Chemotherapy-related amenorrhea common in premenopausal women with breast cancer

Key takeaways:

• Older age and adjuvant tamoxifen increase likelihood of chemotherapy-related amenorrhea (CRA).
• CRA was associated with worse insomnia, systemic therapy-related adverse effects and sexual functioning.

Persistent chemotherapy-related amenorrhea was common and associated with worse long-term quality of life for premenopausal women with breast cancer, according to findings published in JAMA Network Open.

“There is a lack of longitudinal data regarding long-term trajectories of chemotherapy-related amenorrhea (CRA) and midterm to long-term recovery patterns of menses, making it difficult for clinicians to give accurate estimations of the likelihood of recovery over time according to age range at diagnosis of breast cancer,” Rayan Kabirian, MD, an oncologist in the department of medical oncology at Gustave Roussy and Sorbonne University, Paris, and colleagues wrote.

Kabirian and colleagues evaluated data from the Cancer Toxicities Study, a prospective, longitudinal multicenter French cohort study of 1,636 premenopausal women with stage I to III breast cancer (mean age at diagnosis, 42.2 years). All participants were younger than 50 years and were treated with chemotherapy without adjuvant ovarian function suppression. Researchers followed participants for up to 4 years after breast cancer diagnosis from 2012 to 2017.

The primary outcome was CRA at 1, 2 and 4 years after breast cancer diagnosis. Secondary outcomes included quality of life at 4 years after diagnosis.

Eighty-three percent of women reported CRA 1 year after their breast cancer diagnoses, 72.5% reported it at 2 years and 66.1% reported it at 4 years.

CRA was more likely for women aged 35 to 39 years (adjusted OR = 1.84; 95% CI, 1.32-2.56), 40 to 44 years (aOR = 5.9; 95% CI, 4.23-8.24), 45 years or older (aOR = 21.29; 95% CI, 14.34-31.61) and those who received adjuvant tamoxifen (aOR = 1.97; 95% CI, 1.53-2.53).

When evaluating quality of life, researchers observed CRA among 57.1% of the 729 women with menses data available at all time points. Across all age groups, 13.9% of women had menses recovery 1 year after diagnosis, 21.2% between 1 and 2 years after diagnosis and 16% between 2 and 4 years after diagnosis. For women aged 18 to 34 years, 52.4% reported late menses recovery between 2 and 4 years after diagnosis. Persistent CRA was associated with worse insomnia (P = .004), systemic therapy-related adverse effects (P = .04) and worse sexual functioning (P < .001) at 4 years after diagnosis.

“Risk and duration of CRA, including potential late resumption of menses and its downstream implications for quality of life, should be approached using a coordinated biopsychosocial model addressing multiple dimensions of physical, psychological and social health,” the researchers wrote. “Proactive management of premenopausal women with early breast cancer undergoing chemotherapy should also include adapted strategies for risk communication, as well as personalized counseling and early supportive care referrals.”