The burden of genitourinary syndrome of menopause and barriers to treatment in a safety-net breast cancer population.

Abstract

459 Background: Women receiving pharmacologic treatment for breast cancer (BC) often suffer from genitourinary syndrome of menopause (GSM). Many studies have demonstrated the safety of vaginal estrogen in this population with no evidence of higher risk of BC-associated mortality. However, current literature reflects a disproportionately low rate of GSM treatment in this population, and vaginal estrogen use in women with both active BC and GSM remains unreported. We aim to characterize the use of vaginal estrogen in this population, and patients’ knowledge of GSM, treatment options, and perception of these options. Methods: This is a cross-sectional survey-based study of female adults at a multidisciplinary BC clinic diagnosed with hormone receptor positive BC treated with chemotherapy or endocrine therapy. Demographic, cancer, treatment, and medical characteristics were obtained with chart review. Outcomes included validated vulvovaginal symptom scores (Cervantes-GSM), knowledge of GSM treatment options, receipt of treatment, and interest in treatment. GSM symptom severity subgroups were created using total GSM severity score <50 (low) or ≥50 (high). The maximum score is 100, which indicates the worst quality of life (QoL). Characteristics were summarized with descriptive statistics. Associations between covariates and GSM severity subgroups were evaluated with Chi-squared tests. Results: 100 patients completed the survey (Table). 80% received endocrine therapy. 38% received chemotherapy. 86% reported non-GSM symptoms of menopause. Overall, the mean total GSM severity score was 43 ± 21. Only 9% of patients reported GSM treatment receipt, though none received vaginal estrogen. Overall, 45% were interested in receiving treatment, 21% were aware of treatment options, and 40% expressed concerns about potential treatment options. Notably, high GSM symptom severity was significantly associated with interest in treatment (p = 0.004). Conclusions: The majority of this safety net and primarily Hispanic, Spanish speaking population experience GSM symptoms at a level that negatively affects their QoL, but few receive appropriate treatment. Patients, especially those with worse GSM-associated QoL, simultaneously report an interest in treatment and unawareness of options available to them. This indicates the need for intervention to improve the identification of GSM symptoms, education about treatment safety, and effective use of treatment options, including vaginal estrogen, to improve the QoL of BC patients. Cohort characteristics. Low Severity GSM (n = 68) High Severity GSM (n = 32) Overall Age (mean, SD) 53 (10) 55 (11) 54 (11) White (%) 62 66 63 Hispanic/Latino (%) 78 84 80 Publicly insured (%) 81 78 80 Spanish-speaking (%) 71 72 71 Postmenopausal (%) 60 68 63 Living with partner (%) 40* 69* 49 Node negative (%) 95 97 95 HER2+ 18 16 17 *p = 0.007.