Hormone replacement after radiotherapy for premenopausal patients with cervical cancer: a retrospective cohort study
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Katherine Gray1, Kathryn McRae2, Iwa Kong3
1Department of Obstetrics & Gynaecology, University of British Columbia, Vancouver, Canada.
Objective:
Radiotherapy is integral to cervical cancer management, but can cause iatrogenic premature ovarian insufficiency (POI) or early menopause, leading to vasomotor symptoms, sexual dysfunction, mood changes, and long-term health risks. Systemic menopausal hormone therapy (MHT) is recommended to mitigate these effects in women with POI. Its role is physiologic hormone replacement, termed menopausal replacement therapy (MRT). This study assessed systemic MHT use and prescribing patterns in premenopausal patients treated with radiotherapy for cervical cancer in British Columbia.
Methods:
We conducted a retrospective cohort study of women aged 18-45 years, diagnosed with cervical cancer, and treated with curative intent primary or adjuvant radiotherapy between January 1 and December 31, 2022. Data was obtained from the BC Cancer Registry and extracted through chart review. Descriptive statistics and Fisher's exact test were used for analysis.
Results:
Fifty-one patients met inclusion criteria (median age 38 years). Most received primary chemoradiotherapy (86.3%), while 13.7% received adjuvant radiotherapy. Overall, 74.5% (n = 38/51) were prescribed MHT after treatment. The proportion of patients receiving MHT was higher among those treated with adjuvant radiotherapy compared to those who received primary chemoradiotherapy (85.7% vs. 72.7%, P = 0.66). Median time to first MHT prescription was 3.47 months after completing radiotherapy (range 2 weeks-2 years). All MHT prescriptions were provided following completion of radiotherapy. Among those prescribed MHT, 63.2% required dose escalation, 78.9% had formulation changes, 18.4% had dose reductions, and 18.4% discontinued therapy.
Conclusions:
Three quarters of patients were prescribed MHT. Initiation was delayed until after radiotherapy completion. Frequent dose and formulation adjustments highlight the complexity of survivorship care and the need for standardized counseling and management pathways to improve quality of life.