Abstract
e20637
Background: Gynecologic cancer survivors have indicated inadequate treatment of their menopausal symptoms; and while HRT can significantly improve quality of life (QOL) its safety is still debated. Our objective was to evaluate HRT practice patterns and identify potential barriers to prescribing HRT among gynecologic oncologists (GO). Methods: SGO members with active electronic mail (n=823) were queried with single answer and Likert-style questions using an internet-based program. Email reminders were sent at 3, 6, and 9 weeks. Results: Of 207 respondents (25%), 123 (59%) were male and 84 (41%) female. Providers identified personal history of blood clot (81.5%) or breast cancer (75.6%) as contraindications to prescribing HRT. More women than men cited breast cancer and personal history of a blood clot (p=0.038, p=0.08) as contraindications. HRT candidates were women with vasomotor symptoms (sx)(96.1%), those at risk for osteoporosis (55.1%), and postmenopausal women (47.8%). Sx considered amenable to HRT were hot flashes (98.5%), vaginal atrophy (89.3%) and osteoporosis (60%). Fewer women than men (p=0.02) thought HRT was acceptable treatment for vaginal atrophy. Most practitioners would recommend HRT for sexual dysfunction (61.5%). Physicians indicated that they would prescribe HRT for ovarian (55.1%) and endometrial (58.7%) cancer survivors in surveillance. Compared to females, males were more likely to prescribe HRT to ovarian cancer patients who were newly diagnosed (p=0.005), disease-free after adjuvant chemotherapy (p=0.004), on surveillance (p<0.001), or with recurrent disease (p=0.008). Similar trends occurred with endometrial cancer patients. 75% of physicians would prescribe HRT for women with cervical, vaginal, or vulvar cancer following definitive treatment. There was no consensus regarding the duration of HRT once initiated for any cancer. Interestingly, 56-71% of respondents cited evidence- based medicine as the basis for their recommendations. Conclusions: Our survey demonstrated a wide spectrum in HRT prescribing patterns of GO. As more emphasis is placed on QOL and survivorship, rigorous study of the outcomes of HRT use in our patients is of paramount importance.