Symptoms related to sexual health may be associated with decreased adherence to adjuvant endocrine therapy among Black women with early-stage breast cancer, according to new findings presented by Anderson et al at the 2024 American Association for Cancer Research (AACR) Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved (Abstract C053).
Background
Patients with hormone receptor–positive breast cancer often receive endocrine therapy to block estrogen signaling in the breast following surgery, radiation, or chemotherapy. The recommended regimen for adjuvant endocrine therapy can last 5 to 10 years to decrease the risk of cancer recurrence.
However, many patients experience side effects such as anxiety, depression, hot flashes, and joint pain. These symptoms can lead to nonadherence to adjuvant endocrine therapy, marked by premature treatment discontinuation or frequent dose skipping.
Prior studies have indicated that Black women may be more likely to experience these side effects and more likely to experience treatment nonadherence compared with White women, but one subset of adjuvant endocrine therapy side effects has remained understudied.
“Up to this point, we’ve mostly talked about [adjuvant endocrine therapy] symptoms as a collective,” explained Janeane N. Anderson, PhD, MPH, Assistant Professor in the Department of Community and Population Health at the College of Nursing at the University of Tennessee Health Science Center. “[Nonetheless], in research interviews and informal conversations with more than 100 women over the last 7 years, [we’ve] heard over and over that sexual health is one of the greatest unmet needs,” she stressed.
Adjuvant endocrine therapy is known to cause a variety of sexual side effects—including vaginal dryness, reduced libido, and painful intercourse. These side effects may be poorly addressed, especially among women in racial/ethnic minorities.
Study Methods and Results
In the new study, investigators performed a post hoc analysis of the THRIVE clinical trial (ClinicalTrials.gov identifier NCT03592771), which assessed adherence to adjuvant endocrine therapy in patients with early-stage breast cancer. Treatment adherence was monitored with an electronic pillbox and reported as the proportion of days the patients took their medication over a 1-year period.
The patients were also asked to complete surveys about their symptoms at regular intervals. The post hoc analysis was performed using the responses of 102 Black patients and 173 White patients who completed surveys at enrollment, 6 months, and 12 months. The surveys assessed both physical (vaginal itchiness, dryness, bleeding, and pain) and mental or emotional (change in interest in sex and sexual satisfaction) sexual health. Physical and mental quality of life were measured using the 12-item Short Form Health Survey, in which higher scores indicated a better quality of life. The investigators hypothesized that side effects related to sexual health may contribute to the racial disparities observed in treatment adherence rates.
They discovered that vaginal itchiness, vaginal discharge, painful intercourse, and loss of interest in sex were associated with a lower mental quality of life in both Black and White patients at all three time points. However, loss of interest in sex was associated with a lower physical quality of life in just Black patients. Further, vaginal dryness at 6 months as well as decreased libido and sexual satisfaction at 12 months were associated with lower adjuvant endocrine therapy adherence among Black patients but not White patients.
“The evidence shows that women are really being bothered by these symptoms. The takeaway from this is that Black and White women experience some of these symptoms differently,” emphasized Dr. Anderson.
The investigators revealed that both hormonal and nonhormonal treatments may help mitigate some of these symptoms, including vaginal moisturizers, topical estrogen, and counseling. They noted that open communication about sexual health between patients and oncologists at frequent intervals during treatment may be key to managing sexual health symptoms so they can continue receiving adjuvant endocrine therapy.
Conclusions
Limitations of the study included data sourced from a single cancer center, potentially limiting the applicability of the findings to other treatment settings or geographic regions. Further, limited recruitment of women from other minority groups—including Latinas, Asian Americans, and sexual minorities—resulted in little data on sexual health symptoms in these patient populations.
“If we can start addressing some of these symptoms, we may start seeing parity in Black and White women’s [adjuvant endocrine therapy] adherence,” Dr. Anderson underscored. “Women are making the decision to either maintain adherence or reclaim their sexuality, and hopefully we can make it so that they don’t have to make that choice anymore,” she concluded.
Disclosure: The research in this study was funded by the National Cancer Institute of the National Institutes of Health. For full disclosures of the study authors, visit aacrjournals.org.
