Adjuvant Hormone Therapy in Women with Ovarian Cancer

Adjuvant hormone therapy in ovarian cancer
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The majority of women become menopausal between the ages of 45 to 55. However, for some younger, pre-menopausal women, the ovarian cancer diagnosis brings treatments that ensure the start of menopause.

Menopausal symptoms can be significant and can impact quality of life for ovarian cancer survivors. Some of the more common and bothersome symptoms include hot flashes and vaginal atrophy (which causes vaginal dryness).

Menopause can also be associated with mood changes, anxiety, depression, and sleep disturbance.

A recent study investigated the use of adjuvant hormone therapy on survival in women with ovarian cancer, and the results of this study are surprising and encouraging.  I’ll get to that in a moment.

But first, some background…

Some History About Hormone Therapy for Menopause

Hormone replacement therapy became controversial in 2002 when the results of the NIH Women’s Health Initiative (WHI) study were first published. The WHI study found several adverse outcomes with the use of hormone replacement (either estrogen alone or an estrogen-progestin combination) in postmenopausal women, including higher rates of heart disease, stroke, blood clots, and breast cancer.

It’s that increased risk of breast cancer that worries lots of physicians – and patients, too.

The current recommendation of the U.S. Preventive Services Task Force, based on the WHI studies and others, is to avoid the use of hormone replacement therapy for the prevention of chronic conditions in postmenopausal women.

However, the recommendation does not apply to women who are considering hormone therapy for menopausal symptoms, nor does it apply to women younger than 50 who have had surgical menopause.

Most would agree that using short-term hormone replacement therapy (less than 5 years) to treat specific menopausal symptoms -- such as hot flashes and vaginal dryness -- is reasonable.[1, 2]

Adjuvant Hormone Therapy for Ovarian Cancer

The recent study published in the Journal of Clinical Oncology by Dr. Rosalind Eeles and her colleagues studied the use of hormone therapy in women with epithelial ovarian cancer.[3]  In this study, both premenopausal and postmenopausal women diagnosed with any stage of ovarian cancer were randomized to either adjuvant (meaning after surgery for ovarian cancer) hormone therapy for five years or no hormone therapy. Women with a history of hormone-dependent cancer (such as breast cancer) were excluded from the study. 

A total of 150 women were included in the study, 75 assigned to the hormone treatment arm and 75 assigned to the no hormone treatment arm. The groups were well balanced. About 77% in each group were postmenopausal, and 63% had advanced stage ovarian cancer (stages III and IV). The median age was 58 years old, but the range of ages was from 29 to 89.

Overall survival was improved in the women who received adjuvant hormone therapy. After 19 years of follow up, 91% of women in the no-hormone therapy group had died compared with 71% of the women in the hormone therapy group.

But Does it Increase Breast Cancer Risk?

What about the risk of developing breast cancer? In this study, there were just two cases of breast cancer in the hormone therapy group and one case of breast cancer in the group that received no hormone therapy. The authors note that of the three women who developed breast cancer, one of them had a previous family history of breast/ovarian cancer - and this woman was in the control group (she did not receive hormone therapy).

The Bottom Line

Many women with ovarian cancer -- especially younger women who have sudden, surgical menopause after ovarian cancer surgery -- will have menopausal symptoms that affect their daily lives and may decrease quality of life.

In my opinion, this study by Dr. Eeles and colleagues is reassuring to oncologists who wish to be able to relieve the suffering of women with ovarian cancer who are struggling with menopausal symptoms. It seems that using hormone therapy in this group of women (specifically, women with ovarian cancer who do not have an increased risk for breast cancer) may be perfectly safe. And, it may even be beneficial. 

References:

1  Moyer VA, U.S. Preventative Services Task Force. Menopausal hormone therapy for the primary prevention of chronic conditions: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2013 Jan 1;158(1):47-54.

2  Rossouw JE, Manson JE, Kaunitz AM, Anderson GL. Lessons learned from the Women's Health Initiative trials of menopausal hormone therapy. Obstet Gynecol. 2013 Jan;121(1):172-6.

3  Eeles RA, et al. Adjuvant Hormone Therapy May Improve Survival in Epithelial Ovarian Cancer: Results of the AHT Randomized Trial. J Clin Oncol. 2015 Sep 28. [Epub ahead of print]

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