Among early-stage breast cancer patients treated with adjuvant endocrine therapy (AET), sexual health symptoms were associated with decreased treatment adherence among black women, findings show at the 17th AACR Conference on the Science of Cancer Health Disparities. Racial/Ethnic Minorities and Medically Underserved People, September 21-24, 2024.
Patients with hormone receptor-positive breast cancer typically receive endocrine therapy—treatments that block estrogen signaling in the breast—after receiving surgery, radiation, or chemotherapy. The recommended regimen for AET can last five to 10 years to reduce the risk of recurrence.
However, many patients experience a range of side effects, including anxiety and depression, hot flashes and joint pain. These symptoms can lead to non-compliance with AET, marked by premature discontinuation of treatment or frequent dose hopping.
Previous studies have shown that black women are more likely than white women to experience some of these side effects and are also more likely to experience treatment noncompliance but a subset of AET side effects. has remained understudied, explained Janeane N. Anderson, PhD, MPH. , assistant professor in the Department of Community and Population Health in the College of Nursing at the University of Tennessee Health Science Center.
“So far, we’ve mostly talked about the symptoms of AET as a collective,” Anderson said. “But in research interviews and informal conversations with more than 100 women over the past seven years, I have heard again and again that sexual health is one of the biggest unmet needs.”
AET can cause a variety of sexual side effects, including vaginal dryness, reduced libido, and painful intercourse, but Anderson argued that these concerns are not addressed, particularly in women with to minorities. She and her colleagues hypothesized that sexual health-related side effects might contribute to observed racial disparities in treatment adherence rates.
Anderson and colleagues performed a post-hoc analysis of the THRIVE clinical trial, which evaluated adherence to AET among patients treated at the West Cancer Center & Research Institute. Medication adherence was monitored using an electronic pill dispenser and reported as the proportion of days patients took their medication over a 1-year period. Patients were asked to complete surveys about their symptoms at regular intervals.
The analysis was performed on 102 black patients and 173 white patients who completed surveys at enrollment, six months and 12 months. The surveys assessed both physical aspects (i.e., vaginal itching, dryness, bleeding,
and pain) and mental or emotional (i.e. change in interest in sex and sexual satisfaction). Physical and mental quality of life was measured using a 12-item short form health survey, in which higher scores indicated better quality of life.
Vaginal itching, vaginal discharge, painful intercourse, and loss of interest in sex were associated with lower mental quality of life in both black and white patients at all three time points. Loss of interest in sex was associated with lower physical quality of life only in black patients.
Vaginal dryness (at six months), as well as decreased libido and sexual satisfaction (at 12 months) were associated with lower AET compliance in black patients, but not in white patients.
Evidence shows that these symptoms actually bother women. The bottom line is that black and white women experience some of these symptoms differently. »
Janeane N. Anderson, PhD, MPH, Assistant Professor, Department of Community and Population Health, College of Nursing, University of Tennessee Health Science Center
Anderson emphasized that there are hormonal and non-hormonal treatments that can alleviate some of these symptoms, including vaginal moisturizers, topical estrogen and counseling. She emphasized that open communication about sexual health between patients and oncologists – at frequent intervals during treatment – is essential to help patients manage their symptoms so they can stay on AET.
“If we can start to address some of these symptoms, we might start to see parity in black and white women’s membership in AET,” Anderson said. “Women are making the decision to maintain their membership or reclaim their sexuality, and I hope we can ensure that they no longer have to make that choice.”
Limitations of this study include data from a single cancer center, potentially limiting the applicability of the results to other treatment settings or geographic regions. Additionally, limited recruitment of women from other minority groups, including Latinas, Asian Americans, and sexual minorities, has resulted in little data on sexual health symptoms in these groups.
Funding for this study was provided by the National Cancer Institute of the National Institutes of Health.