinoma (SCC) or adenocarcinoma of the cervix who underwent definitive treatment at our institution between 2015 and 2018. Demographic data, tumor characteristics, and treatment data were collected. All gynecologic and radiation oncology visits were reviewed for documentation of menopausal symptoms, sexual dysfunction, and use of HT and vaginal dilators. The frequency of these symptoms was measured as was the time a provider first documented them and readdressed them after diagnosis and initiation of treatment. <h3>Results:</h3> A total of 59 patients were identified, with a mean age of 42 years (range 27-55, 76% ≤50 years) and 83% Hispanic. 32% had clinically early stage disease (IB1 or less) and 68% had locally advanced disease. 68% had SCC, 24% adenocarcinoma and 8% adenosquamous carcinoma. Median recurrence free survival was 20 months (range 1-53) with median follow-up of 25 months (range 4-58). Ten women (17%) underwent hysterectomy or trachelectomy with ovarian conservation, and 1 (2%) underwent bilateral salpingo-oophorectomy (BSO) at the time of radical hysterectomy. 39 women (66%) underwent definitive chemoradiation. The remaining 9 (15%) women underwent surgery (hysterectomy and/or BSO) and adjuvant radiation. A total of 827 visits (median 14 per patient) were reviewed after diagnosis. Of the 48 women who received any radiation, only 27 (56%) were ever asked about vasomotor symptoms with a median time to asking of 19 weeks (range 1-132). When first asked, vasomotor symptoms were reported 71% of the time, but symptoms were only readdressed in 20% of subsequent visits. When first asked, 55% of patients reported vaginal dryness and 60% had sexual dysfunction. 24 patients (50%) were prescribed any kind of HT, and median time to counseling on HT use was 16 weeks (range 1-184). Once initiated, ongoing HT use was readdressed at 74% of visits. Of the 35 patients (73%) ever asked about vaginal dilator use, 54% reported use. None of the 11 patients who underwent hysterectomy±BSO without radiation were asked about the domains studied in any of their 70 visits. <h3>Conclusions:</h3> When asked, the majority of young cervical cancer patients report menopausal symptoms and sexual dysfunction after undergoing definitive treatment. Once initiated, women are compliant with HT use. However, many women are not being counseled about menopausal or sexual dysfunction symptoms nor treated with hormone therapy in a timely fashion. This study identified opportunities for quality improvement at our institution and will be combined with national guidelines to change clinical practice.