Oral Hormone Therapy Research Articles

Analysis of clinical diagnosis and treatment of Behet's disease with sore throat as the first symptom

Objective:To summarize the clinical and diagnostic characteristics of Behet's disease with sore throat as the first symptom, so as to improve clinicians' understanding of the disease. Methods:The clinical data of 28 patients with Behet's disease who were first treated in Department of Otorhinolaryngology, Peking Union Medical College Hospital from January 2015 to January 2022 were analyzed retrospectively. All patients were examined by electronic laryngoscopy at the first visit and treated with local symptomatic therapy. Twenty-one patients were examined for C-reactive protein and blood sedimentation, and some patients were examined for immunological parameters. After the diagnosis of leukoaraiosis was confirmed, treatment was based on immunosuppression and could be supplemented with oral hormone therapy depending on the extent of the lesion and other organ involvement. Results:Sore throat was the first symptom of all patients, which could be accompanied by dysphagia or dyspnea. Endoscopy revealed oropharyngeal ulcer in 25 cases（89.3%）, laryngeal ulcer in 15 cases（53.6%）, hypopharyngeal ulcer in 14 cases（50.0%）, and adhesion of nasopharynx or throat in 8 cases（28.6%）. All patients had oral ulcer at the same time, including 21 cases（75.0%） with genital ulcer, 18 cases（64.3%） with skin damage, and 11 cases（39.3%） with eye disease. In the course of disease, there were 4 cases（14.3%） with joints involvement, 3 cases（10.7%） with nervous system disease, and 1 case（3.6%） with digestive system disease. The treatment is mainly immunosuppressive, and oral hormone therapy can be supplemented according to the extent of the disease and the involvement of other organs. Conclusion:The clinical manifestations of Behet's disease, with sore throat as the first symptom, are diverse. The ulcer may involve multiple parts of the throat, and a few patients may involve multiple systems of the whole body. Clinical attention should be paid to the early diagnosis and timely treatment to prevent or delay the involvement of the lesion in important organs or systems.

The Endocrine Approach of Melanoma: The Puzzle of Estrogen Receptors Expression

"Melanoma outcome seems different between females and males, with a potential protective role of estrogen (E) through estrogen receptors (ER) expression into the tumor. In the study of ERs, both alfa (ERα) and beta (ERβ) is a well-known endocrine elements in non-melanoma tumors, like mammary and endometrial cancer. Immunohistochemistry (IHC) assessment of melanoma concerning ERs represents a path to explore the tumor profile to provide useful information concerning the prognostic and potential adjuvant treatment. Currently, this is not a routine practice, nor a mandatory step for deciding the medical therapy. Typically, IHCs are based on usual kits for mammary tumors regarding ERs configuration. Prior/concomitant use of oral contraceptives and hormonal replacement therapy is not correlated with a better prognostic in melanoma; neither have they represented a contraindication for survivors of melanoma; a subset of tumors might present a higher ER expression which is potentially targeted by the hormone-based treatment as SERMs (Selective Estrogen Receptors Modulator), for instance, tamoxifen. Experimental studies on melanoma cell lines confirmed the anti-tumor activity of ERβ which might function as a prognostic marker. G-protein-coupled estrogen receptors in melanocytes and keratinocytes might be involved, too. Additional crosstalk of TGF-β (Transforming Growth Factor β), respective IGF1 (Insulin-like Growth Factor), and ERα expression are involved in tumorigenic pathways. Recent preclinical studies showed the potential benefits of diarylpropionitrile, a selective agonist of ERβ; pyrazole derivates 21-23 can block ERs. Murine melanoma models showed the interference of anti-estrogenic medication (like molecule fulvestrant) to enhance immune checkpoint blockade, a modern approach to solid cancers. The proliferation of melanoma might be partially explained by ERs; whether this is generally applicable or there is a subgroup of tumors particularly related to E status is still debatable. The subject of E status in melanoma is far from clear at this point and further studies are necessary concerning this particular issue to implement it as a practical approach in the daily management of a disease that still has a very severe prognostic nowadays "

Adherence to oral hormonal therapy in advanced prostate cancer: a scoping review.

Orally administrated agents play a key role in the management of prostate cancer, providing a convenient and cost-effective treatment option for patients. However, they are also associated with adherence issues which can compromise therapeutic outcomes. This scoping review identifies and summarizes data on adherence to oral hormonal therapy in advanced prostate cancer and discusses associated factors and strategies for improving adherence. PubMed (inception to 27 January 2022) and conference databases (2020-2021) were searched to identify English language reports of real-world and clinical trial data on adherence to oral hormonal therapy in prostate cancer using the key search terms 'prostate cancer' AND 'adherence' AND 'oral therapy' OR respective aliases. Most adherence outcome data were based on the use of androgen receptor pathway inhibitors in metastatic castration-resistant prostate cancer (mCRPC). Self-reported and observer-reported adherence data were used. The most common observer-reported measure, medication possession ratio, showed that the vast majority of patients were in possession of their medication, although proportion of days covered and persistence rates were considerably lower, raising the question whether patients were consistently receiving their treatment. Study follow-up for adherence was generally around 6 months up to 1 year. Studies also indicate that persistence may drop further with longer follow-up, especially in the non-mCRPC setting, which may be a concern when years of therapy are required. Oral hormonal therapy plays an important role in the treatment of advanced prostate cancer. Data on adherence to oral hormonal therapies in prostate cancer were generally of low quality, with high heterogeneity and inconsistent reporting across studies. Short study follow-up for adherence and focus on medication possession rates may further limit relevance of available data, especially in settings that require long-term treatment. Additional research is required to comprehensively assess adherence.

Sequestration of steroidal estrogen in aqueous samples using an adsorption mechanism: a systemic scientometric review.

Steroidal estrogens (SEs) remain one of the notable endocrine disrupting chemicals (EDCs) that pose a significant threat to the aquatic environment in this era owing to their interference with the normal metabolic functions of the human body systems. They are currently identified as emerging contaminants of water sources. The sources of SEs are either natural or synthetic active ingredients in oral contraceptive and hormonal replacement therapy drugs and enter the environment primarily from excretes in the form of active free conjugate radicals, resulting in numerous effects on organisms in aquatic habitats and humans. The removal of SEs from water sources is of great importance because of their potential adverse effects on aquatic ecosystems and human health. Adsorption techniques have gained considerable attention as effective methods for the removal of these contaminants. A systemic review and bibliometric analysis of the application of adsorption for sequestration were carried out. Metadata for publications on SE removal utilizing adsorbents were obtained from the Web of Science (WoS) from January 1, 1990, to November 5, 2022 (107 documents) and Scopus databases from January 1, 1949, to November 5, 2022 (77 documents). In total, 137 documents (134 research and 4 review articles) were used to systematically map bibliometric indicators, such as the number of articles, most prolific countries, most productive scholars, and most cited articles, confirming this to be a growing research area. The use of different adsorbents, include activated carbon graphene-based materials, single and multi-walled carbon nanotubes, biochar, zeolite, and nanocomposites. The adsorption mechanism and factors affecting the removal efficiency, such as pH, temperature, initial concentration, contact time and adsorbent properties, were investigated in this review. This review discusses the advantages and limitations of different adsorbents, including their adsorption capacities, regenerative potential, and cost-effectiveness. Recent advances and innovations in adsorption technology, such as functionalized materials and hybrid systems, have also been highlighted. Overall, the bibliographic analysis provides a comprehensive overview of the adsorption technique for the removal of SEs from other sources, serving as a valuable resource for researchers and policymakers involved in the development of efficient and sustainable strategies to mitigate the effects of these emerging contaminants.

OPTIMAL Breast Cancer Care: Effect of an Outpatient Pharmacy Team to Improve Management and Adherence to Oral Cancer Treatment.

Since the approval of cyclin-dependent kinase 4/6 inhibitors in 2015, this oral cancer (OC) therapy has been combined with oral endocrine therapy as first-line treatment in metastatic hormone receptor-positive breast cancer, adding unique toxicity and complexity to the successful administration of this oral medication. Implementation of OC is challenging because of delays in treatment and nonadherence and is worse among vulnerable patient populations. Pharmacists may mitigate these barriers with facilitation of prior authorizations, communication with pharmacies, toxicity management, adherence counseling, and optimization of dosing schedules and regimens. We conducted a quality improvement project to decrease the average number of treatment day delays during the first six cycles of OC. Patients were enrolled on the OPTIMAL protocol, a high-touch pharmacy intervention incorporating pharmacists within outpatient oncology clinic visits with the providers. Pharmacists met with patients, identified individual barriers to treatment, and performed counseling including toxicity and adherence assessments. A preintervention assessment identified an average treatment day delay of 7.7 (range, 3.2-15.3) days during the first six cycles of OC. During the intervention period, 53 patients were enrolled on the OPTIMAL protocol and experienced an average treatment day delay of 2.1 (0.6-4) days, P < .0001. Delays were characterized as modifiable and unmodifiable. Pharmacists documented 640 interventions, including medication reconciliations and clinical recommendations. Forty-two patients reported treatment-related toxicities, resulting in 33 therapy and 20 dose modifications. Our initiative to incorporate pharmacists in clinic visits at an outpatient breast cancer clinic was associated with decreased treatment day delays during the first six cycles of treatment. Pharmacists performed a multitude of meaningful interventions to facilitate treatment in a particularly vulnerable population and play a valuable role in comanaging patients.

Use of Hormonal Therapy Increases the Risk of Venous Thrombosis in COVID-19 Patients; Results of 1071 Patient Cohort

Introduction Coagulopathy is a well-recognized complication of COVID-19, with an incidence of thrombotic events as high as 31% in patients who are critically ill from COVID-19 infection. Estrogen-containing hormonal therapies are also well known to increase the risk of thrombosis. There have been no studies evaluating if estrogen-containing hormonal therapies potentiate thrombotic risk during COVID-19 infection, and there is no consensus on the clinical role of holding hormonal therapy during infection. We performed a large retrospective cohort study to evaluate the thrombotic risk of estrogen therapy during COVID-19 infection in both pre-menopausal and post-menopausal patients. Methods To assess the association between hormonal therapies and thrombosis in COVID-19 patients, we collected data on all female Oregon Health & Science University patients aged 18-80 years who tested positive for COVID-19 between 12/2020 and 2/2022 and were on hormonal therapies. We included a comprehensive range of hormonal therapies to ensure an accurate representation of both pre-menopausal and post-menopausal patients. The experimental group consisted of patients on combined hormonal contraceptives and hormone replacement therapy via the oral and transdermal routes, which have all been associated with increased thrombotic risk. The control group consisted of patients with a progesterone intrauterine device or on topical estrogen, neither of which is associated with an increased thrombosis risk. Pregnant individuals and patients on therapeutic anticoagulation before testing positive for COVID-19 were excluded. We collected data on demographics, vaccination status, thrombotic risk factors, venous thrombotic events, and outcomes (Table 1). The continuous variables were not normally distributed, and p-values were calculated using the Mann-Whitney test. The p-values for the categorical variables were calculated using Fisher's exact test. We then performed cox proportional hazards regression analysis to assess the thrombotic risks between control and experimental groups, while controlling for potential confounding variables. Venous thrombotic events were defined as pulmonary embolism (PE), deep vein thrombosis (DVT), cerebral vein sinus thrombosis (CVST), or hepatic vein thrombosis that occurred within 6 months of testing positive for COVID-19. Results In total, 1071 individuals met inclusion criteria. The experimental group included 546 patients, 407 on combined hormonal contraceptives (CHC) and 139 on oral or transdermal hormone replacement therapy (HRT). The control group included 525 patients, 410 with a progesterone intrauterine device and 115 using topical estrogen creams. The control and experimental groups were similar in all demographics and thrombotic risk factors, except for age (P<0.001) and body mass index (BMI) (p<0.001). There were no differences between groups in the rate of hospitalization for COVID-19, ICU stay for COVID-19, or death. There were 2 venous thrombotic events with an event rate of 1.3% in the control group and 9 events with a rate of 2.3% in the experimental group (p= 0.065). All of these events occurred within 2 months of COVID-19 positive test results. Increasing age (p<0.001) was significantly associated with a higher venous thrombosis risk. A cox proportional hazards regression analysis was utilized to evaluate the hazards ratio (HR) of venous thrombosis between groups, controlling for age and BMI. Patients in the experimental group had a HR of 5.76 (CI 1.24-26.77, p=0.026) for venous thrombotic events. In this model, the HR was 1.06 for age (CI 1.02-1.11, p=0.003) and 1.05 for BMI (CI 1.01-1.10, p=0.018). Conclusion Overall, this data suggests that estrogen-containing oral and transdermal hormonal therapies increase the risk of thrombosis in COVID-19 positive patients, although absolute risks were small. Thrombotic risk was also associated with increasing age and higher BMI. Based on these findings, providers may consider temporarily discontinuing hormonal therapies in patients with COVID-19 who are at high risk for thrombosis, especially older patients, those with a higher BMI, and those on higher doses of oral estrogen. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Breast Cancer- Awareness and Early Detection

Breast cancer (BC) is a heterogeneous group of neoplasms originated via epithelial cells, which line the milk ducts. Breast tumor heterogeneity is matter of discussion and research in histology and clinical outcomes for a long span of time, and these differences pave the paths to disease classification. Out of the few tumor types which successfully use the molecular classification for the design of individualized therapies, BC is one of them. These types of tumors lead to significant improvements in disease-specific survival. The classification based on comprehensive gene expression profiling, divides the breast tumors into at least three broad subtypes: luminal, human epidermal growth factor receptor 2+, and basal like.&#x0D; In both developed and under development countries, BC is the most common type of cancer in females. To be precise, one out of ten cancers identified each year in female is BC. Moreover, it’s a worldwide major cause of deaths occurring among women due to cancer. According to the WHO's 2008 GLOBOCAN, BC is the most frequent cancer in women, affecting an estimated 1.38 million people [1]. Among the Asian population, Pakistan reports the highest incidence of BC i.e., 19.33% [2]. The established risk factors of BC are linked to oestrogens. Risks are increased by several factors including early menarche, late menopause, and obesity in postmenopausal women. Increasing concentrations of endogenous oestradiol also increased risk of BC. Childbearing somehow reduces risk, with a greater protection for early first birth and a larger number of births; illustrated as breastfeeding probably has a protective effect. Moreover, the oral contraceptives and hormonal therapy for menopause both tend to cause a little increase in breast-cancer risk, which appears to diminish once use stops. Alcohol also increases risk, whereas physical activity probably declines. Mutations in certain genes like BRCA1 and BRCA2 also massively enhance the risk to BC, but these certainly account for a minority of cases. Of all the key challenges that occur during BC research, mapping of pathways that give rise to metastasis is one of them. Recent studies have done analysis of gene expression profiles to identify markers which correlate with metastasis. Clinical and pathological risk factors, such as patient age, tumor size, and steroid receptor status, are commonly used to assess the likelihood of metastasis development.&#x0D; In Pakistan socioeconomic factors are to blame for the poor health of women especially in rural communities. One in nine Pakistani women have had BC at some point in their lives. There are no screening facilities for the diagnosis of different types of cancer, and a lot of women lose their lives to BC each year. Most Pakistani women are impoverished and unable to pay for costly screening exams. Talking about BC is considered a taboo and women don’t talk about it due to shyness. Campaigns on awareness of BC are needed country wide specially targeting rural areas. Women who are above 40 should be suggested to get mammogram time to time. Women should be advised to do Breast self-examination (BSE) once a month for detection of cancer at an early stage.

A Qualitative Exploration of Medication Experience and Factors Contributing to Adherence to Oral-Targeted Therapy Among Lung Cancer Survivors

ObjectivesThe introduction of oral-targeted therapy for cancer improves survival while adherence also presents as a challenge to patients. Current studies on oral anticancer agents are primarily limited to patients from developed countries with breast cancer and chronic myeloid leukemia receiving oral chemotherapy and hormonal therapy. This study explored experience of oral-targeted therapy adherence among Chinese patients with nonsmall cell lung cancer and its contributing factors by using a qualitative research. Data SourcesSemi-structured interviews with 16 patients and 7 family caregivers at a tertiary tumor hospital in China were conducted to understand their experience and perceptions of oral-targeted therapy. Thematic analysis was applied to generate the themes and to identify underlying factors associated with the adherence. ConclusionThe lung cancer survivors struggled with ambivalence between survival and relief during taking targeted anticancer medication and showed diverse models of nonadherence, including intentionally or unintentionally intermittent medication and overadherence. Three main themes were identified: (1) cancer-related distresses, (2) inadequate social support, and (3) forgetfulness, together with seven subthemes, representing factors impeding patients’ medication adherence. The themes demonstrate complicated and interrelated factors from personal, interpersonal, sociocultural, and structural forces contributing to patients’ poor adherence. Implications for Nursing PracticeThe findings suggest the imperativeness of reinforcing community- or home-based oral-targeted medication management in which nurses play a principal role to implement strategies of patient education, symptom management, reminder prompts, and monitoring to improve adherence.

Impact of the geriatric assessment on cancer-directed systemic therapy in older Indian persons with cancer: An observational study

ABSTRACT Background: The geriatric assessment is a multidimensional evaluation of an older person. Globally, it is reported that geriatric assessments can lead to a change in the oncologic therapy decisions in approximately 28% of patients, but there are no Indian data regarding this. Objectives: We aimed to assess the proportion of patients in whom there was a change in the planned cancer-directed therapy following evaluation in the geriatric oncology clinic. Furthermore, we studied the proportion of patients who were recommended interventions for non-oncologic vulnerabilities and the factors associated with the change in the cancer-directed treatment plan following the geriatric assessment. Materials and Methods: This was an observational study conducted in the Department of Medical Oncology at the Tata Memorial Hospital, Mumbai, India. Patients aged 60 years and over with a diagnosis of malignancy were evaluated in the geriatric oncology clinic. The results of the geriatric assessment were entered in the electronic medical records (EMR). The systemic therapy plan before the geriatric assessment and the final therapy plan were retrospectively captured from the EMR. Any change in the systemic therapy plan following the geriatric assessment was recorded. Results: We enrolled 617 patients in the study between June 2018 and September 2021. The median age was 69 years (range, 60–100); 470 (76.2%) were men. The common malignancies were lung cancer in 243 (39.4%) and gastrointestinal in 208 (33.7%). The intent of therapy was palliative in 339 (54.9%) patients. There were 498 (80.7%) patients who were vulnerable or frail on the geriatric assessment. Following their geriatric assessment, systemic therapy plans were changed in 239 (38.7%) patients. The most common treatment change was deintensification in 198 patients (32.1%), comprising dose reduction in 83 (13.4%), a decrease in the number of chemotherapy medicines in 23 (3.7%), the substitution of chemotherapy by targeted therapy (4, 0.6%), oral hormonal therapy (4, 0.6%), oral tyrosine kinase inhibitor (16, 2.6%), immunotherapy (7, 1.1%), and withholding systemic therapy in 55 (8.9%) patients. Withholding systemic therapy included a change from chemoradiotherapy to radical radiation alone in 26 (4.2%), withholding neoadjuvant or adjuvant chemotherapy in 8 (1.3%), and a change to best supportive care in 21 (3.4%). Conclusions: The results of the geriatric assessment led to a change in the systemic therapy plan in almost 40% of older Indian patients with cancer. The geriatric assessment adds valuable information to the oncologic decision-making process for older persons with cancer. (Clinical Trials Registry-India: CTRI/2020/04/024675).

FUNCTIONAL DISORDER OF THE HYPOTHALAMUS AS A CAUSE OF PRIMARY AMENORRHEA

Functional hypothalamic amenorrhea (FHA) occurs when the hypothalamic-pituitary-ovarian sequence is suppressed due to an energy deficit usually caused by stress, weight loss, excessive exercise and disordered eating, leading to hypogonadism. The diagnosis is of exclusion, and a clinical examination with complementary blood and imaging tests must be performed. Treatment aims to correct the causes, guide adequate nutrition and physical activity. The combined estrogen can be used to restore menstrual cycles and preserve bone mass. We present the case of a 21-year-old patient with primary amenorrhea and hypogonadotropic hypogonadism, with a history of stress linked to low self-esteem, intense ballet activity during puberty and rigidity in eating. Physical examination showed complete pubertal development and low body mass index (16.9 kg/m2). Decreased serum levels of luteinizing hormone (LH) and follicle stimulating hormone (FSH), and normal levels of prolactin (PRL), thyroid stimulating hormone (TSH). Bone densitometry showed osteoporosis of the femur and lumbar spine. After weight restoration, physical activity monitored by a professional, and prescription and combined oral hormone therapy, the patient started menstrual cycles.

The Development of Schematics to Illustrate Women's Experiences with Adjuvant Hormone Therapy in the Treatment of Breast Cancer.

ObjectiveNon-adherence to adjuvant hormone therapy prescribed orally in the treatment of breast cancer is complex as the literature has shown. Many women find it hard to adhere to the hormonal medicines they are prescribed and expected to take for at least 5 years following the initial management of their breast cancer. Arguably, communicating other women’s ‘trials, tribulations, and triumphs’ with medication-taking could help newly-diagnosed patients to better prepare for the journey ahead. Our objective was to visually represent women’s experiences with these medicines using data synthesized in the literature.MethodsThree schematics were drawn for each phase of medication-taking, namely, starting out, adherence, and cessation. The schematics were validated by interviewing a panel of healthcare professionals (n=10) and calculating a Content Validity Index (CVI). The edited drawings were discussed with a separate panel of breast cancer survivors (n=14) whose responses were elicited qualitatively in one-to-one interviews.ResultsA total of 76 individual pictograms were drawn across the three schematics. The 13 pictograms that had an item-level CVI<0.8 were modified according to feedback resulting in three final schematics with an overall CVI of 87%, 87% and 80%, respectively.ConclusionSynthesised summaries of women’s experiences with oral hormone therapy for breast cancer were visualised via three validated schematics. The schematics could aid patient-professional communication to help anticipate and tackle negative experiences and support decisions to take hormone medication in breast cancer.

Acne treatment review and future perspectives.

Acne affects approximately 9% of people worldwide and is the most common skin condition in the USA. There are abundant topical and oral treatment options available for patients with acne. First-line agents include topical retinoids, azelaic acid, benzoyl peroxide, and combinations of these agents. For recalcitrant or more severe acne, oral medications, including oral antibiotics, isotretinoin, or hormonal therapy, may be considered. This review will also discuss the many advances being made in the treatment of acne vulgaris, from the development of microencapsulated medications to targeted treatments.

Serum lipide profile and the severity of acne vulgaris at a Moroccan referral hospital

Sir, Acne vulgaris (AV) is one of the most frequent concerns in dermatology consultation. It is an inflammatory chronic condition that affects the pilosebaceous follicle. Based on the number and types of lesions, AV is classified as mild, moderate, severe, and highly severe [1]. The pathogenesis of AV is due to multiple factors, such as sebum overproduction, inflammation, colonization by Propionibacterium acnes, hyperkeratinization, the genetic component, and stress [2–4]. It is known that the sebaceous glands produce and secret sebum, which is a combination of complex lipids, such as squalene, triglycerides, wax, and cholesterol, as well as free cholesterol and fatty acids [5]. A number of studies evaluated the relationship between acne vulgaris and the serum lipid profile. Therefore, the aim of our study was to analyze the lipid serum profile among Moroccan patients with acne. We prospectively conducted a study between June 2020 and December 2021 at the Mohammed V Military Hospital in Rabat, Morocco. The criteria for inclusion in the study were AV patients aged from thirteen to thirty years. The exclusion criteria were obesity, pregnancy and lactation, oral contraceptives, hormonal therapy, cardiovascular disease, and health conditions affecting lipid metabolism. The clinical data collected from patients included age, sex, weight, and the severity of AV. Acne grading was performed by the same dermatologist according to the Global Acne Grading System (GAGS). The patients were required to have been fasting between eight to twelve hours at the time of the blood test. Statistical analysis was performed with JAMOVI. The results were presented as follows: mean ± SD. Descriptive statistics were performed; Student’s t-test, ANOVA, and X2 were used as statistical tests to compare between variables, and p &lt; 0.05 was considered a statistically significant difference.

Exogenous Hormone Factors in Relation to the Risk of Malignant Melanoma in Women: A Systematic Review and Meta-Analysis.

Simple SummaryMany epidemiological studies have examined the relationship between cutaneous malignant melanoma (CMM) and both endogenous oestrogen exposure (e.g., age at menarche and parity) and exogenous hormone use (e.g., oral contraceptives (OCs) and menopausal hormone therapy (MHT)). Though a previous meta-analysis investigating the relationship between characteristics of female endocrine status and CMM risk found no significant association, the potential role of THERAPY AS oral contraceptive (OC) and hormonal replacement therapy (MHT) use still remains controversial. Since then, several studies have been published about the therapy with contrasting results, while CMM incidence continues to increase with a significant gender divergence. The therapy of OC and MHT may play a role in CMM and the removal of this could be useful as emerging therapeutics in melanoma. Therefore, we conducted this systematic review and meta-analysis to summarize the evidence and derive a more accurate estimation of exogenous hormone factors in women and CMM.The influence of exogenous female hormones on the risk of developing malignant melanoma in women remains controversial. The aim of our review and meta-analysis is to summarize the evidence and derive a more accurate estimation of the association between oral contraceptives (OCs) or menopausal hormone therapy (MHT) and the risk of developing malignant melanoma in women. PubMed, Web of Science, and Scopus database were searched for studies published up until October 2021. The PRISMA statement and MOOSE guidelines were followed. Studies were pooled using a random effects model. Heterogeneity was explored with the chi-square-based Cochran’s Q statistic and the I2 statistic. Publication bias was assessed with Begg’s test and Egger’s test. Forty-six studies met the eligibility criteria. The pooled analysis (26 studies) on OC use and the risk of developing cutaneous malignant melanoma (CMM) showed no significant association, but demonstrated significant association for cohort studies (OR 1.08, 95% CI 1.01–1.16; I2 = 0.00%, p = 0.544). The pooled analysis (16 studies) showed a significantly increased risk of CMM in association with MHT (OR 1.15, 95% CI 1.08–1.23; I2 = 25.32%, p = 0.169). Stratifying the results by study design showed that a significant increased risk of CMM was associated with MHT in the cohort studies (OR 1.12; 95% CI 1.04–1.19; I2 = 0%, p = 0.467). No significant publication bias could be detected. Further studies are needed to investigate the potential association with formulation, duration of use, and dosage of use, and to better understand the role of possible confounders.

EE169 Impact of Adherence to Novel Hormonal Therapies on Emergency Department Utilization in Patients with Metastatic Castration-Resistant Prostate Cancer

Abiraterone acetate (ABI) and enzalutamide (ENZ) are the first two oral novel hormonal therapies (NHTs) approved for treatment of metastatic castration-resistant prostate cancer (mCRPC). The objectives were to compare prostate cancer (PCa)-related and all-cause emergency department (ED) utilization between ABI and ENZ and examine the impact of demographic and clinical characteristics on ED utilization.

PCR26 Medication Utilization Patterns of Novel Hormonal Therapies for the Management of Metastatic Castration-Resistant Prostate Cancer

Adherence to oral novel hormonal therapies (NHTs) impacts clinical and economic outcomes, but little is known regarding real-world adherence in the US. The objectives were to compare medication adherence between abiraterone acetate (ABI) and enzalutamide (ENZ) users and to determine patient demographic and clinical characteristics associated with adherence.

Attribution of symptoms to adjuvant endocrine therapy and association with adherence among older women with breast cancer: A qualitative study.

e24086 Background: Oral adjuvant endocrine therapy (AET) is an effective treatment for hormone receptor positive breast cancer to decrease recurrence and mortality. However, adherence to AET is poor, with 1/3 of patients not completing the recommended 5-year treatment course. Studies have shown that symptoms of the medication, such as joint pain, hot flashes, and fatigue, are associated with AET discontinuation. While previous studies have focused on symptoms post-AET initiation, preliminary evidence suggests that pre-AET symptoms may be an important predictor of early AET discontinuation. We used qualitative interviews to explore adherence to AET and patients’ attribution of symptoms to AET to provide context for a larger quantitative study on the role of patient-reported distress pre-AET as a predictor of AET discontinuation. Methods: Participants were recruited from the Froedtert/MCW Cancer Center registry, stratified by high (≥4) and low pre-AET Distress Thermometer scores and adherence to/discontinuation of AET. Semi-structured phone interviews followed an interview guide focused on constructs previously identified in the literature as having strong associations with AET adherence. Interviews were recorded and transcribed. A multidisciplinary team developed a codebook based on the conceptual framework describing AET discontinuation by AlOmeir et al. as well as other themes that emerged from the data. Results: Interviews were conducted with 31 participants; ages ranged from 57-86 years. Participants were diverse with respect to race/ethnicity (55% white, 26% Black, 13% Latina, and 6% other racial/ethnic groups). Participants who reported symptoms described hot flashes, joint pain, low appetite, memory loss, depression, and fatigue. We saw support for previous findings by AlOmeir et al in which ability to deal with symptoms affected the decision to continue AET. We uncovered additional nuance related to attribution of symptoms, in that some participants attributed their symptoms to a side effect of AET, while others attributed symptoms to other factors including older age, recent completion of other cancer treatments, and psychological burden associated with a cancer diagnosis and treatment. Those who did not attribute symptoms to AET focused on AET as necessary treatment to increase survival, while those who attributed symptoms to AET reported a more negative AET experience in general, with AET described as an additional burden after cancer. Conclusions: Symptom attribution rather than experience of specific symptoms may be a key factor leading to discontinuation of AET. Patient-reported symptoms and associated distress pre-AET may be a viable way to identify patients at high-risk for AET nonadherence, allowing for timely intervention. This will be quantitatively tested in a large sample.

PD35-07 ANALYSIS OF DISCONTINUATION RATES AND CAUSES OF EARLY DISCONTINUATION OF NOVEL ORAL HORMONE THERAPY IN MEN WITH ADVANCED PROSTATE CANCER

You have accessJournal of UrologyCME1 May 2022PD35-07 ANALYSIS OF DISCONTINUATION RATES AND CAUSES OF EARLY DISCONTINUATION OF NOVEL ORAL HORMONE THERAPY IN MEN WITH ADVANCED PROSTATE CANCER David Gangwish, Bernadette Zwaans, Paul Miriani, Wesley Dejoie, Andrina Ajo, Connor Ervin, Jeff Sarazin, and Jason Hafron David GangwishDavid Gangwish More articles by this author , Bernadette ZwaansBernadette Zwaans More articles by this author , Paul MirianiPaul Miriani More articles by this author , Wesley DejoieWesley Dejoie More articles by this author , Andrina AjoAndrina Ajo More articles by this author , Connor ErvinConnor Ervin More articles by this author , Jeff SarazinJeff Sarazin More articles by this author , and Jason HafronJason Hafron More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002593.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Prostate cancer (PCa) is the second most common cause of cancer-specific death in US men. Novel oral hormone therapy (NHT) significantly prolongs survival and maintains quality of life in advanced PCa patients. Despite known benefits, these medications are commonly discontinued. The study evaluated the prevalence of early discontinuation of NHT, the determinants of early discontinuation and the effect of changing NHT on duration of treatment. METHODS: A retrospective cohort study of 333 patients with advanced PCa who started a NHT in a single community urology practice in the United States between February 2016 and July 2020 were evaluated. NHT medication, start date of treatment, reason for discontinuation, and discontinuation date were collected. Additional data included demographics, stage of PCa, PSA at time of NHT initiation, Gleason score, and prior PCa treatments. The cohort was divided into 2 subgroups, those did not change medication (Group A) and those that did change to a different NHT (Group B). Student’s t-test, Chi-square test, and Kaplan-Meier survival analysis were carried out to determine significant differences between groups (SPSS). RESULTS: At one year 28.8% of patient’s had early discontinuation of NHT. The most common reasons for discontinuation were side effects and death at 34.4% each. Group A (282 patients) and Group B (51 patients) discontinued treatment at a rate of 31%, 88%, respectively. Primary reasons for discontinuation in group A versus group B was due to side effects (36% vs 47%) or cancer progression (34% vs 49%). More patients in group B were deceased than in group A (58.8% vs 29.4%). Of those that discontinued, patients remained on NHT for an average of 382 days in group A versus 593 days in group B (Figure 1, Kaplan-Meier analysis p = 0.003). In group B, patients on average discontinued first NHT after 330 days and continued secondary NHT for an additional 263 days. CONCLUSIONS: Side effects and cancer progression were the main reasons for discontinuing NHT treatment. Providing patients with alternative NHT significantly increases the duration of treatment. It is important for clinicians to understand the causes of early discontinuation to develop strategies to maximize duration of therapy for management of advanced PCa. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e629 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information David Gangwish More articles by this author Bernadette Zwaans More articles by this author Paul Miriani More articles by this author Wesley Dejoie More articles by this author Andrina Ajo More articles by this author Connor Ervin More articles by this author Jeff Sarazin More articles by this author Jason Hafron More articles by this author Expand All Advertisement PDF DownloadLoading ...

Venous thromboembolism: epidemiological, medico-social and economic aspects

Venous thromboembolism (VTE) includes thrombosis of the deep veins of the lower limbs or pelvis and its complication of pulmonary embolism (PE). VTE is common in clinical practice, especially in the elderly and is associated with low survival, substantial costs for care, a high recurrence rate. The disease is complex (multifactorial), which involves interactions between acquired or inherited predispositions for thrombosis. Major risk factors for venous thrombosis include hospitalization for surgery or acute illness, active cancer, neurological disease with neurological deficiencies, trauma or fractures, superficial and specific venous thrombosis for women - pregnancy and puerperium, oral contraception and hormone therapy. Although independent risk factors for venous thrombosis are currently identified, predictors of recurrence, effective remedies are available for primary and secondary prophylaxis, the incidence of VTE remains constant, or even increasing. This paper reflects current information on the epidemiology of venous thromboembolism and risk factors, incidence and recurrence trends, survival, healthcare costs.

No Excess Mortality up to 10 Years in Early Stages of Breast Cancer in Women Adherent to Oral Endocrine Therapy: A Probabilistic Graphical Modeling Approach.

Breast cancer (BC) is globally the most frequent cancer in women. Adherence to endocrine therapy (ET) in hormone-receptor-positive BC patients is active and voluntary for the first five years after diagnosis. This study examines the impact of adherence to ET on 10-year excess mortality (EM) in patients diagnosed with Stages I to III BC (N = 2297). Since sample size is an issue for estimating age- and stage-specific survival indicators, we developed a method, ComSynSurData, for generating a large synthetic dataset (SynD) through probabilistic graphical modeling of the original cohort. We derived population-based survival indicators using a Bayesian relative survival model fitted to the SynD. Our modeling showed that hormone-receptor-positive BC patients diagnosed beyond 49 years of age at Stage I or beyond 59 years at Stage II do not have 10-year EM if they follow the prescribed ET regimen. This result calls for developing interventions to promote adherence to ET in patients with hormone receptor-positive BC and in turn improving cancer survival. The presented methodology here demonstrates the potential use of probabilistic graphical modeling for generating reliable synthetic datasets for validating population-based survival indicators when sample size is an issue.