A Clinical Guide to the Management of Genitourinary Symptoms in Breast Cancer Survivors on Endocrine Therapy

Overview

Journal Ther Adv Med Oncol

Specialty Oncology

Date 2017 May 12

PMID 28491147

Citations 20

Authors

Mariana S Sousa

Michelle Peate

Sherin Jarvis

Martha Hickey

Michael Friedlander

Affiliations

Soon will be listed here.

Abstract

There is increasing attention and concern about managing the adverse effects of adjuvant endocrine therapy for women with early breast cancer as the side effects of therapy influence compliance and can impair quality of life (QoL). Most side effects associated with tamoxifen (TAM) and aromatase inhibitors (AIs) are directly related to estrogen deprivation, and the symptoms are similar to those experienced during natural menopause but appear to be more severe than that seen in the general population. Prolonged estrogen deprivation may lead to atrophy of the vulva, vagina, lower urinary tract and supporting pelvic structures, resulting in a range of genitourinary symptoms that can in turn lead to pain, discomfort, impairment of sexual function and negatively impact on multiple domains of QoL. The genitourinary side effects may be prevented, reduced and managed in most cases but this requires early recognition and appropriate treatment. We provide an overview of practical clinical approaches to understanding the pathophysiology and the management of genitourinary symptoms in postmenopausal women receiving adjuvant endocrine therapy for breast cancer.

Citing Articles

Beyond cancer treatment: dermo-aesthetic and other wellness recommendations for breast cancer patients.

Falcon Gonzalez A, Gallegos Sancho M, Gonzalez Flores E, Galve Calvo E, Ruiz Vozmediano J, Domingo Garcia P Clin Transl Oncol. 2024; .

PMID: 39210207 DOI: 10.1007/s12094-024-03636-9.

Vaginal CO laser therapy for genitourinary syndrome in breast cancer survivors-VagLaser study protocol: a randomized blinded, placebo-controlled trial.

Jacobsen S, Glavind-Kristensen M, Jensen A, Forman A, Bor P BMC Cancer. 2023; 23(1):1164.

PMID: 38031020 PMC: 10685468. DOI: 10.1186/s12885-023-11656-x.

Vaginal Laser Treatment for the Genitourinary Syndrome of Menopause in Breast Cancer Survivors: A Narrative Review.

Okui N Cureus. 2023; 15(9):e45495.

PMID: 37731685 PMC: 10508706. DOI: 10.7759/cureus.45495.

Emerging Use of Vaginal Laser to Treat Genitourinary Syndrome of Menopause for Breast Cancer Survivors: A Review.

Jugulyte N, Zukiene G, Bartkeviciene D Medicina (Kaunas). 2023; 59(1).

PMID: 36676756 PMC: 9860929. DOI: 10.3390/medicina59010132.

Quality of Life and Sexual Satisfaction in Women with Breast Cancer Undergoing a Surgical Treatment and in Their Male Partners.

Martins R, Otero P, Torres A, Vazquez F J Clin Med. 2022; 11(23).

PMID: 36498539 PMC: 9739064. DOI: 10.3390/jcm11236960.

References

Loibl S, Lintermans A, Dieudonne A, Neven P . Management of menopausal symptoms in breast cancer patients. Maturitas. 2010; 68(2):148-54. DOI: 10.1016/j.maturitas.2010.11.013. View

Burgio K . Current perspectives on management of urgency using bladder and behavioral training. J Am Acad Nurse Pract. 2004; 16(10 Suppl):4-7. View

. Management of symptomatic vulvovaginal atrophy: 2013 position statement of The North American Menopause Society. Menopause. 2013; 20(9):888-902. DOI: 10.1097/GME.0b013e3182a122c2. View

Greenlee H, Balneaves L, Carlson L, Cohen M, Deng G, Hershman D . Clinical practice guidelines on the use of integrative therapies as supportive care in patients treated for breast cancer. J Natl Cancer Inst Monogr. 2015; 2014(50):346-58. PMC: 4411539. DOI: 10.1093/jncimonographs/lgu041. View

Vincent A . Management of menopause in women with breast cancer. Climacteric. 2014; 18(5):690-701. DOI: 10.3109/13697137.2014.996749. View

Wardell S, Nelson E, McDonnell D . From empirical to mechanism-based discovery of clinically useful Selective Estrogen Receptor Modulators (SERMs). Steroids. 2014; 90:30-8. PMC: 4192009. DOI: 10.1016/j.steroids.2014.07.013. View

Ganz P, Rowland J, Desmond K, Meyerowitz B, Wyatt G . Life after breast cancer: understanding women's health-related quality of life and sexual functioning. J Clin Oncol. 1998; 16(2):501-14. DOI: 10.1200/JCO.1998.16.2.501. View

Lipp A, Shaw C, Glavind K . Mechanical devices for urinary incontinence in women. Cochrane Database Syst Rev. 2014; (12):CD001756. PMC: 7061494. DOI: 10.1002/14651858.CD001756.pub6. View

Mariappan P, Alhasso A, Ballantyne Z, Grant A, Ndow J . Duloxetine, a serotonin and noradrenaline reuptake inhibitor (SNRI) for the treatment of stress urinary incontinence: a systematic review. Eur Urol. 2006; 51(1):67-74. DOI: 10.1016/j.eururo.2006.08.041. View

10.

Portman D, Palacios S, Nappi R, Mueck A . Ospemifene, a non-oestrogen selective oestrogen receptor modulator for the treatment of vaginal dryness associated with postmenopausal vulvar and vaginal atrophy: a randomised, placebo-controlled, phase III trial. Maturitas. 2014; 78(2):91-8. DOI: 10.1016/j.maturitas.2014.02.015. View

11.

Salvatore S, Nappi R, Zerbinati N, Calligaro A, Ferrero S, Origoni M . A 12-week treatment with fractional CO2 laser for vulvovaginal atrophy: a pilot study. Climacteric. 2014; 17(4):363-9. DOI: 10.3109/13697137.2014.899347. View

12.

Kelley C . Estrogen and its effect on vaginal atrophy in post-menopausal women. Urol Nurs. 2007; 27(1):40-5. View

13.

Salvatore S, Nappi R, Parma M, Chionna R, Lagona F, Zerbinati N . Sexual function after fractional microablative CO₂ laser in women with vulvovaginal atrophy. Climacteric. 2014; 18(2):219-25. DOI: 10.3109/13697137.2014.975197. View

14.

Burstein H, Temin S, Anderson H, Buchholz T, Davidson N, Gelmon K . Adjuvant endocrine therapy for women with hormone receptor-positive breast cancer: american society of clinical oncology clinical practice guideline focused update. J Clin Oncol. 2014; 32(21):2255-69. PMC: 4876310. DOI: 10.1200/JCO.2013.54.2258. View

15.

Abban G, Yildirim N, Jetten A . Regulation of the vitamin D receptor and cornifin beta expression in vaginal epithelium of the rats through vitamin D3. Eur J Histochem. 2008; 52(2):107-14. DOI: 10.4081/1200. View

16.

Spina E, Trifiro G, Caraci F . Clinically significant drug interactions with newer antidepressants. CNS Drugs. 2011; 26(1):39-67. DOI: 10.2165/11594710-000000000-00000. View

17.

Herbison G, Dean N . Weighted vaginal cones for urinary incontinence. Cochrane Database Syst Rev. 2013; (7):CD002114. PMC: 7086390. DOI: 10.1002/14651858.CD002114.pub2. View

18.

Chin S, Trinkaus M, Simmons C, Flynn C, Dranitsaris G, Bolivar R . Prevalence and severity of urogenital symptoms in postmenopausal women receiving endocrine therapy for breast cancer. Clin Breast Cancer. 2009; 9(2):108-17. DOI: 10.3816/CBC.2009.n.020. View

19.

Lester J, Bernhard L . Urogenital atrophy in breast cancer survivors. Oncol Nurs Forum. 2009; 36(6):693-8. DOI: 10.1188/09.ONF.693-698. View

20.

Lammerink E, de Bock G, Schroder C, Mourits M . The management of menopausal symptoms in breast cancer survivors: case-based approach. Maturitas. 2012; 73(3):265-8. DOI: 10.1016/j.maturitas.2012.07.010. View