Exploring knowledge, attitudes and experience of genitourinary symptoms in women with early breast cancer on adjuvant endocrine therapy
Corresponding Author
M. Sousa MD, PhD
Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, Australia
School of Nursing and Midwifery, Centre for Applied Nursing Research, South Western Sydney Local Health District, Ingham Institute for Applied Medical Research, Western Sydney University, Sydney, NSW, Australia
Correspondence
Mariana S. Sousa, Locked Bag 7103, Liverpool BC, NSW 1871, Australia.
Email: [email protected]
Search for more papers by this authorM. Peate BSc, GradDipSc, MScMed, PhD
Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, VIC, Australia
The Royal Women's Hospital, Parkville, VIC, Australia
Search for more papers by this authorC. Lewis MBBS, MMed, FRACP
Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, Australia
Department of Medical Oncology, Prince of Wales Hospital, Randwick, NSW, Australia
Search for more papers by this authorS. Jarvis BAppSc (Physio)
Pelvic Floor Physiotherapy, Women's Health & Research Institute of Australia, Sydney, NSW, Australia
Search for more papers by this authorA. Willis BMedSc, MScMed(RH&HG), MGC
PhD candidate
Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, Australia
Department of Medical Oncology, Prince of Wales Hospital, Randwick, NSW, Australia
Search for more papers by this authorM. Hickey MBChB, FRANZCOG, MD, PhD
Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, VIC, Australia
The Royal Women's Hospital, Parkville, VIC, Australia
Joint senior authors.Search for more papers by this authorM. Friedlander AM, MBChB(Hon), MRCP, FRACP, PhD
Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, Australia
Department of Medical Oncology, Prince of Wales Hospital, Randwick, NSW, Australia
Joint senior authors.Search for more papers by this authorCorresponding Author
M. Sousa MD, PhD
Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, Australia
School of Nursing and Midwifery, Centre for Applied Nursing Research, South Western Sydney Local Health District, Ingham Institute for Applied Medical Research, Western Sydney University, Sydney, NSW, Australia
Correspondence
Mariana S. Sousa, Locked Bag 7103, Liverpool BC, NSW 1871, Australia.
Email: [email protected]
Search for more papers by this authorM. Peate BSc, GradDipSc, MScMed, PhD
Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, VIC, Australia
The Royal Women's Hospital, Parkville, VIC, Australia
Search for more papers by this authorC. Lewis MBBS, MMed, FRACP
Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, Australia
Department of Medical Oncology, Prince of Wales Hospital, Randwick, NSW, Australia
Search for more papers by this authorS. Jarvis BAppSc (Physio)
Pelvic Floor Physiotherapy, Women's Health & Research Institute of Australia, Sydney, NSW, Australia
Search for more papers by this authorA. Willis BMedSc, MScMed(RH&HG), MGC
PhD candidate
Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, Australia
Department of Medical Oncology, Prince of Wales Hospital, Randwick, NSW, Australia
Search for more papers by this authorM. Hickey MBChB, FRANZCOG, MD, PhD
Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, VIC, Australia
The Royal Women's Hospital, Parkville, VIC, Australia
Joint senior authors.Search for more papers by this authorM. Friedlander AM, MBChB(Hon), MRCP, FRACP, PhD
Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, Australia
Department of Medical Oncology, Prince of Wales Hospital, Randwick, NSW, Australia
Joint senior authors.Search for more papers by this authorAbstract
Clinical trials of adjuvant endocrine therapy in women with early breast cancer have consistently reported that genitourinary symptoms are common. However, little is known about women's experiences of genitourinary symptoms, their views about the symptoms and how they impact on their lives. The aim of this study was to explore knowledge, attitudes and experiences of genitourinary symptoms among women receiving adjuvant endocrine therapy for early breast cancer. Thirty-two semi-structured interviews were conducted and subjected to a rigorous qualitative analysis. Genitourinary symptoms were commonly reported to negatively impact on personal, social and physical activities, were often attributed to anxiety and stress and were a source of embarrassment. Women also commented on the limited information available or provided regarding the potential genitourinary adverse effects of adjuvant endocrine therapy. There was a general lack of awareness that their symptoms could be associated with or exacerbated by adjuvant endocrine therapy. Women indicated a preference to receive information and advice about potential management options from either their general practitioner or specialist. These findings underscore the importance of improving communication and increasing awareness among both clinicians and patients about the potential impact of adjuvant endocrine therapy on genitourinary symptoms.
CONFLICT OF INTEREST
The authors confirm that there is no conflict of interest between themselves and others that might bias their work.
REFERENCES
- American Joint Committee on Cancer (2010). Cancer staging manual. In S. Edge, D. Byrd, & C. Compton (Eds.), Breast cancer staging ( 7th edn). New York: Springer-Verlag.
- Australian Institute of Health and Welfare (2014). Cancer in Australia: an overview, 2014. Cancer series no. 78. Cat. no. CAN 75. Canberra, ACT: Author.
- Baumgart, J., Nilsson, K., Evers, A., Kallak, T., & Poromaa, I. (2013). Sexual dysfunction in women on adjuvant endocrine therapy after breast cancer. Menopause, 20, 162–168.
- Baumgart, J., Nilsson, K., Stavreus-Evers, A., Kask, K., Villman, K., Lindman, H., … Sundström-Poromaa, I. A. (2011). Urogenital disorders in women with adjuvant endocrine therapy after early breast cancer. American Journal of Obstetrics and Gynecology, 204, e1–e7.
- Binkley, J. M., Harris, S. R., Levangie, P. K., Pearl, M., Guglielmino, J., Kraus, V., & Rowden, D. (2012). Patient perspectives on breast cancer treatment side effects and the prospective surveillance model for physical rehabilitation for women with breast cancer. Cancer, 18, 2207–2216.
- Bush, T. A., Castellucci, D. T., & Phillips, C. (2001). Exploring women's beliefs regarding urinary incontinence. Urologic Nursing, 21, 211–218.
- Buzdar, A., Howell, A., Cuzick, J., Wale, C., Distler, W., Hoctin-Boes, G., … Nabholtz, J. M. (2006). Comprehensive side-effect profile of anastrozole and tamoxifen as adjuvant treatment for early-stage breast cancer: Long-term safety analysis of the ATAC trial. The Lancet. Oncology, 7, 633–643.
- Cella, D., Fallowfield, L., Barker, P., Cuzick, J., Locker, G., & Howell, A. (2006). Quality of life of postmenopausal women in the ATAC (“Arimidex”, tamoxifen, alone or in combination) trial after completion of 5 years’ adjuvant treatment for early breast cancer. Breast Cancer Research and Treatment, 100, 273–284.
- Chin, S. N., Trinkaus, M., Simmons, C., Flynn, C., Dranitsaris, G., Bolivar, R., & Clemons, M. (2009). Prevalence and severity of urogenital symptoms in postmenopausal women receiving endocrine therapy for breast cancer. Clinical Breast Cancer, 9, 108–117.
- Cowley, L., Heyman, B., Stanton, M., & Milner, S. J. (2000). How women receiving adjuvant chemotherapy for breast cancer cope with their treatment: A risk management perspective. Journal of Advanced Nursing, 31, 314–321.
- Coyne, K. S., Wein, A. J., Tubaro, A., Sexton, C. C., Thompson, C. L., Kopp, Z. S., & Aiyer, L. P. (2009). The burden of lower urinary tract symptoms: Evaluating the effect of LUTS on health-related quality of life, anxiety and depression: EpiLUTS. BJU International, 103, 4–11.
- Donovan, K. A., Boyington, A. R., Ismail-Khan, R., & Wyman, J. F. (2012). Urinary symptoms in breast cancer: A systematic review. Cancer, 118, 582–593.
- Fallowfield, L. J., Bliss, J. M., Porter, L. S., Price, M. H., Snowdon, C. F., Jones, S. E., … Hall, E. (2006). Quality of life in the intergroup exemestane study: A randomized trial of exemestane versus continued tamoxifen after 2 to 3 years of tamoxifen in postmenopausal women with primary breast cancer. Journal of Clinical Oncology, 24, 910–917.
- Fu, M. R., Liu, B., & Haber, J. (2008). ‘Making the best of it’: Chinese women's experiences of adjusting to breast cancer diagnosis and treatment. Journal of Advanced Nursing, 63, 155–165.
- George, A., & Davenport, T. C. (2012). Management of urinary incontinence. Pharmacy and Therapeutics, 37(345–361), 361B–361H.
- Goldstein, I., Dicks, B., Kim, N. N., & Hartzell, R. (2013). Multidisciplinary overview of vaginal atrophy and associated genitourinary symptoms in postmenopausal women. Sexual Medicine, 1, 44–53.
- Gupta, P., Sturdee, D. W., Palin, S. L., Majumder, K., Fear, R., Marshall, T., & Patterson, I. (2006). Menopausal symptoms in women treated for breast cancer: The prevalence and severity of symptoms and their perceived effects on quality of life. Climacteric: The Journal of the International Menopause Society, 9, 49–58.
- Howell, A., Cuzick, J., Baum, M., Buzdar, A., Dowsett, M., Forbes, J. F., … Tobias, J. S. (2005). Results of the ATAC (Arimidex, Tamoxifen, Alone or in Combination) trial after completion of 5 years’ adjuvant treatment for breast cancer. Lancet, 365, 60–62.
- Janz, N. K., Mujahid, M. S., Hawley, S. T., Griggs, J. J., Hamilton, A. S., & Katz, S. J. (2008). Racial/ethnic differences in adequacy of information and support for women with breast cancer. Cancer, 113, 1058–1067.
- Lester, J. L., & Bernhard, L. A. (2009). Urogenital atrophy in breast cancer survivors. Oncology Nursing Forum, 36, 693–698.
- Lester, J. L., Bernhard, L. A., & Ryan-wenger, N. (2012). A self-report instrument that describes urogenital atrophy symptoms in breast cancer survivors. Western Journal of Nursing Research, 34, 72–96.
- Marshall, M. N. (1996). Sampling for qualitative research. Family Practice, 13, 522–526.
- Miles, M. B., & Huberman, A. M. (2002). Reflections and advice. Thousand Oaks, CA: Sage.
- Morales, L., Neven, P., Timmerman, D., Christiaens, M. R., Vergote, I., Van Limbergen, E., … Paridaens, R. (2004). Acute effects of tamoxifen and third-generation aromatase inhibitors on menopausal symptoms of breast cancer patients. Anti-Cancer Drugs, 15, 753–760.
- Morse, J. M. (1995). The significance of saturation. Qualitative Health Research, 5, 147–149.
- Murphy, C. C., Bartholomew, L. K., Carpentier, M. Y., Bluethmann, S. M., & Vernon, S. W. (2012). Adherence to adjuvant hormonal therapy among breast cancer survivors in clinical practice: A systematic review. Breast Cancer Research and Treatment, 134, 459–478.
- Niravath, P., Rimawi, M. F., & Osborne, C. K. (2014). Aromatase inhibitor adverse effects: Are we sweeping them under the rug? Journal of Clinical Oncology, 32, 3779.
- Papanicolaou, S., Hunskaar, S., Lose, G., & Sykes, D. (2005). Assessment of bothersomeness and impact on quality of life of urinary incontinence in women in France, Germany, Spain and the UK. BJU International, 96, 831–838.
- Partridge, A. H., LaFountain, A., Mayer, E., Taylor, B. S., Winer, E., & Asnis-Alibozek, A. (2008). No adherence to initial adjuvant anastrozole therapy among women with early-stage breast cancer. Journal of Clinical Oncology, 26, 556–562.
- Perera, J., Kirthinanda, D. S., Wijeratne, S., & Wickramarachchi, T. K. (2014). Descriptive cross sectional study on prevalence, perceptions, predisposing factors and health seeking behaviour of women with stress urinary incontinence. BMC Women's Health, 14, 78.
- Portman, D. J., & Gass, M. L. (2014). Genitourinary syndrome of menopause: New terminology for vulvovaginal atrophy from the International Society for the Study of Women's Sexual Health and the North American Menopause Society. Menopause, 21, 1063–1068.
- Rosendale, M., & Fu, M. R. (2010). Confronting the unexpected: Temporal, situational, and attributive dimensions of distressing symptom experience for breast cancer survivors. Oncology Nursing Forum, 37, E28–E33.
- Schiavon, G., & Smith, I. E. (2014). Status of adjuvant endocrine therapy for breast cancer. Breast Cancer Research, 16, 206.
- Shaw, C., Brittain, K., Tansey, R., & Williams, K. (2008). How people decide to seek health care: A qualitative study. International Journal of Nursing Studies, 45, 1516–1524.
- Shaw, C., Tansey, R., Jackson, C., Hyde, C., & Allan, R. (2001). Barriers to help seeking in people with urinary symptoms. Family Practice, 18, 48–52.
- Sheri, A., & Dowsett, M. (2012). Developments in Ki67 and other biomarkers for treatment decision making in breast cancer. Annals of Oncology, 23, x219–x227.
- Sousa, M. S., Peate, M., Jarvis, S., Hickey, M., & Friedlander, M. (2017). A clinical guide to the management of genitourinary symptoms in breast cancer survivors on endocrine therapy. Therapeutic Advances in Medical Oncology, 9, 269–285.
- Tariman, J. D., Doorenbos, A., Schepp, K. G., Singhal, S., & Berry, D. L. (2014). Information needs priorities in patients diagnosed with cancer: A systematic review. Journal of the Advanced Practitioner in Oncology, 2014, 115–122.
- Thurlimann, B., Keshaviah, A., Coates, A. S., Mouridsen, H., Mauriac, L., Forbes, J. F., … Goldhirsch, A. (2005). A comparison of letrozole and tamoxifen in postmenopausal women with early breast cancer. New England Journal of Medicine, 353, 2747–2757.
- Trinkaus, M., Chin, S., Wolfman, W., Simmons, C., & Clemons, M. (2008). Should urogenital atrophy in breast cancer survivors be treated with topical estrogens? Oncologist, 13, 222–231.
- Zibecchi, L., Greendale, G. A., & Ganz, P. A. (2003). Continuing education: Comprehensive menopausal assessment: An approach to managing vasomotor and urogenital symptoms in breast cancer survivors. Oncology Nursing Forum, 30, 393–407.
