Who Prescribes Hormone Replacement Therapy for Young Women With Radiation-Induced Premature Ovarian Failure?

Abstract

One of the major consequences of treatment of gynecologic and gastrointestinal cancers with pelvic RT in young women is premature ovarian failure (PMOF). Hormone replacement therapy (HRT) can relieve menopausal symptoms and prevent long-term complications of early estrogen deficiency; however, its use is controversial. The purpose of this study is to evaluate practice patterns regarding PMOF and potential use of HRT among radiation oncologists (RO) treating women with pelvic RT. 2452 surveys were emailed to ASTRO members who specified their occupation as RO with a specialty in gynecological malignancies. The survey consisted of 17 questions focusing on responders’ practice patterns regarding pelvic RT and HRT, as well as demographic factors, practice scope and residency training. Data was analyzed using SPSS. A total of 237 respondents (10%) completed the survey, 64.5% men and 35.5% women. Mean age was 49 and mean number of years in practice was 17. 29.5% indicated practicing in an academic setting, 43.9% private practice and 80% identified as Caucasian. When asked whether respondents offer HRT when appropriate in patients undergoing pelvic RT, 58.8% of respondents indicated almost never, while 41.2% indicated either occasionally (<50%), frequently (>50%), or almost always (>90%). Younger age and fewer years in practice both significantly decreased recommendation for offering HRT (p=0.001), while age and years in practice did not have a significant relationship with how often a RO considered checking menopause status. Males were 2.79 times more likely to report almost never considering offering HRT than females. RO in private practice were 2.24 times more likely to report almost never considering offering HRT than those who did not indicate private practice. Of RO who reported that they do not prescribe HRT (n=152, 65.8% of sample), a total of 82.9% reported they referred patients for HRT management (p=0.006). RO most often indicated patient perceived barriers to receiving HRT included risk of developing breast cancer (73%), blood clot (63.7%), uterine cancer (45.1%). Half of RO indicated between 3 and 7 patient perceived barriers to HRT. There was no significant relationship with receiving training from RO specializing in gynecologic oncology and how often RO consider checking menopausal status or offering HRT. HRT in women affected by PMOF can relieve menopausal symptoms and prevent long-term complications of early estrogen deficiency. Though PMOF is a well-known consequence of RT for the treatment of pelvic malignancies, use of HRT is controversial due to potential serious complications and lack of published evidence based guidelines. Further investigation is critical to elucidate gender, age, practice setting, and numerous other disparities in considering HRT when appropriate.