Burden of induced vasomotor symptoms in patients with HR+ breast cancer receiving adjuvant endocrine therapy.
Authors: Joehl Nguyen, Sophie Maille, Senka Djordjevic, Christian Seitz, Kelly Genga, Ann-Kathrin Frenz, Jelena Milosavljevic, Saskia Hagenaars, Luis Antunes, Nicolas Niklas, Anne Marie Saunders, Nils Schoof
Journal: Journal of Clinical Oncology (2025)

e12504 Background: Adjuvant endocrine therapy (AET) is standard treatment for hormone-receptor positive (HR+) breast cancer (BC) and is associated with induced vasomotor symptoms (VMS), also known as hot flashes. Induced VMS can negatively affect quality of life and contribute to discontinuation of therapy. AET discontinuation is associated with increased recurrence of BC and reduced survival. Understanding characteristics of women with HR+ BC receiving AET and the burden of induced VMS in HR+ BC is critical to develop treatment strategies to improve adherence and patient outcomes. Methods: This retrospective cohort study analyzed electronic medical records (EMR) from the Guardian Research Network in the United States. The study included women aged 18–70 years with newly diagnosed Stage 0-III HR+ BC initiating AET between 2016-2023. Those with history of any non-breast malignancy were excluded. Demographics and clinical data were extracted from structured EMR. Variables not in structured EMR, including induced VMS and other symptoms, were collected through text-mining and natural language processing. Physician notes were manually curated for select variables in a random sample to assess concordance with the full cohort. The proportion of patients with induced VMS and other symptoms observed during AET was assessed; patients were followed until earliest of AET discontinuation, BC recurrence, death, or the end of the study period. Results: The study cohort included 4459 patients who met inclusion criteria. Mean age at start of AET was 57 years and a majority were stage 0-II (92%). At BC diagnosis, 57% of patients with induced VMS had a postmenopausal status record versus 51% of patients without induced VMS. Most common primary BC treatments were surgery alone (49%) and surgery with radiotherapy (19%). Index AET included 71 % and 26% receiving aromatase inhibitors (AI) and tamoxifen, respectively. Hot flashes (50%) and night sweats (13%) were among the most prevalent symptoms during AET. The prevalence of hot flashes and night sweats were similar among patients treated with AI (47% and 12%, respectively) and tamoxifen (58% and 16%, respectively). Other common symptoms during AET included mood problems(34%), vaginal dryness (18%), and sleep disturbance (18%). The sample of 292 patients with manually curated data differed from the full cohort in some variables such as postmenopausal status (75%), BC surgery alone (36%), and surgery with radiotherapy (32%), alldriven by structured data limitations. However, the prevalence of symptoms during AET was similar to the full cohort for hot flashes (52%), night sweats (7%),mood problems(24%), vaginal dryness (13%), and sleep disturbance (21%). Conclusions: This study describes the baseline characteristics and highlights the substantial burden of induced VMS and other symptoms commonly associated with menopause among women receiving AET for HR+ BC.