Endocrine therapy associated with worse menopause symptoms in patients with breast cancer

Among patients with breast cancer in China, those who underwent adjuvant endocrine therapy had more prevalent and more severe menopausal symptoms, according to data published in Menopause.

Of note, patients who participated in health-promoting behaviors and had social support reported fewer menopausal symptoms.

“Although endocrine therapy significantly improves the prognosis of the disease, treatment is associated with multiple symptoms that may result in early menopause and medication nonadherence and may negatively affect quality of life,” Tingting Wei, MD, of the Tianjin Key Laboratory of Cancer Prevention and Therapy at Tianjin Medical University Cancer Institute and Hospital in Tianjin, China, and colleagues wrote. “Because of the suppression of estrogen, patients receiving adjuvant endocrine therapy generally report more frequent and severe menopausal symptoms than healthy women.”

To explore associations of social support and health-promoting behaviors on the prevalence and severity of menopausal symptoms among these patients, Wei and colleagues recruited 226 participants who were receiving endocrine therapy for breast cancer from December 2020 to December 2021. All participants had undergone modified radical mastectomy from Tianjin Medical University Institute and Hospital’s outpatient breast cancer clinic. Participants in the cross-sectional study had regular menses prior to surgical treatment.

Participants reported menopause symptoms on the Menopause Rating Scale — with scores of 17 or greater indicating severe symptoms — and completed the Health-Promoting Lifestyle Profile II, which reports behaviors in the dimensions of health responsibility, exercise, nutrition, spiritual growth, interpersonal relationship and stress management. They also completed the Perceived Social Support Survey, which assessed individual social support.

At enrollment, 86.7% of participants were postmenopausal, 65.9% received aromatase inhibitors and 70.2% received endocrine therapy for 3 years or less.

Most (92.9%) participants reported menopausal symptoms, with 30.5% reporting severe symptoms. The most common symptoms were hot flashes/night sweats, physical and mental exhaustion, joint and muscular discomfort, irritability and sleep problems.

In multivariate analyses, monthly family income (beta = 0.29; P = .01), education level (beta = 0.19; P < .01), health responsibility (beta = 0.15; P = .03), spiritual growth (beta = 0.28; P < .01), support from friends (beta = 0.43; P < .01) and support from other people (beta = 0.31; P = .01) were associated with fewer menopausal symptoms. The use of aromatase inhibitors and selective estrogen receptor modulators was associated with more menopausal symptoms (beta = 0.2; P < .01).

“Overall, this study showed that the prevalence and severity of menopausal symptoms are high in patients with breast cancer receiving adjuvant endocrine therapy,” Wei and colleagues wrote. “Several sociodemographic characteristics, health-promoting behaviors and social support were associated with menopausal symptoms. Medical providers are recommended to identify these symptoms and provide appropriate interventions in patients receiving adjuvant endocrine therapy, taking full account of the potential influencing factors.”