Years Of Hormone Treatment Research Articles

Prospective evaluation of sexual health in breast cancer women during the first year of adjuvant hormonal treatment using a cancer patient's dedicated questionnaire: A glaring gap of communication between health professionals and patients.

Sexual quality of life (QoL) is affected during and after breast cancer (BC) treatment and is not specifically evaluated with the general health-related quality-of-life questionnaires EORTC QLQ-C30 or QLQ-BR23. A specific questionnaire, the EORTC SHQ-C22, including physical, psychological, and social aspects of sexuality, was recently developed to address this issue in cancer patients. A prospective bicentric study was conducted to evaluate the sexual QoL of women with BC during the first year of adjuvant hormonal treatment. A total of 106 women completed the 3 questionnaires at baseline and 92 of them, at 12months. At baseline, we showed low sexual satisfaction and importance given to sexual activity and a very low communication with healthcare professionals about this issue. Twelve months later, the importance given to sexuality had increased. While the communication with professionals had improved, it remained at a very low level. We were unable to identify specific clinical factors (chemotherapy, menopausal status, type of surgery or radiotherapy) that would negatively affect the global sexual well-being in BC patients. The analysis of sexual QoL of BC patients during the first year of hormonal treatment with a recently developed, cancer-dedicated, standardized tool pointed out the need for deeper communication between professionals and patients regarding sexual issues to fill the current gap in care of cancer patients and help patients with adequate intervention and support.

Prostate Cancer Incidence under Androgen Deprivation: Nationwide Cohort Study in Trans Women Receiving Hormone Treatment.

ContextTrans women (male sex assigned at birth, female gender identity) mostly use antiandrogens combined with estrogens and can subsequently undergo vaginoplasty including orchiectomy. Because the prostate remains in situ after this procedure, trans women are still at risk for prostate cancer.ObjectiveTo assess the incidence of prostate cancer in trans women using hormone treatment.DesignIn this nationwide retrospective cohort study, data of participants were linked to the Dutch national pathology database and to Statistics Netherlands to obtain data on prostate cancer diagnosis and mortality. SettingGender identity clinic.ParticipantsTrans women who visited our clinic between 1972 and 2016 and received hormone treatment were included.Main Outcome MeasuresStandardized incidence ratios (SIRs) were calculated using the number of observed prostate cancer cases in our cohort and the number of expected cases based on age-specific incidence numbers from the Netherlands Comprehensive Cancer Organization.ResultsThe study population consisted of 2281 trans women with a median follow-up time of 14 years (interquartile range 7-24), and a total follow-up time of 37 117 years. Six prostate cancer cases were identified after a median 17 years of hormone treatment. This resulted in a lower prostate cancer risk in trans women than in Dutch reference males (SIR 0.20, 95% confidence interval 0.08-0.42).ConclusionsTrans women receiving androgen deprivation therapy and estrogens have a substantially lower risk for prostate cancer than the general male population. Our results support the hypothesis that androgen deprivation has a preventive effect on the initiation and development of prostate cancer.

Hormonal Treatment Effect on Sexual Distress in Transgender Persons: 2-Year Follow-Up Data

IntroductionAs far as we know, no studies to date have investigated the psychobiological correlates of sexual distress (SD) nor the impact of hormonal treatment (HT) on SD in transgender persons. AimTo evaluate the psychobiological correlates of SD and assess the effects of HT on SD in transgender persons without gender-affirming surgery. MethodsA consecutive series of 301 transgender persons (160 transwomen and 141 transmen) was considered for the cross-sectional study, and a subset of 72 subjects was studied in a 2-year follow-up. A physical examination was performed. Blood samples were drawn for determination of cortisol levels. Subjects completed psychometric measures. During 2 years of HT, the evaluation of SD was prospectively repeated. Main Outcome MeasurePsychobiological correlates of SD in transgender population. Changes in SD during gender affirming hormonal treatment. Clinical ImplicationsKnowing how hormonal treatment influence SD will help care providers when counseling transgender people. Strengths & LimitationsTo the authors’ knowledge, this is the first study prospectively evaluating the impact of gender affirming hormonal treatment on sexual distress in transgender individuals. The main limitations are represented by the small size of the sample and the use of questionnaires validated only in the cisgender population. ResultsSD showed a positive correlation with body uneasiness (P < .0001) and with dissatisfaction toward gender-related body parts or shapes (all P < .05). In addition, SD correlated positively with general psychopathology (P < .0001), alexithymia, social anxiety, and humiliation scales (all P < .05). In transmen, SD was positively associated with autism levels (P < .005), as well as with cortisol levels (P < .02). A significant correlation between SD and perceived discrimination was observed in transwomen (P < .05). In transwomen, SD was positively associated with hair density and negatively with breast growth (both P < .05). Finally, in transmen, a negative correlation was found between SD and hair density (P < .05). When the impact of HT on SD was evaluated, a significant reduction of SD was observed across time in both transwomen and transmen (P = .001 and P = .01, respectively). ConclusionsThe present results support the efficacy of HT in reducing SD in transgender persons.Ristori J, Cocchetti C, Castellini G, et al. Hormonal Treatment Effect on Sexual Distress in Transgender Persons: 2-Year Follow-Up Data. J Sex Med 2020;17:142–151.

Bone Mineral Density in Transgender Individuals After Gonadectomy and Long-Term Gender-Affirming Hormonal Treatment

IntroductionEstablishing the influence of long-term, gender-affirming hormonal treatment (HT) on bone mineral density (BMD) in transgender individuals is important to improve the therapeutic guidelines for these individuals. AimTo examine the effect of long-term HT and gonadectomy on BMD in transgender individuals. Methods68 transwomen and 43 transmen treated with HT who had undergone gonadectomy participated in this study. Dual-energy x-ray absorptiometry (DXA) scans were performed to measure BMD at the lumbar spine and total hip. Laboratory values related to sex hormones were collected within 3 months of performing the DXA scan and analyzed. Main Outcome MeasureBMD and levels of sex hormones in transwomen and transmen. ResultsIn transwomen, the mean BMD values at the lumbar spine and total hip at the first DXA scan were, respectively, 0.99 ± 0.15 g/cm2 (n = 68) and 0.94 ± 0.28 g/cm2 (n = 65). In transmen, the mean BMD values at the lumbar spine and total hip at the first DXA scan were, respectively, 1.08 ± 0.16 g/cm2 (n = 43) and 1.01 ± 0.18 g/cm2 (n = 43). A significant decrease in total hip BMD was found in both transwomen and transmen after 15 years of HT compared with 10 years of HT (P = .02). ConclusionIn both transwomen and transmen, a decrease was observed in total hip bone mineral density after 15 years of HT compared to the first 10 years of HT.Dobrolińska M, van der Tuuk K, Vink P, et al. Bone Mineral Density in Transgender Individuals After Gonadectomy and Long-Term Gender-Affirming Hormonal Treatment. J Sex Med 2019; 16:1469–1477.

Bone geometry and trabecular bone score in transgender people before and after short- and long-term hormonal treatment.

Gender-affirming hormonal treatment (HT) in adult transgender people influences bone mineral density (BMD). Besides BMD, bone geometry and trabecular bone score are associated with fracture risk. However, it is not known whether bone geometry and TBS changes during HT. To investigate the bone geometry and TBS in adult transgender people at different time points, up to 25 years, of HT. A total of 535 trans women and 473 trans men were included, who were divided into three groups at time of their DXA: 20-29 years, 30-39 years, and 40-59 years. Subsequently, each group was divided into different HT durations: baseline, or after 5, 15, or 25 years of HT. Hip structure analysis was performed to measure subperiosteal width, endocortical diameter, average cortical thickness, and section modulus. TBS was calculated based on lumbar spine DXA images. In trans women in all age groups and in young trans men, no differences were observed in periosteal width, endocortical diameter, average cortical thickness, and section modulus for different durations of HT. In trans men aged 40-59 years, subperiosteal width, endocortical diameter, and section modulus were slightly higher in the groups who were using HT compared to the (peri- or postmenopausal) baseline group. In younger trans women, TBS tended to be higher in those using HT compared to the baseline groups, and in older trans women TBS was higher in those using HT for 25 years versus baseline (+0.04, 95%CI +0.00; +0.08). In younger trans men, TBS tended to be lower in those who used HT compared to the baseline groups, and in older trans men TBS was lower in those using 5 years HT versus baseline (-0.05, 95%CI -0.08; -0.01). No differences in cortical bone geometry parameters were found during different HT-durations. TBS increased in trans women and decreased in trans men, indicating that estrogens have positive effects on TBS. These data may be helpful in determining what sex reference values for calculating T-scores and Z-scores in adult transgender people should be used.

Change in grip strength in trans people and its association with lean body mass and bone density.

ObjectiveGender-affirming hormonal treatment (HT) in trans people changes physical appearance. Muscle mass and strength are important aspects of physical appearance, but few data exist on the effect of HT on grip strength and muscle mass. This study aimed to investigate the change in grip strength in trans people during the first year of HT and to study the possible determinants of this change and the associations between changes in grip strength, lean body mass and bone mineral density (BMD).Design and methodsA multicenter, prospective study was performed, including 249 transwomen and 278 transmen. Grip strength, lean body mass and BMD were measured at baseline and after 1 year.ResultsAfter 1 year of HT, grip strength decreased with −1.8 kg (95% CI −2.6; −1.0) in transwomen and increased with +6.1 kg (95% CI +5.5; +6.7) in transmen. No differences in grip strength change was found between age groups, BMI groups, hormonal administration routes or hormone concentrations. In transmen, increase in grip strength was associated with increase in lean body mass (per kg increase in grip strength: +0.010 kg, 95% CI +0.003; +0.017), while this was not found in transwomen (per kg increase in grip strength: +0.004 kg, 95% CI −0.000; +0.009). Change in grip strength was not associated with change in BMD in transwomen and transmen.ConclusionsAfter 1 year of HT, grip strength decreased in transwomen, and increased in transmen. In transmen only, change in grip strength was associated with change in lean body mass.

Explorative Prospective Evaluation of Short-Term Subjective Effects of Hormonal Treatment in Trans People—Results from the European Network for the Investigation of Gender Incongruence

IntroductionAlthough many studies on the short- and long-term effects of hormonal treatment (HT) in trans people focus on objective changes such as body composition or bone density, few studies have evaluated self-reported effects of HT. AimTo evaluate self-reported symptoms during the first year of HT in trans people. MethodsThis study is part of the European Network for the Investigation of Gender Incongruence, a multicenter prospective cohort study. For this study, 205 trans women and 193 trans men from the gender clinics of Amsterdam, Ghent, and Florence, who were >18 years of age and started hormonal treatment were included. Questionnaires, self-developed based on the Menopause Rating scale and clinical experiences, were completed, and changes in symptom scores were analyzed using linear mixed models. Main Outcome MeasuresSelf-reported psycho vegetative symptoms, as well as physical, cognitive, emotional, sexual and genital complaints, and pain were evaluated at baseline and after 3, 6, and 12 months of HT using a 4-point Likert scale (no, mild, moderate, or severe complaints). ResultsIn trans men, with a median age of 23, transient increases were reported in night sweats, weight gain, and clitoral pain. Persistent increases were reported for hot flashes, balding, voice instability, acne, and increase in sexual desire, whereas emotional instability, fear, and menses decreased. For trans women, with a median age of 29, hot flashes, night sweats, fatigue, weight gain, changes in olfactory sense, brittle nails, emotional instability, mood swings, and breast tenderness increased persistently during 12 months of HT, whereas a decrease was observed for balding and sexual desire. Sleeping difficulties decreased temporarily. No changes were observed in palpitations, dizziness, abdominal complaints, anxiety, panic attacks, cognition, and pain, except for clitoral and breast pain. Clinical ImplicationsKnowledge on the occurrence of these self-reported, subjective effects and their course over time may help physicians informing trans people starting with and during HT. Strengths & LimitationsThis study was performed in a large cohort of trans people. The follow-up period was limited to 12 months. ConclusionChanges in self-reported symptoms were mentioned in all investigated areas, except cognition. Most symptoms were as expected and even desired, whereas others may be considered unpleasant by some trans people.van Dijk D, Dekker MJHJ, Conemans EB, et al. Explorative Prospective Evaluation of Short-Term Subjective Effects of Hormonal Treatment in Trans People—Results from the European Network for the Investigation of Gender Incongruence. J Sex Med 2019;16:1297–1309.

Gender-Affirming Hormone Treatment Induces Facial Feminization in Transwomen and Masculinization in Transmen: Quantification by 3D Scanning and Patient-Reported Outcome Measures

IntroductionHormone treatment induces feminization of the body in transwomen and masculinization in transmen. However, the effect of hormone treatment on facial characteristics is still unknown. AimWe aimed to study whether hormone treatment induces facial feminization and masculinization and how this potential change affects satisfaction and self-esteem. MethodsIn this single-center cohort study, we included 27 transwomen and 15 transmen who received standardized hormone treatment in the Center of Expertise on Gender Dysphoria, VU University Medical Center Amsterdam. Facial 3-dimensional images were obtained at baseline and at 3 and 12 months. At each image, 22 facial landmarks were placed. Furthermore, the FACE-Q Satisfaction with Facial Appearance Overall and the Rosenberg self-esteem scale were obtained at the same measurement points. Main Outcome MeasuresThe main outcome measures included the relative local shift of skin in millimeters in the 22 landmarks in the transverse (x-axis), coronal (y-axis), and sagittal (z-axis) anatomic axes, the color maps, and the outcomes of the questionnaires. ResultsAfter 12 months, cheek tissue in transwomen increased, with 0.50 mm (95% CI 0.04–0.96) in the x-axis and 1.08 mm (95% CI 0.31–1.85) in the z-axis. Tissue in the jaws decreased with −0.60 mm (95% CI −1.28–0.08) in the x-axis and −0.18 mm (95% CI −0.03–0.33) in the y-axis. Cheek tissue in transmen decreased with −0.45 mm (95% CI −1.00–0.11) in the x-axis and −0.84 mm (95% CI −1.92–0.25) in the z-axis. These changes already started after 3 months. An increase in satisfaction with the facial appearance was found in both transwomen and transmen. There were no changes in reported self-esteem. Clinical implicationThese results could lead to more realistic expectations of facial changes. Furthermore, our results suggest that the face continues to change for at least a year, which could suggest that performing facial feminization surgery after 1 year of hormone treatment might be too early. Strength & LimitationsThis study is the first that provides insight into the facial changes in transgender individuals receiving hormone treatment, and it introduces an objective method to examine (small) facial changes. Our study is limited by the poor reliability of the landmarks, the difficulty of facial fixation, and the lack of gender-specific questions in the questionnaires. ConclusionsHormone treatment in transwomen induces an increase in cheek tissue and a decrease in jaw tissue. In transmen a tendency of decrease in cheek tissue and an increase in jaw tissue was found. These changes are in the direction of the desired gender.Tebbens M, Nota NM, Liberton NPTJ, et al. Gender-Affirming Hormone Treatment Induces Facial Feminization in Transwomen and Masculinization in Transmen: Quantification by 3D Scanning and Patient-Reported Outcome Measures. J Sex Med 2019;16:746–754.

Prescription Refill Gap of Endocrine Treatment from Electronic Medical Records as a Prognostic Factor in Breast Cancer Patients.

PurposeDiscontinuation of hormone therapy is known to lead to a poorer prognosis in breast cancer patients. We aimed to investigate the prescription gap as a prompt index of medication adherence by using prescription data extracted from patient electronic medical records.MethodsA total of 5,928 patients diagnosed with invasive, non-metastatic breast cancer, who underwent surgery from January 1, 1997 to December 31, 2009, were enrolled retrospectively. The prescription data for 4.5 years of hormonal treatment and breast cancer-related events after treatment completion were analyzed. We examined the characteristics and prognoses of breast cancer in patients with and without a 4-week gap.ResultsPatients with a gap showed a significantly higher risk of breast cancer recurrence, distant metastasis, breast cancer-specific death, and overall death after adjustment (hazard ratio [HR], 1.389; 95% confidence interval [CI], 1.089–1.772; HR, 1.568; 95% CI, 1.158–2.123; HR, 2.108; 95% CI, 1.298–3.423; and HR, 2.102; 95% CI, 1.456–3.034, respectively). When patients were categorized based on gap summation, the lower third (160 days) and fourth (391 days) quartiles showed a significantly higher risk of distant metastasis (HR, 1.758; 95% CI, 1.186–2.606 and HR, 1.844; 95% CI, 1.262–2.693, respectively).ConclusionA gap of > 4 weeks in hormonal treatment has negative effects on breast cancer prognosis, and can hence be used as a sentinel index of higher risk due to treatment non-adherence. Further evaluation is needed to determine whether the gap can be used as a universal index for monitoring the adherence to hormonal treatment.

Bone Safety During the First Ten Years of Gender-Affirming Hormonal Treatment in Transwomen and Transmen.

ABSTRACTConcerns about the effects of gender‐affirming hormonal treatment (HT) on bone mineral density (BMD) in transgender people exist, particularly regarding the decrease in estrogen concentrations in transmen. Although it is known that HT is safe for BMD in the short term, long‐term follow‐up studies are lacking. Therefore this study aimed to investigate the change in BMD during the first 10 years of HT, to determine whether HT is safe and if assessing BMD during HT is necessary. A follow‐up study was performed in adult transgender people receiving HT at the VU University Medical Center Amsterdam between 1998 and 2016. People were included if they were HT naive and had a dual‐energy X‐ray absorptiometry (DXA) scan at the start of HT. Follow‐up DXA scans performed after 2, 5, and/or 10 years of HT were used for analyses. The course of BMD of the lumbar spine during the first 10 years of HT was analyzed using multilevel analyses. A total of 711 transwomen (median age 35 years; IQR, 26 to 46 years) and 543 transmen (median age 25 years; IQR, 21 to 34 years) were included. Prior to the start of HT, 21.9% of transwomen and 4.3% of transmen had low BMD for age (Z‐score < –2.0). In transwomen lumbar spine BMD did not change (+0.006; 95% CI, –0.005 to +0.017), but lumbar spine Z‐score increased by +0.22 (95% CI, +0.12 to +0.32) after 10 years of HT. Also in transmen lumbar spine BMD did not change (+0.008; 95% CI, –0.004 to +0.019), but lumbar spine Z‐score increased by +0.34 (95% CI, +0.23 to +0.45) after 10 years of HT. This study showed that HT does not have negative effects on BMD, indicating that regularly assessing BMD during HT is not necessary. However, a high percentage of low BMD was found prior to HT, especially in transwomen. Therefore, evaluation of BMD before start of HT may be considered. © 2018 The Authors. Journal of Bone and Mineral Research Published by Wiley Periodicals, Inc.

Beyond hormone replacement: quality of life in women with congenital hypogonadotropic hypogonadism

ObjectiveLittle is known about how women with isolated GnRH deficiency cope with their condition. This study aimed to examine the health and informational needs of women with congenital hypogonadotropic hypogonadism (CHH) and evaluate if their experiences differ from women with more common forms of infertility.DesignCross-sectional, multiple methods study using web-based data collection to reach dispersed rare disease patients.MethodsA community-based participatory research framework was employed to develop an online survey and collect quantitative and qualitative data. Adult women diagnosed with CHH who had received at least one year of hormonal treatment completed the Morisky Medication Adherence Scale, Revised Illness Perception Questionnaire and Zung Self-Rating Depression Scale. Information on health care experiences, treatment outcomes and patient-reported challenges were also collected.ResultsWomen (n = 55) were often diagnosed late (20.7 ± 7.4, range: 10–48 years) and 16/20 patients receiving fertility treatment conceived. Poor adherence was frequently observed (34/55) while more than half (27/49) reported a gap in treatment exceeding a year. Low adherence correlated with depressive symptoms (r = 0.3, P > 0.05). Negative illness perceptions were pervasive and 30/55 exhibited some depressive symptoms – significantly greater than women with common female factor infertility (P < 0.01). Symptoms were underappreciated by providers as only 15 of 55 patients had discussions about psychological services. Women identified isolation, need for information and finding expert care as challenges to living with CHH.ConclusionsDespite being a treatable form of female infertility, the presumable availability of treatment does not necessarily ensure adequate quality of life for women with isolated GnRH deficiency.

Bone Mineral Density Increases in Trans Persons After 1 Year of Hormonal Treatment: A Multicenter Prospective Observational Study.

Sex steroids are important determinants of bone acquisition and bone homeostasis. Cross-sex hormonal treatment (CHT) in transgender persons can affect bone mineral density (BMD). The aim of this study was to investigate in a prospective observational multicenter study the first-year effects of CHT on BMD in transgender persons. A total of 231 transwomen and 199 transmen were included who completed the first year of CHT. Transwomen were treated with cyproterone acetate and oral or transdermal estradiol; transmen received transdermal or intramuscular testosterone. A dual-energy X-ray absorptiometry (DXA) was performed to measure lumbar spine (LS), total hip (TH), and femoral neck (FN) BMD before and after 1 year of CHT. In transwomen, an increase in LS (+3.67%, 95% confidence interval [CI] 3.20 to 4.13%, p < 0.001), TH (+0.97%, 95% CI 0.62 to 1.31%, p < 0.001), and FN (+1.86%, 95% CI 1.41 to 2.31%, p < 0.001) BMD was found. In transmen, TH BMD increased after 1 year of CHT (+1.04%, 95% CI 0.64 to 1.44%, p < 0.001). No changes were observed in FN BMD (-0.46%, 95% CI -1.07 to 0.16%, p = 0.144). The increase in LS BMD was larger in transmen aged ≥50 years (+4.32%, 95% CI 2.28 to 6.36%, p = 0.001) compared with transmen aged <50 years (+0.68%, 95% CI 0.19 to 1.17%, p = 0.007). In conclusion, BMD increased in transgender persons after 1 year of CHT. In transmen of postmenopausal age, the LS BMD increased more than in younger transmen, which may lead to the hypothesis that the increase in BMD in transmen is the result of the aromatization of testosterone to estradiol. © 2017 American Society for Bone and Mineral Research.

Incidence of Venous Thromboembolism in Transgender Women Receiving Oral Estradiol

IntroductionOne of the most serious known adverse effects of feminizing cross-sex hormone therapy (CSHT) is venous thromboembolism (VTE); however, no study has assessed the incidence of VTE from the hormone therapies used in the United States because previous publications on this topic have originated in Europe. CSHT in the United States typically includes estradiol with the antiandrogen spironolactone, whereas in Europe estradiol is prescribed with the progestin cyproterone acetate. AimTo estimate the incidence of VTE from the standard feminizing CSHTs used in the United States. MethodsA retrospective chart review of transgender women who had been prescribed oral estradiol at a District of Columbia community health center was performed. Main Outcome MeasureThe primary outcomes of interest were deep vein thrombosis or pulmonary emboli. ResultsFrom January 1, 2008 through March 31, 2016, 676 transgender women received oral estradiol-based CSHT for a total of 1,286 years of hormone treatment and a mean of 1.9 years of CSHT per patient. Only one individual, or 0.15% of the population, sustained a VTE, for an incidence of 7.8 events per 10,000 person-years. ConclusionThere was a low incidence of VTE in this population of transgender women receiving oral estradiol.

Predictors of Discontinuation of Adjuvant Hormone Therapy in Patients With Breast Cancer.

To identify predictors of discontinuation of adjuvant hormone therapy in patients with breast cancer. We conducted a record-linkage study based on data from Stockholm-Gotland Breast Cancer Register, Swedish Prescribed Drug Register, and self-reported questionnaire. Women diagnosed with breast cancer between 2005 and 2008 in Stockholm, Sweden, were prospectively followed for 5 years until 2013, starting from their first prescription of tamoxifen or aromatase inhibitors (N = 3,395). Family history of ovarian cancer (hazard ratio [HR], 1.55; 95% CI, 1.19 to 2.02); younger (< 40 years; HR, 1.39; 95% CI, 1.08 to 1.78) and older (≥ 65 years; HR, 1.15; 95% CI, 1.03 to 1.28) age; higher Charlson comorbidity index (≥ 2 v 0; HR, 1.35; 95% CI, 1.03 to 1.76); and use of analgesics (HR, 1.33; 95% CI, 1.16 to 1.52), hypnotics/sedatives (HR, 1.24; 95% CI, 1.07 to 1.43), GI drugs (HR, 1.25; 95% CI, 1.08 to 1.43), and hormone replacement therapy (HR, 1.27; 95% CI, 1.08 to 1.49) were identified as baseline predictors for hormonal treatment discontinuation. Use of analgesics (HR, 1.22; 95% CI, 1.08 to 1.37), hypnotics/sedatives (HR, 1.21; 95% CI, 1.07 to 1.37), antidepressants (HR, 1.22; 95% CI, 1.06 to 1.40), or GI drugs (HR, 1.27; 95% CI, 1.13 to 1.43), and switching therapy between tamoxifen and aromatase inhibitors (HR, 1.50; 95% CI, 1.23 to 1.83) during the first year of hormonal treatment were associated with increased risk of discontinuation during the next 4 years. Predictors identified in our study can be used in developing targeted intervention to prevent adjuvant hormone therapy discontinuation and subsequently to improve breast cancer outcomes.

Concomitant psychiatric problems and hormonal treatment induced metabolic syndrome in gender dysphoria individuals: A 2 year follow-up study

ObjectiveSeveral studies indicate increased prevalence of metabolic syndrome (MetS) among patients with psychiatric disorders as well as among individuals with gender dysphoria (GD) treated by cross-sex hormonal treatment. However, the MetS prevalence among hormone treated GD individuals suffering from psychiatric problems has not been detected. MethodsFrom a sample of 146 GD patients we selected 122 metabolically healthy individuals in order to investigate the prevalence of MetS after the beginning of the cross-sex hormonal treatment in a 2year follow-up assessment. Furthermore, we assessed differences in MetS prevalence between hormone treated GD patients with and without concomitant psychiatric problems. ResultsWhen treated with hormone therapy, GD patients reported changes in several parameters which are clustered in MetS, with statistically significant differences compared to baseline. Glyco-insulinemic alterations were more pronounced in male to female patients (MtFs). However, weight gain, waist circumference increases, blood pressure increases, and lipid alterations were similar in MtFs and female to male patients (FtMs). 14.8% of the sample at year 1 and 17.2% at year 2 developed MetS. Among patients with concomitant psychiatric problems, 50% at year 1 and 55% at year 2 developed MetS against 8% at year 1 and 10% at year 2 of patients without concomitant psychiatric problems. ConclusionThis study indicates that sex hormones induce MetS in a relatively low proportion of healthy GD individuals and especially during the first year of hormonal treatment. Most importantly, concomitant psychiatric problems are associated with considerably greater MetS prevalence in hormone treated GD individuals.

5163 POSTER Quality of Life of Women With Breast Cancer Treated in Adjuvant Setting With Tamoxifen or Aromatase Inhibitors

Background: To determine the quality of life of women with early breast cancer treated with Tamoxifen, Letrozole, Anastrazole, Exemestane, after 2 years of treatment. Materials and Methods: A total of 237 women treated in the period 2001–2009 with adjuvant hormonotherapy, were selected to complete the EORTC-C30 and EORTC BR-23 questionnaire. From these women, 115 patients were treated with Tamoxifen and 122 have received aromatase inhibitors: 60 patients have received letrozole, 29 patients anastrazole and 33 patients exemestane. The women had completed the questionnaires after 2 years of hormonal treatment. The primary end point was the comparison of global health status among the groups receiving tamoxifen, letrozole, anastrazole and exemestane. The secondary end point was the analysis of functional scales, emotional scales, cognitive scales and symptom scales of every hormonal treatment group. Results: The assessments available for analysis were in proportion of 88% from questionnaire completion target. There were no differences between the tamoxifen group and the aromatase inhibitors group (letrozole, anastrazole and exemestane) after 2 years of hormonal therapy. Evaluating separately the scales, there is a superiority of the group receiving aromatase inhibitors (anastrazole, letrozole and exemestane) comparing with tamoxifen group regarding symptom scale (sexual function and fatigability) and emotional scale. Among the three groups treated with letrozole, anastrazole and exemestane, was found a statistically significant difference in symptom scale (nausea, dizziness) in favour of anastrazole compared with letrozole. Conclusions: After two years of adjuvant hormonal treatment, the treatment with tamoxifen or aromatase inhibitors has a similar overall impact regarding quality of life. The statistic significant differences appears to be related with symptom scale and emotional scale, where aromatase inhibitors are superior.

Metabolic and hormonal parameters in post-menopausal women 10 years after transdermal oestradiol treatment, alone or combined to micronised oral progesterone

Background. In the post-Women's Health Initiative Study era few post-menopausal women complete long term hormonal treatment (HT). Objective. To analyse metabolic/hormonal parameters and frequency of the metabolic syndrome (METS) in post-menopausal women after 10 years of HT. Methods. Retrospective data from parallel cohorts of post-menopausal women receiving HT for 10 years was analysed. Regimens included: transdermal oestradiol (50 μg) (n = 22), sequential cyclic HT with transdermal oestradiol (50 μg) plus 200 mg/day micronised oral progesterone (cycle days 12–25) (n = 83), or continuous combined HT with transdermal oestradiol (50 μg) plus 100 mg/day micronised oral progesterone (n = 46). A group of women who elected not to use HT served as a control group (n = 35). Results. Frequency of the METS did not significantly increase after 10 years of HT. Oestradiol and sex hormone binding globulin (SHBG) levels displayed a significant increase compared to baseline after 10 years of HT (all regimens). These values were significant higher when compared to the control group. Glucose levels were significantly higher after 10 years in women receiving the sequential cyclic regimen. Although not reaching statistical significance, there was a trend for transdermal oestradiol alone to increase HDL-C and decrease triglyceride levels. Conclusion. Serum oestradiol and SHBG levels were significantly higher after 10 years of transdermal oestradiol, alone or combined with micronised oral progesterone, without differences observed in serum metabolic parameters. More research through randomised clinical trials is required.

Adherence to adjuvant endocrine therapy in estrogen receptor-positive breast cancer patients with regular follow-up.

e11039 Background: Non-adherence (NAdh) rate to hormonal treatment (HT) has been reported to reach 60%. The goal of this study was to evaluate the level of adherence (Adh) to HT in patients followed in a surgeon's private practice. Methods: From November 2008 to April 2009, all patients with estrogen receptor-positive breast cancer were interviewed at their follow-up visit to the surgeon's office. They were checked for Adh to HT and were asked to detail the reasons for Adh or Nadh. Records were also reviewed for demographics, cancer and treatment characteristics. Qualitative and correlative analyses were carried out. Adh was considered when 100% compliance was reached. Results: Among 398 patients with breast cancer, 161 were eligible: 81% (n = 130) had complete Adh to HT. In patients with Adh, 5 years of HT was completed in 26% (n = 42) and at least 48 months in 36% (n = 58); 52% (n = 88) were ongoing HT at the time of the interview. Median duration on HT was 25 months. Patients reported a unique reason for NAdh (n = 31): forgetting (n = 17); side effects (n = 7); absence of conviction (n = 4); financial problems (n = 1); other acute diseases (n = 1); metastatic disease (n = 1). Patients reported various reasons for Adh: importance of the diagnosis of cancer (100%), fear of recurrence (100%), regular follow-up and supervision by physician and/or nurse (61%), meticulous personality (22%), use of helping device (18%), other medication and/or other medical problems (13%), history of cancer in family and circle (11%), working in the medical or paramedical field (8%), influence of friends and family (5%), inclusion in a research project (3%), and the presence of young children (3%). Multivariate analysis showed that HER2 positivity and postoperative chemotherapy were significantly associated with NAdh (p < 0.05). Conclusions: Adh to HT can be evaluated in a private office practice. Fear of cancer and/or recurrence along with regular follow-up appear to influence Adh to HT. The use of a specific interview to evaluate Adh proved to be a useful tool. Further follow-up and studies should be done to evaluate the relationship between the data and the contribution of regular follow-up by cancer specialist in the Adh to HT. Author Disclosure Employment or Leadership Position Consultant or Advisory Role Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration AstraZeneca, Genomic Health, Novartis

Prise en charge des métastases osseuses du cancer de la prostate. À propos d’un cas

Androgen deprivation therapy with LHRH agonists is the gold standard in the treatment of metastatic prostate cancer. This treatment leads to decrease the bone mass, thus bone mineral density evaluation is recommended after one year of hormonal treatment to measure bone loss. Bisphosphonate is recommended when metastasis occurred during hormonal resistance phase to reduce bone events. The necessity of preventive treatment and the appropriate schedule is not well established. Long term fracture risk should be ideally evaluated with a CT scan and an MRI. Fragmented and focal radiotherapy is considered as the treatment of choice to decrease localized pain. Metastasis surgery has functional results and should be performed before major neurologic symptoms occur. Metabolic radiotherapy is an option for multifocal bone metastases.

Assessing fatal cardiovascular disease risk with the SCORE (Systematic Coronary Risk Evaluation) scale in post-menopausal women 10 years after different hormone treatment regimens

Objective. To assess fatal cardiovascular disease (FCD) risk among women in early post-menopausal years, as evaluated with the Systematic Coronary Risk Evaluation (SCORE) scale.Design. This was a retrospective study of parallel cohorts. Two hundred seventy-three healthy post-menopausal women. Participants received one of the following hormone treatment (HT) regimens: transdermal estradiol (50 μg) (n = 99), sequential cyclic HT with transdermal estradiol (50 μg/day) plus 200 mg/day natural micronised oral progesterone (cycle days 12–25) (n = 63) and combined HT using transdermal estradiol (50 μg) plus 100 mg/day of micronised oral progesterone (n = 61). A group of women who elected not to use HT served as control group (n = 50). SCORE values were assessed before HT or follow up.Results. Only one woman displayed a high-risk SCORE value both before and after 10 years of HT, the remaining had low risk values (<5%) for FCD. After 10 years, SCORE values increased significantly as compared to baseline among HT users (all three regimens) and controls. Although post-treatment SCORE values significantly differed among groups, values were all below the high risk cut-off (5%). There were no FCD events during the 10 year observation period.Conclusion. As assessed with the SCORE scale, FCD risk in young post-menopausal women (HT users and controls) had a slight significant increase after 10 years, being values in the low risk range.