Differences in clinician understanding and management of early menopause after breast cancer

Abstract

Objective Investigation of clinicians’ understanding of early menopause diagnosis/management in women with breast cancer.

Methods A cross-sectional study of 176 randomly recruited Australian clinicians (35 gynecologists, 35 endocrinologists, 36 oncologists, 35 breast surgeons and 35 general practitioners (GPs)) involved in the care of women with breast cancer. This questionnaire study utilized an index case to assess understanding of early menopause diagnosis and management. Analysis involved descriptive statistics, χ² tests and Student's t-test.

Results Significant differences between clinician groups regarding diagnostic criteria for early menopause were observed; gynecologists, endocrinologists and GPs selected amenorrhea > 12 months, whereas oncologists and breast surgeons selected elevated serum follicle stimulating hormone level (p < 0.05). Non-hormonal treatment was preferred by most clinician groups. Complementary/alternative medicines were more commonly prescribed by breast surgeons (57%), gynecologists (54%) and endocrinologists (49%) compared to oncologists (28%) or GPs (9%) (p = 0.0001). Exercise (63%) and nutrition (66%) were selected by most gynecologists for treatment of hot flushes, whereas endocrinologists (91%), oncologists (94%), breast surgeons (69%) and GPs (63%) prescribed venlafaxine. Hormone therapy was mainly prescribed by breast surgeons (43%) compared to other groups (p = 0.001). Most clinicians reported that the main problem with menopausal therapies was failure to resolve hot flushes. Exercise, lifestyle and stress management were recommended by all clinician groups for treatment of anxiety/depression.

Conclusion This exploratory study demonstrated a lack of consensus between clinician groups in their investigation, diagnosis and management of early menopause in women with breast cancer, with implications for both diagnosis and treatment.

Key words::

• CLINICIANS
• DIAGNOSIS
• MENOPAUSE MANAGEMENT
• BREAST CANCER
• EARLY MENOPAUSE

ACKNOWLEDGEMENTS

The authors would like to thank the clinicians who participated in this study. We would like to thank the Education Unit of Jean Hailes for Women's Health, and the outpatient menopause and breast oncology clinics at Southern Health. Some data from this paper were presented as a poster at the 13th World Congress on the Menopause, Rome, 2010.

Conflict of interest Dr Amanda Vincent is a member of the Editorial Board of Climacteric. There are no other conflicts of interest. The authors alone are responsible for the content and writing of the paper.

Source of funding This study was supported by a grant from the Victoria Cancer Agency Early Career Bench and Bedside Collaboration awards in 2009. Professor Helena Teede is a NHMRC research fellowship holder, Padaphet Sayakhot is a Monash Graduate Scholarship holder and Melanie Gibson-Helm holds an Australian Postgraduate Award.