Impact of pre-treatment counseling on uptake of hormone replacement therapy in patients undergoing chemoradiation for cervical cancer.

Abstract

5519 Background: Chemoradiation therapy (CRT) for cervical cancer can lead to premature ovarian insufficiency (POI) in premenopausal women, accelerating the onset of menopause and its related symptoms, and adversely affecting sexual health. This study aimed to assess the impact of pre-CRT counseling on the initiation of hormone replacement therapy (HRT) in patients with cervical cancer, and to describe common practice patterns in the management CRT-related side effects. Methods: This retrospective cohort study included patients treated for cervical cancer at four New York City hospitals (one public and three private) from 2010 to 2024. Patients were included if they underwent CRT as first-line treatment and were premenopausal before treatment initiation. Data were extracted from medical records including demographics, pretreatment counseling, CRT side effects, and HRT use. Descriptive statistics and chi-square were used for analysis, with p<0.05 as significant. Results: Of the 2,009 patients identified with a history of cervical cancer at our institutions, 81 premenopausal patients who underwent CRT were included, with a median age of 41.9 years at diagnosis. Prior to CRT, 69.1% of patients (n=56/81) were counseled on potential vaginal toxicity (e.g., stenosis/shortening), 63% (n=51/81) on the risk of POI, and 11.3% (n=9/81) on CRT’s impacts on sexual health. Following treatment, 46.9% of patients (n=38/81) experienced menopausal symptoms, including vasomotor symptoms (84.2%, 32/38), vaginal dryness (36.8%, 14/38), and mood alternations (18.4%, 7/38). Among symptomatic patients, 55.3% (n=21/38) were prescribed HRT. Common regimens included vaginal estrogen (33.3%, 7/21) and combined estrogen/progestin pills (28.6%, n=6/21) followed by systemic estrogen patches (19%, n=4/21) and systemic estrogen pills (19%, n=4/21). Factors statistically significantly associated with HRT use after CRT included pre-treatment counseling on vaginal toxicity (X 2 =13.77, p=0.008) and POI (X 2 =13, p=0.011), as well as vaginal dilator use after CRT (X 2 =31.68, p<0.01). Compared to patients at the public hospital, private hospital patients were more likely to be prescribed HRT (18.5% vs 40%, p=0.046). No significant differences were noted in HRT initiation rates by language (p=0.201), insurance type (p=0.234), or race (p=0.617). Conclusions: In this study we demonstrate that pre-CRT counseling on risks of vaginal toxicity and POI leads to a significant increase in HRT uptake after treatment. Further, we highlight a notable gap in counseling, as only two-thirds of premenopausal patients at our institutions undergoing CRT were counseled on side effects. To enhance patient care, vigilant screening on vaginal toxicity and vasomotor symptoms should be performed with each surveillance visit to ensure rapid treatment initiation and reduce morbidity from CRT.