Addressing sexual health issues of breast cancer patients undergoing endocrine therapy

Breast cancer treatments that could save a woman’s life could seriously harm her sexual health, says Dr. Kristin E. Rojas, a breast cancer surgeon at the Sylvester Comprehensive Cancer Center at the University of Miami Miller School of Medicine. While doctors historically have not been equipped to help patients deal with these toxic side effects, Rojas is leading the effort to turn the tide.

Rojas, both a trained breast surgical oncologist and gynecological surgeon, is a national leader in the treatment of sexual dysfunction in female cancer patients. Other more widely recognized side effects of life-saving estrogen-blocking drugs – also known as endocrine therapy – include challenges in planning pregnancy for premenopausal patients and reduced bone mineralization. According to Rojas, all three of these issues must be addressed as early as possible when planning a course of therapy for a breast cancer patient with an estrogen-sensitive tumor.

Rojas will identify the risks posed by endocrine therapies, define symptoms and discuss treatment options in a presentation at the 2023 ASCO Annual Meeting in Chicago.

“By using endocrine therapy to treat hormone-positive breast cancers, we’re putting a lot of young women through menopause, but we’re not doing a good job of preparing them for it,” said Rojas, who created a program to address female sexual health. . after cancer treatment, the Menopause Urogenital Sexual Health and Intimacy Clinic (MUSIC) in Sylvester. Faced with unexpectedly high demand, the clinic needed to be expanded shortly after opening in 2020. Since Rojas expanded the program by training additional specialists to meet this great need, the MUSIC program has become a prototype for similar programs across the country. It remains the only sexual health program focused on female oncology led by a dual-trained surgeon in the United States.

Patients are often hesitant to bring up sexual health issues with their providers, which is why we created this innovative program where patients can openly discuss these issues in an individual survival program. If we don’t address these common concerns experienced by more than 80% of female cancer survivors, patient adherence to endocrine care declines and the progress we’ve made in improving breast cancer survival is impeded.”

Kristin E. Rojas, breast cancer surgeon at the Sylvester Comprehensive Cancer Center at the University of Miami Miller School of Medicine

Rojas’ ASCO presentation will help providers anticipate and address the most common side effects experienced by patients on endocrine therapy (or estrogen blocking medications), formulate a personalized treatment plan, guide patients toward evidence-based practices and away from of potentially harmful “fringe” therapies and address common problems encountered in treating menopausal symptoms.

Among the specific topics:

  • Hot flashes – causes, triggers and treatments.
  • Vaginal dryness and painful sex – causes, irritants and changes in the vaginal microbiome.
  • Genitourinary Menopausal Syndrome (GSM) – causes, treatments, lubricants, devices and medication options.
  • Products, “therapies” and devices to avoid.
  • Risk of infertility and options for fertility preservation.
  • Decreased bone mineralization and increased risk of fractures – monitoring and prevention strategies.

Rojas’ presentation is part of a session she will chair: “The Juggling Act: Managing the Toxicity of Estrogen Deprivation for Patients with Breast Cancer,” Education Session E451. It will begin at 8:00 am on June 5, 2023 (CDT), part of the annual meeting of the American Society of Clinical Oncology.

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