A joint specialist breast cancer and menopause symptoms (BCMS) clinic: Service development using a clinical governance approach

Tanna, Nuttan; Woyka, Jane; Abernathy, Kristen; Reichart, Rupert

doi:10.1016/j.ejso.2009.07.156

Cited by 3 publications

(5 citation statements)

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“…300 mg a day for two weeks, 300 mg twice daily for two weeks and finally 300 mg thrice daily after the first month. 7 If drowsiness is an issue during the day then the total dose may be administered at night. In all, 50% of patients report side-effects, but there is good evidence for vasomotor symptom control.…”

Section: Non-hormonal Treatments For Vasomotors Symptomsmentioning

confidence: 99%

“…Venlafaxine is less likely to interfere with tamoxifen metabolism than fluoxetine and therefore is more advantageous in breast cancer patients taking anti-estrogens, but can reduce libido. 7 Reports of suicide ideation have been exaggerated and do not occur at this dose. Nausea can be a side-effect, reduced by using long-acting formulation, as a once daily dose at night.…”

Section: Non-hormonal Treatments For Vasomotors Symptomsmentioning

confidence: 99%

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Alternative and complementary therapies for the menopause

Pitkin

2012

Menopause International

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Despite a re-evaluation of risks in recent years, hormone replacement therapy is still surrounded by controversy. Almost 30% of women in a recent survey sought a natural approach to combat climacteric symptoms. Nevertheless, a large proportion of patients felt that they wanted a good safety profile and strong evidence base for treatment. This article seeks to review the evidence supporting non-hormonal approaches to treatment. There is only conflicting evidence at best to support alpha-2 agonists, e.g. clonidine and limited evidence for dihydroepiandrosterone and natural progesterones. There is limited randomized controlled trial data for gabapentin, selective norepinephrine re-uptake inhibitors (SNRIs) and selective serotonin re-uptake inhibitors (SSRIs), many of these studies being related to breast cancer patients. Of the herbal medicinal products, the largest evidence base rests with phytoestrogens. A Cochrane Database review looking at all types of phytoestrogens, e.g. red clover extracts, dietary soya and soya extracts concluded that there was no evidence to support improvement in climacteric symptoms and the meta-analysis of a 178 studies on soy products was inconsistent. Nevertheless, other studies disagree. Mammographic density is not affected by soy or phytoestrogen products and recent in vitro work shows only a weakly proliferative effect of soy isoflavone on breast cancer cells and evidence that soy isoflavone blocks the proliferative effect of estradiol on these cells. There are no studies looking at clinical outcome measures for cardiovascular disease but a number of studies looking at biochemical markers including arterial wall stiffness and apolipo protein B. Recent studies have also looked at the effects of red clover isoflavone on mood and depression, using specific depression rating scales. Finally, it is important to note that herbal medicinal products should not be used without caution. Some may produce quite marked side-effects in high doses and others can interact with pre-existing medication. A strategy for which patients are suitable for herbal medicinal products is reviewed.

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Section: Non-hormonal Treatments For Vasomotors Symptomsmentioning

confidence: 99%

Section: Non-hormonal Treatments For Vasomotors Symptomsmentioning

confidence: 99%

Alternative and complementary therapies for the menopause

Pitkin

2012

Menopause International

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“…We identified a need for individualized support for breast cancer survivors due to an increase in GP referrals over 2007 to our weekly hospital menopause clinics for support for menopausal symptoms. We established a dedicated pilot breast cancer and menopause (BCMS) service, [23][24][25][26] and worked in close collaboration with our hospital's breast unit to ensure a high standard of safe NHS care delivery to our breast cancer patients. Referrals to the BCMS service initially came mainly from the hospital breast unit; but we are now getting referrals, more recently, directly from GPs.…”

Section: The Nw London Breast Cancer and Menopause Servicementioning

confidence: 99%

Exploring the breast cancer patient journey: do breast cancer survivors need menopause management support?

Tanna

Buijs

2011

Menopause International

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This research identifies a need for more information that is culturally sensitive on managing menopause symptoms, both as side-effects of breast cancer treatments as well as for affect on quality of life during the survivorship phase. Our work also gives insight into cultural remedies used for hot flushes by Asian patients, which they consider as 'cooling' foods. Breast cancer patients want to know whether side-effects of cancer treatment persist long term and how these can be managed. There is a need for improved patient support within any new NHS service models that are developed along breast cancer patient pathways, and inclusion of personalized advice for menopause symptoms.

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“…With close working between a specialist outpatient menopause service and the hospital's breast unit, a dedicated BCMS clinic was piloted in late 2006, with the service formally established by April 2007. [15][16][17][18] The menopause service is also supported by a pharmacist-led medication management clinic. 19,20 Patients are seen on the third Thursday of each month.…”

Section: Introductionmentioning

confidence: 99%

“…Referrals are for patients with either a personal or family history of breast cancer, seeking specialist menopause management advice. 15 The BCMS team engaged in action cycles of improvements [15][16][17][18] as the service was being developed. This included ensuring competency and optimizing patient management with multidisciplinary team (MDT) patient case discussions at the end of each clinic, close working with the breast team, development of BCMS patient history taking proformas, setting up of a BCMS database, Hospital Drugs and Therapeutics Committee ratified BCMS service prescribing guidance and patient satisfaction questionnaire surveys.…”

Section: Introductionmentioning

confidence: 99%