TREATMENT POSSIBILITIES OF MENOPAUSAL SYMPTOMS IN BREAST CANCER PATIENTS
Keywords:
breast cancer, menopausal symptoms, treatmentAbstract
Background. Breast cancer is the most common cancer in women. Menopausal symptoms, which can highly reduce quality of life in women of all ages, are frequent side-effects of systemic treatment of early breast cancer whether treated by hormonal or cytotoxic therapy.
Methods. The article presents literature review of the causes, assessment and management of menopausal symptoms in breast cancer patients.
Results. There are a number of non-hormonal drugs effective in treating vasomotor symptoms, and same alternative therapies, such as black cohosh, phytoestrogens, homeopathy, acupuncture, yoga and behaviour strategies. The decision, whether and which pharmacologic or non-pharmacologic treatment to choose, depends on symptoms and on patient wishes. The most effective drugs for reducing hot flashes are venlafaxine, paroxetine and gabapentin, unfortunately, the side effects are common. Vaginal estrogens are the most effective for treating atrophic vaginitis, but the safety in breast cancer patients is not established.
Conclusions. Menopausal symptoms after breast cancer are severe and frequent and significantly reduce quality of life. Unfortunately, the possibility of treatment is limited.
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References
Incidenca raka v Sloveniji 2006. Ljubljana: Onkološki inštitut,
Register raka za Slovenijo; 2009.
Fellowes D, Fallowfield LJ, Saunders CM, Houghton J. Tolerability
of hormone therapies for breast cancer: how informative
are documented symptom profiles in medical notes for »welltolerated«
treatment? Breast cancer Res Treat 2001; 66: 73–81.
Barron TI, Connolly R, Bennett K Feely J, Kennedy MJ. Early
discontinuation of tamoxifen: a lesson for oncologists. Cancer
; 109: 832–9.
Lie Fong S, Lugtenburg PJ, Schipper I, Themmen AP, de Jong FH,
Sonneveld P, et al. Anti-müllerian hormone as a marker of ovarian
function in women after chemotherapy and radiotherapy for
haematological malignancies. Hum Reprod 2008; 23: 674–8.
Howell A, Cuzick J, Baum M, Buzdar A, Dowsett M, Forbes JF, et
al. Results of ATAC (Arimidex, Tamoxifen, Alone or Combination)
trial after completion of 5 years’ adjuvant treatment for breast
cancer. Lancet 2005; 365: 60–2.
Cella D, Fallowfield LJ. Recognition and management of tretmentrelated
side effects for breast cancer patients receiving adjuvant
endocrine therapy. Breast cancer Res Treat 2008; 107: 167–80.
Burwell SR, Case LD, Kaelin C, Avis NE. Sexual problems in
younger women after breast cancer surgery. J Clin Oncol 2006;
: 2815–21.
Hickey M, Saunders CM, Stuckey BG. Management of menopausal
symptoms in patients with breast cancer: an evidencebased
approach. Lancet Oncol 2005; 6: 687–95.
Greene J. Constructing a standard climacteric scale. Maturitas
; 29: 25–31.
MacLennan A, Lester S, Moore V. Oral oestrogen and combined
oestrogen/progestogen therapy versus placebo for hot flusches.
Cohrane Database Syst Rev 2004: CD002978
Holmberg L, Anderson H. Habits steering data monitoring committees.
HABITS (hormonal replacement therapy after breast
cancer – is it safe?), a randomised comparison: trial stopped.
Lancet 2004; 363: 453–5.
Holmberg L, Iversen OE, Rudenstam CM, Hammar M, Kumpulainen
E, Jaskiewicz J et al; HABITS Study Group. Increased risk of
recurrence after hormone raplacement therapy in breast cancer
survivors. J Natl Cancer Inst. 2008; 100: 475–82.
Kenemans P, Bundrel NJ, Foidart JM, Kubista E, Von Schoultz B,
Sismondi P et al. Safety and efficacy of tibolone in breast-cancer
patients with vasomotor symptoms: a double-blind, randomised,
non-inferiority trial. Lancet Oncol 2009; 10: 135–46.
Baum MBA, Cuzick J, Forber, Houghton J, Howell A, Sahmound
T et al. Anastrazole alone or in combination with tamoxifen
versus tamoxifen alone for adjuvant treatment of postmenopausal
women with early-stage breast cancer: results of the ATAC
(Arimidex, Tamoxifen, Alone or Combination) trial efficacy and
safty update analyses. Cancer 2003; 98: 1802–10.
Fallowfield L, Cella D, Cuzick J, Francis S, Locker G, Howell A.
Quality of life of postmenopausal women in the Arimidex, Tamoxifen,
Alone or Combination (ATAC) adjuvant breast cancer
trial. J Clin Oncol 2004; 22: 4261–71.
Nelson HD, Vesco KK, Haney E, Fu R, Nedrow A, Miller J et al.
Nonhormonal therapies for menopausal hot flashes: systemic
review and meta-analasys. JAMA 2006; 395: 2057–71.
Rapkin AJ. Vasomotor symptoms in menopause: psyhologic
condition and central nervous system approaches to treatment.
Am J Obstet Gynecol 2007; 196: 97–106.
Loprinzi CL, Sloan JA, Perez EA, Quella SK, Stella Pj, Mailliard
Ja et al. Phase III evaluation of fluoxetine for treatment of hot
flashes. J Clin Oncol 2002; 20: 1578–83.
Suvanto-Lukkonen E, Koivuner R, Sundstrom H, Bloigu R, Karjalainen
E, Häivä-Mällinen L, et al. Citalopram and fluoxetine
in treatment of postmenopausal symptoms: a prospecitive
randomized, 9-month, placebo-controlled, double-blind study.
Menopause 2005; 12: 18–26.
Gordon PR, Kerwin JP, Boesen KG, Senf J. Sertraline to treat hot
flashes: a randomized controlled, double-blind, crossover trial
in a general population. Menopause 2006; 13: 568–75.
Grady D, Cohen B, Tice J, et al. Ineffectiveness of sertraline for
treatment of menopausal hot flushes: a randomized controlled
trial. Obstet Gynecol 2007; 109: 823–30.
Stearns V, Beebe KL, Iyengar M, Dube E. Paroxetine controlled
release in the treatment of menopausal hot flashes: a randomized
controlled trial. JAMA 2003; 289: 2827–34.
Loprinzi CL, Kugler JW, Sloan JA, et al. Venlafaxine in management
of hot flashes in survivors of breast cancer: a randomised
controlled trial. Lancet 2000; 356: 2059–63.
Stearns V. Clinical update: new treatments for hot flushes. Lancet
; 369: 2062–4.
Toulis KA, Tzellos T, Kouvelas D, Goulis DG. Gabapentin for the
treatment of hot flashes in women with natural or tamoxifeninduced
menopause: a systemic review and meta-analysis. Clin
Ther 2009; 31: 221–35.
Brown JN, Wright BR. Use of gabapentin in patients experiencing
hot flashes. Pharmacotherapy 2009; 29:74–81.
Kronenberg F, Fugh-Berman A. Complementary and alternative
medicine for menopausal symptoms: a review of randomized,
controlled trials. Ann Intern Med 2002; 137: 805–13.
Antoine C, Liebens F, Carly B, Pastijn A, Rozenberg S. Safety of
alternative treatments for menopausal symptoms after breast
cancer: a qualitative systematic review. Climacteric 2007; 10:
–6.
Newton KM, Reed SD, LaCroix AZ, Grothaus LC, Ehrlich K, Guiltinan
J. Treatment of vasomotor symptoms of menopause with
black cohosh, multibotanicals, soy, hormone therapy, or placebo:
a randomized trial. Ann Intern Med 2006; 145: 869–79.
Palacio C, Masri G, Mooradian AD. Black cohosh for the management
of menopausal symptoms: a systematic review of clinical
trials. Drugs Aging. 2009; 26: 23–36.
Jacobs J, Herman P, Herok K, Olsen S, Vaughter L. Homeopathy
for menopausal symptoms in breast cancer survivors: a preliminary
randomized trial. J Alter Complement Med 2005; 11:
–7.
Thompson EA, Relton C. Designing clinical trials of homeopathy
for menopausal symptoms: a review of the literature. Menopause
Int 2009; 15: 31–4.
Huang MI, Nir Y, Chen B, Schnyer R, Manber R. A randomized
controlled pilot study of acupuncture for postmenopausal hot
flashes: effect on nocturnal hot flashes and sleep quality. Fertil
Steril 2006; 86: 700–10.
Vincent A, Barton DL, Mandrekar JN, Cha SS, Zais T, WahnerRoedler
DL et al. Acupuncture for hot flashes: a randomized,
sham-controlled clinical study. Menopause 2006; 14: 45–52.
Deng G, Vickers A, Yeung S, Cassileth B. Randomized, controlled
trial of acupuncture for the treatment of hot flashes in breast
cancer patients. J Clin Oncol 2007; 25: 5584–90.
Carson JW, Carson KM, Porter LS, Keefe FJ, Seewald VL. Yoga of
Awareness program for menopausal symptoms in breast cancer
survivors: results from randomized trial. Support Care Cancer.
V tisku 2009.
Kendall A, Dowsett M, Folkerd E, Smith I. Caution: vaginal estradiol
appears to be contraindicated in postmenopausal women
on adjuvant aromatase inhibitors. Ann Oncol 2006; 17: 584–7.
Derzko C, Elliott S, Lam W. Management of sexual dysfunktion
in postmenopausal breast cancer patients taking adjuvant aromatase
inhibitor therapy. Curr Oncol 2007; 14: 20–40.
Hickey M, Saunders C, Partridge A, Santoro N, Joffe H, Stearns
V. Practical clinical guidelines for assessing and managing
menopausal symptoms after breast cancer. Ann Oncol 2008;
: 1669–80.
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