Chemotherapy-induced amenorrhea, menopause-specific quality of life, and endocrine profiles in premenopausal women with breast cancer who received adjuvant anthracycline-based chemotherapy: a prospective cohort study

Yoo, Changhoon; Yun, Mi Ra; Ahn, Jin Hee; Jung, Kyung Hae; Kim, Hwa Jung; Kim, Jeong Eun; Park, Jeong-Yun; Park, Kwang Ok; Yoon, Dok Hyun; Kim, Sung‐Bae

doi:10.1007/s00280-013-2227-5

Cited by 30 publications

(24 citation statements)

References 28 publications

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“…However, younger patients were found to be resistant to CIA because they have a larger primordial follicle pool (Oktem & Oktay 2007). In studies of ovarian function after chemotherapy without docetaxel, the decrease in serum estradiol concentrations and increase in FSH levels showed greater variations than our observations (Yoo et al 2013; Yu et al 2010). …”

Section: Discussioncontrasting

confidence: 82%

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Changes in ovarian function in premenopausal women with breast cancer undergoing adjuvant TC (docetaxel and cyclophosphamide) chemotherapy during a brief period of amenorrhea around the last chemotherapy cycle

Yoshimura

Furuya

2014

SpringerPlus

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PurposeDocetaxel, a chemotherapeutic agent, induces high rates of transient chemotherapy-induced amenorrhea (CIA) when used as adjuvant chemotherapy for premenopausal women with breast cancer. Clinical laboratory data to assess the hormonal environment implicated in inducing transient CIA was assessed.MethodsAn observational study was conducted in 35 premenopausal women with hormone-responsive breast cancer who were receiving adjuvant docetaxel/cyclophosphamide (TC) chemotherapy. Serum estradiol and follicular stimulating hormone (FSH) levels were measured at one (n = 6) or two (n = 29) time point(s) around the completion of chemotherapy.ResultsAs early as week 6 after the start of chemotherapy, just before the third TC cycle, serum estradiol levels were invariably suppressed (median of 5.5 pg/ml, n = 15, range <5–18.7 pg/ml) and FSH levels increased (median of 63.9 mIU/ml, range 24.5–127.4 mIU/ml), indicative of ovarian suppression to the menopausal levels. Subsequently, at 9 and 12 weeks, serum estradiol levels were suppressed to a median of 6.6 pg/ml (n = 49, range <5–17.3 pg/ml), while FSH levels were high (median of 66.8 mIU/ml, range 29.2–134.5 mIU/ml). There was a significant Spearman’s correlation (ρ = 0.95, n = 29, p < 0.01) of high serum FSH levels (24.5–134.5 mIU/ml) between two time points of repeated measurements in 29 patients. TC chemotherapy induced rapid ovarian suppression with the formation of a high and stable plateau in serum FSH levels from week 6 to week 12.ConclusionsRecovery from transient CIA post-therapy may be partially attributed to high, stable FSH levels that occurred as early as after completion of the second TC chemotherapy cycle.

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Section: Discussioncontrasting

confidence: 82%

“…Amenorrhea was shown to be transient, lasting for 3 (Parulekar et al 2005; Yoo et al 2013) or 6 months (Swain & Land 2009; Park et al 2012; Swain et al 2010a; Swain et al 2010b), or persistent. Onset of amenorrhea occurred anywhere from soon after chemotherapy completion to up to 24 months of follow-up.…”

Section: Introductionmentioning

confidence: 99%

Changes in ovarian function in premenopausal women with breast cancer undergoing adjuvant TC (docetaxel and cyclophosphamide) chemotherapy during a brief period of amenorrhea around the last chemotherapy cycle

Yoshimura

Furuya

2014

SpringerPlus

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“…In premenopausal breast cancer patients who have received chemotherapy, endocrine changes may affect fertility and menstrual status, which in turn may have a detrimental effect on QoL [26][27][28]. The decrease in estrogen secondary to ovarian failure is marked by a series of vasomotor symptoms including night sweats and hot flashes along with other symptoms such as vaginal dryness, dyspareunia and weight changes [28]. When compared to women who had undergone natural menopause, breast cancer patients who developed menopause following anti-cancer treatment have reported more severe menopausal symptoms [28].…”

Section: Discussionmentioning

confidence: 99%

Menopausal symptoms in relationship to breast cancer-specific quality of life after adjuvant cytotoxic treatment in young breast cancer survivors

Park

Pang

Liem

et al. 2020

Health Qual Life Outcomes

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Introductions: For young premenopausal breast cancer patients, adjuvant chemotherapy may cause menstrual disruptions and premature menopause, which may in turn impair their quality of life (QoL). In this study among young breast cancer survivors who have undergone adjuvant chemotherapy, the objectives were to assess posttreatment menopausal symptoms and their associated factors, and to correlate these symptoms with breast cancerspecific QoL.Methods: The study population included premenopausal young Chinese women with early-stage breast cancer who had undergone adjuvant chemotherapy between 3 and 10 years prior to enrolling into this study. At study entry, patients' characteristics and clinical features were collected; each patient had detail menstrual history collected and each filled in MENQOL and FACT-B + 4 questionnaires.Results: Two hundred eighty eligible patients were recruited. For adjuvant chemotherapy, 92% received anthracyclines and 28% received taxanes; 76% received adjuvant tamoxifen. At a median of 5.0 years from initial cancer diagnosis, 49 and 11% had become post-and peri-menopausal respectively. MENQOL at study entry revealed that physical domain score was worse in overweight/obese patients (mean scores for underweight/normal vs overweight/obese: 2.65 vs 2.97, p = 0.0162). Vasomotor domain score was worse in those who received taxanes or tamoxifen (taxane vs non-taxane: 2.91 vs. 2.35, p = 0.0140; tamoxifen vs no tamoxifen: 2.75 vs. 2.34, p = 0.0479). Sexual domain score was worse among those who had become peri/post-menopausal (peri/postmenopausal vs premenopausal: 2.82 vs. 2.29, p = 0.0229). On the other hand, patients who utilized traditional Chinese medicine had significantly worse scores for vasomotor, psychosocial and physical domains. Further, there was a significant association between MENQOL scores and FACT-B + 4 scores; less severe symptoms in the MENQOL domains were associated with better QoL scores in FACT-B + 4 physical, functional, psychosocial and emotional well-being, Breast Cancer Subscale, Arm Subscale and FACT-B total score.

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“…Physiologic changes in menopause, including chemotherapy-induced, surgical, and natural, primarily focus on the withdrawal and gradual depletion of estradiol (Hale and Burger 2009 ;Yoo et al 2013 ). As the follicles become depleted, antimullerian hormone decreases and follicle stimulating hormone concentrations rise resultant from decreases in estradiol (Hunter and Rendall 2007 ;Harlow et al 2013 ).…”

Section: Menopause: More Than Estrogenmentioning

confidence: 95%

Symptoms: Menopause, Infertility, and Sexual Health

Barton

Ganz

2015

Improving Outcomes for Breast Cancer Survivors

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By 2022, the number of survivors is expected to grow to nearly 18 million. Therefore, addressing acute and chronic negative sequelae of a cancer diagnosis and its treatments becomes a health imperative. For women with a history of breast cancer, one of the common goals of treatment and prevention of recurrence is to reduce circulating concentrations of estradiol, especially in women with hormone receptor positive breast cancer. Hormone deprivation after a diagnosis of breast cancer impacts physiological targets other than in the breast tissue and can result in unwanted side effects, all of which can negatively impact quality of life and function and cause distress. Symptoms that are most strongly linked by evidence to hormone changes after cancer diagnosis and treatment include hot flashes, night sweats, sleep changes, fatigue, mood changes, and diminishing sexual function, including vaginal atrophy (decreased arousal, dryness and dyspareunia), infertility, decreased desire and negative self-image. Weight gain and resulting body image changes are often concomitants of the abrupt onset of treatment-induced menopause. The purpose of this chapter is to briefly review what is known about the advent of premature menopause in women treated for breast cancer, menopausal symptoms that are exacerbated by endocrine treatments for breast cancer, and the associated concerns of hot flashes and related menopausal symptoms, sexual health and fertility issues. We will discuss limitations in the current research and propose strategies that address current limitations in order to move the science forward.

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Chemotherapy-induced amenorrhea, menopause-specific quality of life, and endocrine profiles in premenopausal women with breast cancer who received adjuvant anthracycline-based chemotherapy: a prospective cohort study

Abstract: This study showed that most premenopausal breast cancer patients who received adjuvant chemotherapy experienced clinically significant CIA, followed by impaired MENQOL. Our findings may be relevant in the decision-making processes for premenopausal women with breast cancer.

Cited by 30 publications

References 28 publications

Changes in ovarian function in premenopausal women with breast cancer undergoing adjuvant TC (docetaxel and cyclophosphamide) chemotherapy during a brief period of amenorrhea around the last chemotherapy cycle

Changes in ovarian function in premenopausal women with breast cancer undergoing adjuvant TC (docetaxel and cyclophosphamide) chemotherapy during a brief period of amenorrhea around the last chemotherapy cycle

Menopausal symptoms in relationship to breast cancer-specific quality of life after adjuvant cytotoxic treatment in young breast cancer survivors

Symptoms: Menopause, Infertility, and Sexual Health

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