Hormone replacement therapy in gynecological cancer survivors and BRCA mutation carriers: a MITO group survey

Innocenza Palaia; Giuseppe Caruso; Violante Di Donato; Camilla Turetta; Antonella Savarese; Giorgia Perniola; Roberta Gallo; Andrea Giannini; Vanda Salutari; Giorgio Bogani; Federica Tomao; Diana Giannarelli; Gabriella Gentile; Angela Musella; Ludovico Muzii; Sandro Pignata; MITO group

doi:10.3802/jgo.2024.35.e70

Hormone replacement therapy in gynecological cancer survivors and BRCA mutation carriers: a MITO group survey

J Gynecol Oncol. 2024 May;35(3):e70. doi: 10.3802/jgo.2024.35.e70. Epub 2024 Mar 4.

Authors

Innocenza Palaia¹, Giuseppe Caruso², Violante Di Donato¹, Camilla Turetta¹, Antonella Savarese³, Giorgia Perniola¹, Roberta Gallo¹, Andrea Giannini¹, Vanda Salutari⁴, Giorgio Bogani¹, Federica Tomao¹, Diana Giannarelli⁵, Gabriella Gentile¹, Angela Musella¹, Ludovico Muzii¹, Sandro Pignata⁶; MITO group

Affiliations

¹ Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Rome, Italy.
² Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Rome, Italy. g.caruso@uniroma1.it.
³ Department of Oncology, Regina Elena National Cancer Institute, Rome, Italy.
⁴ Division of Gynecologic Oncology, Department of Women and Child Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica, Rome, Italy.
⁵ Biostatistic Unit, Regina Elena National Cancer Institute, Rome, Italy.
⁶ Department of Urology and Gynecology, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Naples, Italy.

Abstract

Objective: Early iatrogenic menopause in gynecological cancer survivors and BRCA mutation (BRCAm) carriers undergoing risk-reducing salpingo-oophorectomy (RRSO) is a major health concern. Hormone replacement therapy (HRT) is the most effective remedy, but remains underused in clinical practice. The Multicenter Italian Trials in Ovarian cancer and gynecologic malignancies (MITO) group promoted a national survey to investigate the knowledge and attitudes of healthcare professionals regarding the prescription of HRT.

Methods: The survey consisted of a self-administered, multiple-choice 45-item questionnaire, available online to all MITO members for 2 months starting from January 2022.

Results: A total of 61 participants completed the questionnaire (47 out of 180 MITO centers; compliance: 26.1%). Most respondents were female (73.8%), younger than 50 years (65.6%), and gynecologic oncologists (55.7%), working in public general hospitals (49.2%). An 84.4% of specialists actively discuss HRT with patients and 51.0% of patients ask the specialist for an opinion on HRT. The rate of specialists globally in favor of prescribing HRT was 22.9% for ovarian cancer, 49.1% for cervical cancer, and 8.2% for endometrial cancer patients. Most respondents (70.5%) believe HRT is safe for BRCA-mutated patients after RRSO. Nearly 70% of physicians prescribe systemic HRT, while 23.8% prefer local HRT. Most specialists recommend HRT for as long as there is a benefit and generally for up to 5 years.

Conclusion: Real-world data suggest that many healthcare professionals still do not easily prescribe HRT for gynecological cancer survivors and BRCA mutation carriers after RRSO. Further efforts are required to implement the use of HRT in clinical practice and to support both clinicians in recommending HRT and patients in accepting it.

Keywords: Hormone Replacement Therapy; Menopause; Ovarian Neoplasms; Surgery; Survivors; Uterine Neoplasms.

MeSH terms

Adult
Aged
Cancer Survivors* / statistics & numerical data
Female
Genes, BRCA1
Genes, BRCA2
Genital Neoplasms, Female* / genetics
Health Knowledge, Attitudes, Practice
Heterozygote
Hormone Replacement Therapy*
Humans
Italy
Middle Aged
Mutation
Ovarian Neoplasms / drug therapy
Ovarian Neoplasms / genetics
Practice Patterns, Physicians' / statistics & numerical data
Salpingo-oophorectomy
Surveys and Questionnaires