Missing documentation in breast cancer survivors: genitourinary syndrome of menopause

Abstract

Objective Breast cancer survivors often take hormonal treatments to prevent the recurrence of breast cancer, particularly aromatase inhibitors that can worsen the symptoms of genitourinary syndrome of menopause (GSM) such as dyspareunia, dysuria, and urinary incontinence, all of which may adversely affect survivors’ quality of life. Few breast cancer survivors experiencing GSM receive adequate assessment or treatment. Methods In this descriptive study, we reviewed medical records for documented GSM and any treatments administered or referrals for treatment in 800 female patients who visited the Breast Cancer Survivorship Clinic at a comprehensive cancer center between July 1, 2010, and June 30, 2011, either ≥5 years after completion of treatment for invasive breast cancer or ≥6 months after completion of treatment for ductal carcinoma in situ. Results Of the 279 patients with documented symptoms of vaginal atrophy, only 111 (39.8%) had documentation of having received any form of treatment or referral. Of the 71 patients with documented symptoms of urinary tract atrophy, only 33.8% had documentation of having received treatment or referral for treatment. Conclusion Breast cancer survivors often experience GSM due to lack of estrogen. The worrisome lack of documentation of assessment or treatment for GSM in a large breast cancer survivorship practice reveals missed opportunities to improve quality of life. Dissemination of recent progress in the development of GSM assessment tools, patient handouts, and new treatments to providers who care for breast cancer survivors is needed to improve this process.

Management of Primary Ovarian Insufficiency Symptoms in Survivors of Childhood and Adolescent Cancer

“…We therefore searched the literature on breast cancer survivors, and found recent evidence showing that genitourinary symptoms are rarely assessed or treated in this population, revealing a missed opportunity to improve QoL. 74 In addition to physical discomfort, hormonal changes in survivors with POI are also associated with alterations in libido and arousal. Libido may be affected by the emotional burden of disease and its ongoing sequalae.…”

Management of genitourinary syndrome of menopause in female cancer patients: a focus on vaginal hormonal therapy

“…5 GSM affects more than 50% of postmenopausal women, and is even more pervasive in the female cancer population. 2,6,7 As breast cancer is often diagnosed after menopause, women with breast cancer may experience GSM prior to diagnosis, and breast cancer treatments may intensify symptoms. Broeckel et al 8 compared women with breast cancer treated with chemotherapy to age-matched controls without cancer, and found that breast cancer patients experienced worse sexual function, with vaginal dryness as one of the most significant predictors of poorer sexual function.…”

Prevalence and impact of bladder and bowel disorders in women with breast cancer: A systematic review with meta‐analysis

“…A total of 3405 articles were identified, 32 studies were included in the qualitative synthesis, and 17 studies were included in the meta‐analysis (see Figure 1). Our review included seven randomized controlled trials, 14–20 eight cohort studies, 2,12,21–26 and 17 cross‐sectional studies 27–43 . A total of 12,611 women with breast cancer were represented in this systematic review; 10,441 of these women were in the meta‐analysis.…”

“…In studies that reported follow‐up time points, the median time postdiagnosis when participants were assessed was 2 years (range: 1 month to 5 years) 2,14,19,21,24,25,29,36,38,40,42 . Of the studies that provided a range of follow‐up time points, all were within 5 years postdiagnosis, 15,32,37,39,43 except two studies 27,35 which followed‐up for 10 years. A total of 14 studies did not indicate the number of years postdiagnosis 12,16–18,20,22,23,26,28,30,31,33,34,41 .…”