Topical estrogen prescribing patterns for urogenital atrophy among women with breast cancer

2019 ◽  
Vol 26 (7) ◽  
pp. 714-719 ◽  
Author(s):  
Lee A. Richter ◽  
Jim Han ◽  
Sarah Bradley ◽  
Filipa C. Lynce ◽  
Shawna C. Willey ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Prescribing Patterns ◽  
Urogenital Atrophy ◽  
Topical Estrogen

scholarly journals Factors affecting radiotherapy prescribing patterns in the post-mastectomy setting

2018 ◽  
Vol 25 (2) ◽  
pp. 146 ◽  
Author(s):  
T.A. Koulis ◽  
A. Dang ◽  
C. Speers ◽  
R.A. Olson
Keyword(s):  
Breast Cancer ◽  
Background Radiation ◽  
Prescribing Patterns ◽  
Autologous Reconstruction ◽  
Breast Cancer Patients ◽  
Prescribing Practices ◽  
Curative Intent ◽  
Factors Affecting ◽  
Treatment Information ◽  
Treatment Centre

Background Radiation therapy (rt) after mastectomy for breast cancer can improve survival outcomes, but has been associated with inferior cosmesis after breast reconstruction. In the literature, rt dose and fractionation schedules are inconsistently reported. We sought to determine the pattern of rt prescribing practices in a provincial rt program for patients treated with mastectomy and reconstruction.Methods Women diagnosed with stages 0–iii breast cancer between January 2012 and December 2013 and treated with curative-intent rt were identified from a clinicopathology database. Patient demographic, tumour, and treatment information were extracted. Of the identified patients, those undergoing mastectomy were the focus of the present analysis.Results Of 4016 patients identified, 1143 (28%) underwent mastectomy. The patients treated with mastectomy had a median age of 57 years, and 37% of them underwent reconstruction. Treatment with more than 16 fractions of rt was associated with autologous reconstruction [odds ratio (or): 37.2; 95% confidence interval (ci): 11.2 to 123.7; p < 0.001], implant reconstruction (or: 93.3; 95% ci: 45.3 to 192.2; p < 0.001), and treating centre. Hypofractionated treatment was associated with older age (or: 0.94; 95% ci: 0.92 to 0.96; p < 0.001), and living more than 400 km from a treatment centre (or: 0.37; 95% ci: 0.16 to 0.86; p = 0.02).Conclusions Prescribing practices in breast cancer patients undergoing mastectomy are influenced by reconstruction intent, age, nodal status, and distance from the treatment centre. Those factors should be considered when making treatment decisions.

Should Urogenital Atrophy in Breast Cancer Survivors Be Treated with Topical Estrogens?

2008 ◽  
Vol 13 (3) ◽  
pp. 222-231 ◽  
Author(s):  
Mateya Trinkaus ◽  
Sheray Chin ◽  
Wendy Wolfman ◽  
Christine Simmons ◽  
Mark Clemons
Keyword(s):  
Breast Cancer ◽  
Cancer Survivors ◽  
Breast Cancer Survivors ◽  
Urogenital Atrophy

Practice patterns in bone modifying agent utilization: An analysis in patients with metastatic cancer and bone involvement at an NCI-designated center.

2020 ◽  
Vol 38 (29_suppl) ◽  
pp. 62-62
Author(s):  
Poorni Manohar ◽  
Kyle Bastys ◽  
Micah Tratt ◽  
Julie Gralow ◽  
Keith D. Eaton
Keyword(s):  
Breast Cancer ◽  
Cancer Care ◽  
Practice Patterns ◽  
Metastatic Cancer ◽  
Metastatic Breast ◽  
Bone Involvement ◽  
Prescribing Patterns ◽  
Fiscal Year ◽  
Skeletal Related Events ◽  
Over Time

62 Background: Bone modifying agents (BMA) can reduce skeletal related events for patients with metastatic cancer and bone involvement. ASCO supports use of Zoledronic acid (ZA) and Denosumab (DB), with specific endorsement of both an every 3 to 4-week (Q1 month) and every 12-week (Q3 month) schedule for ZA in metastatic breast cancer. Trends in BMA utilization may identify areas to improve value in cancer care. Methods: We retrospectively reviewed utilization of BMAs at Seattle Cancer Care Alliance/University of Washington from fiscal year 2015-2019. We identified 1,286 patients who underwent 12,594 administrations. Data was categorized by BMA (ZA acid vs DB) and disease group. A 45-day cutoff defined interval of treatment (Q1 vs Q3). Whole-sale acquisition cost (WAC) and administration costs were estimated from CMS allowed charges. We calculated total costs spent during time period and projected potential savings for switching from Q1 to Q3 ZA administration. Results: A total of 904 patients received ZA (7201 administrations) and 473 patients received DB (5,393 administrations). The breast, myeloma, prostate, and kidney groups accounted for 81% of administrations. In breast, 427 patients received ZA (1,761 administrations) and 411 patients received DB (2,708 administrations). Among all patients, DM and ZA administrations remained constant over time, however, in breast, there was a trend towards less DB and more ZA administrations. The administration frequency (Q1 vs Q3) for both drugs stayed constant in the total cohort. Among ZA administrations in breast, there was a reversal in the trend for Q1 vs Q3, with Q1 being most common in 2015, and Q3 the most common in 2019 (crossover in 2018 fiscal year). In breast, 30 patients transitioned from Q1 to Q3, with majority occurring before 2017 ASCO update. Total costs on BMA utilization was estimated as $11,672,189,80, 90% attributable to DB. The projected savings for switching from Q1 to Q3 ZA administration was $1,223,961.08. Conclusions: BMA prescribing patterns from 2015-2019 show no change in ZA and DB utilization, though a trend towards increased ZA and decreased DB use in breast cancer was observed. There was a transition in practice patterns to adopt the Q3 ZA administration over time, however, the uptake of this has been incomplete. It is hoped that raising awareness of these practice patterns will lead to adoption of guideline-based decision making and promote value-based cancer care.

Current Overview of the Management of Urogenital Atrophy in Women with Breast Cancer

2011 ◽  
Vol 17 (4) ◽  
pp. 403-408 ◽  
Author(s):  
Sandhya Pruthi ◽  
James A. Simon ◽  
Amy P. Early
Keyword(s):  
Breast Cancer ◽  
Urogenital Atrophy

1608 Essential oil pessaries for the management of urogenital atrophy in women with breast cancer

2015 ◽  
Vol 51 ◽  
pp. S240-S241
Author(s):  
A. Armstrong ◽  
J. Stringer ◽  
R. Knowles ◽  
G. Zucchini ◽  
S. Howell
Keyword(s):  
Breast Cancer ◽  
Essential Oil ◽  
Urogenital Atrophy

Use of intravaginal 17-β estradiol to improve sexual function and menopausal symptoms in postmenopausal women with breast cancer on aromatase inhibitors.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 9610-9610 ◽  
Author(s):  
Shari Beth Goldfarb ◽  
Maura N. Dickler ◽  
Ann M. Dnistrian ◽  
Sujata Patil ◽  
Lara Dunn ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Sexual Function ◽  
Postmenopausal Women ◽  
Aromatase Inhibitors ◽  
Early Stage ◽  
Menopausal Symptoms ◽  
Desire Satisfaction ◽  
Hormone Receptor Positive ◽  
Urogenital Atrophy ◽  
Prospective Longitudinal

9610 Background: The majority of women with early stage breast cancer (BC) will become long-term survivors, living with the sequelae of treatment. Attention to symptoms and quality of life (QoL) are therefore of increasing importance both during treatment and survivorship. Aromatase inhibitors (AIs) are used to treat postmenopausal women with hormone-receptor positive (HR+) BC and can lead to profound urogenital atrophy. Atrophic vaginitis in BC survivors is prevalent, its management is complex and it negatively impacts QoL. Methods: A prospective longitudinal IRB-approved study was performed at MSKCC in26 postmenopausal women with stage I-III HR+ BC on adjuvant letrozole or anastrozole for at least 3 months and had urogenital atrophy. All women were initiated on 10µg intravaginal 17-β estradiol. Patients completed the Female Sexual Function Index (FSFI) and Menopausal Symptom Checklist (MSCL) at baseline and wks 12 & 24. Increase in FSFI score means better sexual function and a decrease in MSCL score means improved symptoms. We used the Wilcoxon Signed Rank Sum test to compare QoL measures at baseline to wks 12 and 24. The primary endpoint was change in systemic estradiol level from baseline to wk 12. Serial estradiol/FSH levels were measured at baseline and wks 2, 7, 12, 18 & 24; we used a highly sensitive estradiol radioimmunoassay, ESTR-US-CT, from Cisbio US, Inc. Herein we report the results from the QoL secondary endpoints. Results: During treatment with intravaginal 17-β estradiol 10mcg, improvement in sexual function as measured by the FSFI was seen from a median of 12.4 at baseline to 21.2 at wk 12 (p=.0091) and 21.8 at wk 24 (p=.0271). Improvement was seen from baseline to wk 12 in lubrication (p=.0091), desire (p=.0303), satisfaction (p=.0331) and pain (p=.0005) and from baseline to wk 24 in lubrication (p=.0210), desire (p=.0309) and orgasm (p=.0369). A reduction in menopausal symptoms was also seen from 30.0 at baseline to 23.6 at wk 12 (p=.01) and 22.5 at wk 24 (p=.003). Conclusions: Intravaginal 10μg 17-β estradiol provided relief from menopausal symptoms and improvement in sexual dysfunction in the domains of lubrication, desire, satisfaction, orgasm, and pain.

Compliance with every 12-week zoledronic acid dosing guidelines for bone metastasis in breast cancer patients.

2020 ◽  
Vol 38 (29_suppl) ◽  
pp. 81-81
Author(s):  
Monika Kumar ◽  
Pallavi Dev ◽  
Radhika Kainthla
Keyword(s):  
Breast Cancer ◽  
Zoledronic Acid ◽  
Bone Metastasis ◽  
Cancer Patients ◽  
Educational Interventions ◽  
Prescribing Patterns ◽  
Breast Cancer Patients ◽  
National Guidelines ◽  
Hospital System ◽  
Teaching Clinics

81 Background: Bisphosphonates, including zoledronic acid (Zometa), decrease skeletal-related events in breast cancer patients with bone metastasis but are also associated with side effects and utilization costs. Data from a randomized trial supporting 12-week versus 4-week dosing of Zometa was released in July 2016 and officially published in January 2017. We examined the practice pattern of Zometa dosing over time in our practice to determine compliance and develop interventions for improvement. Methods: We conducted a retrospective chart review on all breast cancer patients treated at Parkland Health and Hospital System oncology clinic to identify patients who were initiated on Zometa for bone metastasis between June 2015 and September 2019. The initially prescribed dosing frequencies were assessed for time periods before and after the Zometa dosing data was made available. The prescribing patterns were also compared between teaching and non-teaching clinics. An educational review of the guidelines was presented to providers in all clinics in March 2020 to improve compliance. Results: In the year prior to July 2016, of the 27 patients who started Zometa, only 1 (4%) was on every 12-week dosing. In the six months after release of the data, 29% (6/21 patients) were placed on 12-week Zometa dosing. Between January 2019 and September 2019, 52% of patients were started on the recommended 12-week dosing interval. These patterns were consistent between teaching and non-teaching clinics. Conclusions: We found that the variability in Zometa prescribing patterns persisted despite updated national guidelines and multiple studies supporting 12-week dosing intervals. In addition to educational interventions, we plan to implement electronic interventions to improve rates of compliance with the goal of 80% adherence by September 2020. Improved adherence will likely lead to a reduction in potential complications from treatment as well as infusion costs (estimated $482.81 saved per patient annually).

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