Sexual health and therapy adherence of hormone-sensitive breast cancer survivors on maintenance endocrine therapy: The SHE-CAN project in Toronto, Canada.
Authors: Remtulla Tharani Alliya , Townsley Carol , Smith Janet , Salman Noor , Rattansi Sahaar , Signarowski Karina , Nandakumar Shankavi , Czerwoniak Taissa , Lawryshyn Alexandra , Singh Navreet , Abbruzzino Alexandria , Richard Emilie , Hu Emily , Hrycyshyn Adriyan , Elliott Jaqueline , Pankiw Maya , Wertelecky Tiana , Watson Geoffrey Alan , Elser Christine , Brezden-Masley Christine 
Published: May 2024

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Background: Endocrine therapy (ET) is the standard of care for hormone sensitive (HR) breast cancer. While these drugs are highly efficacious and patients remain on them for extended periods of time, there are many side effects. It is estimated that 20-30% of women on ET stop early due to these side effects, most commonly due to gynecological symptoms of menopause (GSM). The purpose of this study is to better understand the vaginal health, sexual health, quality of life, sexual dysfunction, and adherence to therapy for HR breast cancer patients treated with anti-estrogen therapy. Methods: From August 2021 to January 2024, women from Mount Sinai Hospital’s outpatient oncology clinic and Women’s College Hospital After Cancer Treatment Transition (ACTT) clinic, who presented with HR breast cancer and who were being treated with anti-estrogen agents for a minimum of three months, were invited to participate in the study. Participants were asked to complete a survey examining their treatment experience and adherence, occurrence and frequency of GSM, patient-provider communication, along with two validated measurement tools (Female Sexual Function Index [FSFI} and Menopause-Specific Quality of Life questionnaire [MENQOL]). Medical history was also reviewed from the participant’s medical chart. Analysis was conducted using Excel. Results: A total of 417 participants completed the questionnaire. The median age was 60 years [IQR:52-69] with 401 participants (96.2%) being treated in the adjuvant setting versus 16 patients (3.8%) in the metastatic setting. At the time of diagnosis, 156 participants (37.4%) were pre-menopausal, 52 participants (12.5%) were peri-menopausal, and 185 participants (44.4%) were post-menopausal. When surveyed, 134 participants (32.1%) were on tamoxifen and 272 participants (65.2%) were on an aromatase inhibitor. Within six months prior to survey completion, 214 participants (51.3%) stopped taking their medication for a period of time. Within the past year, participants reported experiencing the following symptoms “all of the time”: vaginal dryness (24.9%), hot flashes (24.7%), and decreased sex drive (34.5%). Only 144 participants (34.5%) reported that a healthcare provider had asked them about experiencing GSM. The mean FSFI score was 21.9 ± 7.7 among 168 sexually active participants. Of these 168 participants, 116 (69.0%) had a final score of 26.5 or less, the cut-point used to demonstrate female sexual dysfunction. Symptoms captured in the MENQOL’s sexual domain (3.7 ± 2.3) and physical domain (3.7 ± 1.4) were found to be most bothersome. Conclusions: In our study, patients with breast cancer on ET report significant sexual dysfunction. Management of GSM and improved communication between patients and healthcare providers is required and should be prioritized to improve sexual dysfunction and treatment adherence.