Hormone therapy prescribing for iatrogenic menopause after definitive chemoradiation for squamous cell cervical cancer: A retrospective review.

Abstract

355 Background: Squamous cell cervical cancer (SCCC) is not hormonally driven and comprises 70% of cervical cancer diagnosed before age 40. Definitive treatment with chemoradiation (CRT) induces premature menopause and genitourinary symptoms, which may be alleviated with hormone therapy (HT). Although current clinical practice guidelines recommend consideration of HT in this population, HT remains underprescribed, particularly in those with an intact uterus. No previous work has specifically assessed HT prescribing in SCCC. We hypothesize that HT is underutilized in patients with SCCC treated with chemoradiation, despite the absence of a hormonally driven oncologic process. Methods: We performed a retrospective chart review of women under 50 treated with definitive chemoradiation for SCCC at a single academic cancer center from 2015 to 2023. Eligible patients completed >90% of planned external beam radiation treatment and all planned brachytherapy fractions at least 2 years prior, and had at least one post-treatment surveillance visit. IVB patients were excluded from this study. Collected data included HT prescribing (counseling, timing, agent, prescriber specialty), oncologic treatment details, and patient demographics. Descriptive statistics were used to summarize practice patterns. KM plots were used to compare survival curves by HT status. Results: Of 58 patients, 21 (36.2%) were prescribed HT and 37 (63.8%) were not. HT receipt did not differ by age (37.9 HT vs 40.7 years no HT), premenopausal status at diagnosis (90.5% HT vs. 91.9% no HT), and current smoking (57.1% HT vs 67.6% no HT). Race and ethnicity distributions did not differ between the HT and non-HT groups (p = 1.00). Patients who received HT compared to those who did not present with stage I disease (19.0% vs. 10.8%), stage II (28.6% vs. 27.0%), stage III (47.6% vs. 59.5%), and stage IVA (4.8% vs 2.7%). Documentation of hot flashes was significantly more common in the HT group (90.5% vs 24.3%; p < 0.0001). Of 23 patients counseled, 21 (91.3%) were prescribed HT. HT was initiated a mean of 49.6 weeks after chemoradiation, and most often prescribed by gynecologic oncologists (71.4%) and radiation oncologists (14.3%). HT regimens included combined estrogen and progesterone (57.1%), vaginal estrogen alone (33.3%), and estradiol patch alone (9.5%). HT was not associated with decreased 2 year overall survival. Conclusions: Only 36.2% of women with SCCC who were treated with chemoradiation were prescribed HT, revealing a clear gap between guidelines and real-world practice among a cohort of patients with non-hormonally mediated cancers. Despite a well-selected cohort of patients with non-hormonally mediated disease, this underprescribing is consistent with patterns reported in prior studies. Further work is needed to identify clinician barriers and guide strategies to improve survivorship care.