Iatrogenic Menopause After Treatment for Cervical Cancer

Moss, Esther L.; Taneja, Satyam; Munir, Fehmidah; Kent, Christopher; Robinson, Lynne; Potdar, Neelam; Sarhanis, P.; McDermott, Hilary

doi:10.1016/j.clon.2016.08.016

Cited by 21 publications

(20 citation statements)

References 110 publications

(117 reference statements)

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“…osteopenia and vasomotor symptoms [7]). Additionally, long-term psychological distress is common [8], often due to sexual dysfunction, fear and anxiety related to cancer recurrence and a loss of fertility [9]. Previous explorations have demonstrated a need for psychosocial intervention to improve the survivorship experience [5].…”

Section: Introductionmentioning

confidence: 99%

Increasing physical activity levels following treatment for cervical cancer: an intervention mapping approach

et al. 2021

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Purpose The purpose of this study was to utilise the intervention mapping (IM) protocol as a framework with which to develop an intervention underpinned by relevant behaviour change theory to promote physical activity (PA) following treatment for cervical cancer. Methods The six steps of the IM protocol were followed. A qualitative semi-structured interview study and a rapid review of the literature were conducted along with the development of a logic model of the problem and a logic model of change to inform intervention development. Results An intervention was developed which aims to increase PA levels following treatment for cervical cancer, tailored to address key findings from the IM needs assessment. These include embedding behavioural and social strategies that help participants to overcome perceived barriers to PA participation; goal setting strategies to gradually increase PA levels with a view of reaching relevant PA guidelines for cancer survivors and feedback to encourage self-assessment of well-being and PA capability. Conclusion This study maps the development of a novel PA intervention for those who have been treated for cervical cancer. The use of a systematic development framework was necessary as little insight exists regarding PA preferences after treatment for cervical cancer. Implications for Cancer Survivors PA behaviour is associated with positive physical and psychological health outcomes for cancer survivors. Optimising targeted promotion of PA behaviour following treatment for cervical cancer may result in an enhanced survivorship experience through increased PA behaviour and improved quality of life (QOL).

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Section: Introductionmentioning

confidence: 99%

Increasing physical activity levels following treatment for cervical cancer: an intervention mapping approach

et al. 2021

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“…In the limited studies available, no significant difference in recurrence rate or survival63–66 has been linked with menopausal hormone therapy use after treatment for cervical squamous cell carcinomas. In women who have been treated with radiotherapy, rather than hysterectomy, for cervical cancer, opposed estrogen therapy to prevent stimulation of residual endometrium should be used 67…”

Section: Introductionmentioning

confidence: 99%

European Menopause and Andropause Society (EMAS) and International Gynecologic Cancer Society (IGCS) position statement on managing the menopause after gynecological cancer: focus on menopausal symptoms and osteoporosis

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Angioli

Coleman

et al. 2020

Int J Gynecol Cancer

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Worldwide, it is estimated that about 1.3 million new gynecological cancer cases are diagnosed each year. For 2018, the predicted annual totals were cervix uteri 569 847, corpus uteri 382 069, ovary 295 414, vulva 44 235, and vagina 17 600. Treatments include hysterectomy with or without bilateral salpingo-oophorectomy, radiotherapy, and chemotherapy. These can result in loss of ovarian function and, in women under the age of 45 years, early menopause. The aim of this position statement is to set out an individualized approach to the management, with or without menopausal hormone therapy, of menopausal symptoms and the prevention and treatment of osteoporosis in women with gynecological cancer. Our methods comprised a literature review and consensus of expert opinion. The limited data suggest that women with low-grade, early-stage endometrial cancer may consider systemic or topical estrogens. However, menopausal hormone therapy may stimulate tumor growth in patients with more advanced disease, and non-hormonal approaches are recommended. Uterine sarcomas may be hormone dependent, and therefore estrogen and progesterone receptor testing should be undertaken to guide decisions as to whether menopausal hormone therapy or non-hormonal strategies should be used. The limited evidence available suggests that menopausal hormone therapy, either systemic or topical, does not appear to be associated with harm and does not decrease overall or disease-free survival in women with non-serous epithelial ovarian cancer and germ cell tumors. Caution is required with both systemic and topical menopausal hormone therapy in women with serous and granulosa cell tumors because of their hormone dependence, and non-hormonal options are recommended as initial therapy. There is no evidence to contraindicate the use of systemic or topical menopausal hormone therapy by women with cervical, vaginal, or vulvar cancer, as these tumors are not considered to be hormone dependent.

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“…However, adjuvant chemoradiation is associated with increased morbidity (with reported symptoms such as nausea, pain, vaginal tightness and urinary complaints) and impaired quality of life [ 10 ]. Of note, adjuvant (chemo)radiation in cervical cancer may also result in ovarian failure, and most patients diagnosed with cervical cancer are relatively young [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

‘DURVIT’: a phase-I trial of single low-dose durvalumab (Medi4736) IntraTumourally injected in cervical cancer: safety, toxicity and effect on the primary tumour- and lymph node microenvironment

et al. 2018

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BackgroundTreatment with programmed cell death receptor (PD-1) and programmed cell death ligand 1 (PD-L1) inhibitors is a promising strategy to lift tumour-induced immune response suppression. However, the current systemic treatment often causes autoimmune side effects. In more than 50% of squamous cell cervical cancer, PD-L1 expression is detected. Moreover, we observed high and interrelated rates of PD-L1 positive macrophages and regulatory T cells in metastatic lymph nodes of cervical cancer patients. As cervical cancer in general initially metastasizes to regional lymph nodes, local administration of durvalumab (a PD-L1 checkpoint inhibitor) at an early stage will deliver these antibodies exactly where they are needed, facilitating immune protection. This may result in a clinical benefit while reducing undesirable side effects.MethodsDURVIT is a non-randomized, single-arm, open-label, phase I study. Three escalating dose levels of intratumourally (i.t.) injected durvalumab will be tested, i.e. 5, 10 and 20 mg (three patients per dose level, with an additional three at the highest tolerated dose). The primary endpoint of this phase-I study is safety. Immune monitoring will consist of flow cytometric, immunohistochemical and functional T cell reactivity testing. The first patient has been included in this trial in November 2017.DiscussionEvidence of safety and biological efficacy of this locally administered checkpoint blockade may expand adjuvant therapy options for cervical cancer patients. Early metastatic spread of cervical cancer cells may thus be controlled in the draining lymph node basin, and beyond, and hopefully delay or even prevent the onset of disease recurrence.Trial registrationNTR6119, 1-nov-2016.Electronic supplementary materialThe online version of this article (10.1186/s12885-018-4764-0) contains supplementary material, which is available to authorized users.

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Iatrogenic Menopause After Treatment for Cervical Cancer

Cited by 21 publications

References 110 publications

Increasing physical activity levels following treatment for cervical cancer: an intervention mapping approach

Increasing physical activity levels following treatment for cervical cancer: an intervention mapping approach

European Menopause and Andropause Society (EMAS) and International Gynecologic Cancer Society (IGCS) position statement on managing the menopause after gynecological cancer: focus on menopausal symptoms and osteoporosis

‘DURVIT’: a phase-I trial of single low-dose durvalumab (Medi4736) IntraTumourally injected in cervical cancer: safety, toxicity and effect on the primary tumour- and lymph node microenvironment

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