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Updated: Feb 18, 2026
Stereotactic Radiosurgery for Gynecologic Cancer
Published on: April 17, 2012
Improving Treatment of Radiation-Induced Premature Ovarian Insufficiency After Cervical Cancer: A Practice Quality
Emily E Smith1, Jonathan R Heintz2, Arina Chesnokova3
1Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania.
Purpose:
Curative-intent pelvic radiation for cervical cancer causes premature ovarian insufficiency (POI) in premenopausal patients. Despite evidence-based recommendations for hormone replacement therapy (HRT) to treat POI, prior studies have shown low HRT use among cervical cancer survivors, particularly those treated with radiation. This study evaluates the impact of practice quality improvement (PQI) initiative within a radiation oncology department on the rates of HRT prescriptions, POI documentation, and counseling.
Methods And Materials:
A retrospective chart review was conducted to identify premenopausal patients aged ≤50 years who received curative-intent radiation for cervical cancer at a single institution from 2018 to 2024. Rates of POI-related counseling and HRT prescriptions were evaluated before and after a PQI intervention targeting POI treatment. HRT prescriptions were stratified by physiological sex steroid replacement regimens (PSSRR), defined as ≥0.1 mg/d transdermal or ≥2 mg oral 17β-estradiol, versus other regimens, including oral contraceptives and nonreplacement doses of PSSRR. Binary outcomes were analyzed using generalized estimating equations.
Results:
Sixty patients met the inclusion criteria. Patients seen after PQI intervention implementation had 2.1 times higher odds of receiving any HRT prescription, PSSRR, or non-PSSRR, than patients seen before PQI intervention implementation (OR = 2.09; P = .015). PSSRR prescriptions increased from 3.4% preintervention to 57.7% postintervention, with 80.7% of patients seen by an advanced practice provider receiving PSSRR. POI documentation increased from 48.3% to 80.8%, and inclusion on the problem list increased from 6.9% to 34.6%. High-quality POI counseling improved from 6.9% to 44.2%, and high-quality HRT counseling improved from 0.0% to 46.2%.
Conclusion:
The radiation oncology department-based PQI initiative significantly improved documentation, counseling, and PSSRR prescriptions for cervical cancer survivors.
