Clinical barriers hinder access to hormone therapy after cervical cancer treatment

Most oncologists say they would prescribe hormone therapy to cervical cancer patients who experience early menopause from radiation therapy, but barriers prevent many from doing so in practice, according to a new University of Kentucky Markey Cancer Center study published in JAMA Network Open.

Premenopausal patients treated for cervical cancer with chemoradiotherapy, a combination of chemotherapy and radiation given at the same time, often experience menopause as a side effect of ovarian radiation, causing symptoms such as hot flashes, sleep disturbance and vaginal dryness. Clinical guidelines support the use of hormone therapy to manage menopausal symptoms in this group, but research has shown that the treatment remains underutilized.

The study, led by Markey Cancer Center radiation oncologist Denise Fabian, MD, with Morgan Levy, MD, as first author, identifies barriers to prescribing that can contribute to efforts to improve patient care.

The research team surveyed 178 gynecology and radiation oncology physicians nationwide through the Society of Gynecologic Oncology and the American Brachiotherapy Society about their attitudes and prescribing habits regarding hormone therapy for cervical cancer patients who received chemotherapy and radiation.

The survey found that 99.3% of gynecologic oncologists and 73.8% of radiation oncologists said they would consider prescribing hormone therapy after chemoradiation. Despite this willingness, both groups reported barriers: ability to manage patient care long-term and lack of awareness of existing clinical guidelines.

“This study highlights a critical opportunity to enhance survivorship care for patients with cervical cancer, both in Kentucky and nationally,” said Fabian.

Hormone therapy can significantly improve not only quality of life, but also long-term health. We need to make sure more patients have access to it.”

Denise Fabian, University of Kentucky Markey Cancer Center

“This work showed us that oncologists are interested in prescribing hormone therapy to improve the quality of life of our patients,” Levy said. “We are excited to continue working with our multidisciplinary team in survivorship and gynecologic oncology to design interventions to improve the standard of care.”

The researchers say future work will focus on increasing awareness of the guidelines and finding ways to make prescribing more manageable for clinicians, with the goal of giving more patients access to care that evidence shows is safe and effective.