Background: Sexual dysfunction is reported after chemotherapy and endocrine therapies. However, the prevalence and severity of sexual dysfunction in premenopausal women undergoing therapy for both local and metastatic disease is not well defined. This study was performed in order to understand the impact of contemporary breast cancer treatment on the prevalence and severity of sexual health in premenopausal women. Methods: We developed a survey that includes a previously validated questionnaire, the Female Sexual Function Index (FSFI), as well as an established measure of health-related quality of life (the EuroQol EQ-5D), and disease-specific items to characterize sexual dysfunction and its causes based on literature review and expert consultations. Anonymous administration of the surveys was conducted in outpatient clinic waiting areas of the Breast Cancer Center at Memorial Sloan-Kettering Cancer Center (MSKCC), under an IRB waiver of consent. Results: 372 consecutively approached premenopausal women with breast cancer of any stage, undergoing treatment were each queried once. The mean age was 47. 87% reported current or past hormonal treatment, and 86% reported current or past chemotherapy (76% adjuvant; 24% for metastatic disease). Sexual dysfunction attributed to breast cancer or its treatment, defined as an FSFI score <26, was reported by 75% of respondents with a mean score of 16.3. Among these women, 79% of patients considered their sexual symptoms to be bothersome, with 51% noting moderate or severe levels of bother (score >=5/10). In a multivariate analysis, metastatic disease, development of amenorrhea from cancer treatment, antidepressant use and poorer overall health were each significantly associated with worse FSFI scores. Lower FSFI scores were also significantly associated with worse health-related quality of life. Conclusion: Sexual dysfunction is prevalent in premenopausal women treated for breast cancer and should be discussed with patients as a potential adverse effect of therapy. Assessment of sexual symptoms throughout treatment and beyond may facilitate the use of potential interventions such as lubricants, dilators, treatment modification and counseling. Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr PD04-03.
Background: To determine the longitudinal impact of adjuvant chemotherapy and tamoxifen-only treatments on ovarian reserve by serum anti-Mullerian hormone (AMH) levels in women with breast cancer. Methods: One-hundred-and-forty-two women with a primary diagnosis of breast cancer were prospectively followed with serum AMH assessments before the initiation, and 12, 18 and 24 months after the completion of adjuvant chemotherapy or the start of tamoxifen-only treatment. The chemotherapy regimens were classified into Anthracycline- Cyclophosphamide-based (AC-based) and Cyclophosphamide-Methotrexate+5-Fluorouracil (CMF). Longitudinal data were analyzed by mixed effects model for treatment effects over time, adjusting for baseline age and BMI. Results: Both chemotherapy regimens resulted in significant decline in ovarian reserve compared to the tamoxifen-only treatment (p<0.0001 either regimen vs. tamoxifen for overall trend). AMH levels sharply declined at 12 months but did not show a significant recovery from 12 to 18 and 18 to 24 months after the completion of AC-based or CMF regimens. The degree of decline did not differ between the two chemotherapy groups (p=0.53). In contrast, tamoxifen-only treatment did not significantly alter the age-adjusted serum AMH levels over the 24-month follow up. Likewise, the use of adjuvant tamoxifen following AC-based regimens did not affect AMH recovery. Conclusions: Both AC-based and CMF regimens significantly compromise ovarian reserve, which does not recover during the 12-24-month post-chemotherapy follow up. In contrast, tamoxifen treatment does not seem to alter ovarian reserve. This novel information should be valuable for fertility preservation counselling and in assessing future reproductive potential of breast cancer survivors.
Objectives: This is a single-arm prospective longitudinal clinical trial investigating the feasibility of using a non-hormonal hyaluronic acid (HLA) vaginal gel (Hydeal-D) to improve estrogen deprivation vaginal health symptoms in postmenopausal women with a history of hormone receptor-positive cancer. Methods: Preliminary data from an ongoing clinical trial were examined. Demographics, medical information, and clinical assessment from breast cancer patients enrolled on study at baseline (n=23) and at 4-6 weeks (n=18) are presented. Eligible participants included those with a history of breast cancer receiving treatment with an aromatase inhibitor (AI) at the time of enrollment. Furthermore, participants could not have evidence of disease and had to have completed treatment for at least 3 months and no longer than 5 years (excluding AIs). Study participants were instructed to use HLA daily for 2 weeks, then 3 times per week for 12-14 weeks. Study outcomes include: pelvic exam results as recorded on a clinician evaluation form with the Vaginal Assessment Scale (VAS); patient-reported outcomes (PROs) of the Sexual Activity Questionnaire (SAQ), Sexual Self-Schema Scale, and Female Sexual Function Index (FSFI); PROMIS sexual function items; and exploratory items. Results: The mean age was 56 years (range, 42-75). Seventy-four percent (17/23) were married or living with a partner. Fifty-seven percent (13/23) reported sexual activity with a partner at baseline, which was 72% (13/18) at 4-6 weeks. On the VAS, 65% (15/23) reported symptoms of severe dryness at baseline and 61% (14/23) reported severe dyspareunia; these reported symptoms decreased to 6% (1/18) and 6% (1/18), respectively, at 4-6 weeks. Vaginal pH scores were greater than 6.5 in 30% (7/23) at baseline; by 4-6 weeks, only 22% (4/18) had a pH in this elevated range. At baseline, 78% (18/23) had minimal moisture and 22% (5/23) had no vaginal moisture seen on exam; by 4-6 weeks, 11% (2/18) had normal moisture and 89% (16/18) had minimal moisture. Pain with pelvic exams declined over time—87% (20/23) had pain at baseline, with 22% (5/23) rating it as severe, and 78% (14/18) had pain at 4-6 weeks, with none of the women rating their pain as severe. Forty-eight percent (11/23) indicated confidence about future sexual activity at baseline, which was 56% (10/18) at 4-6 weeks. Level of concern about sexual/vaginal health was measured on a scale of 0-10, with greatest concern rated as a 9 or 10. Sixty-one percent (14/23) of the women fell into this range at baseline; the percentage decreased to 28% (5/18) at 4-6 weeks. Conclusions: Preliminary findings suggest that an HLA vaginal gel may improve vaginal/sexual health issues and concerns of breast cancer survivors both in their perceived symptoms and on clinical exam; however, further study is needed to examine if these promising trends continue over time and to determine the ideal frequency of product administration. Citation Format: Carter J, Seidel B, Stabile C, Dickler M, Goldfrank D, Baser R, Goldfarb S. Feasibility of a non-hormonal vaginal moisturizer in postmenopausal cancer survivors. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P4-11-06.
In response to a prior editorial in Lancet,1 we are reporting a case of IgD multiple myeloma that developed into acute myelomonocy-
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