Assessment of ovarian failure and osteoporosis in premenopausal breast cancer survivors.
Premenopausal women who develop ovarian failure after receiving chemotherapy are at a higher risk of rapid bone loss. Pharmacists have successfully implemented osteoporosis screening programmes in the general population and thus, assessment of breast cancer survivors for ovarian failure and osteopenia could represent a novel focus for oncology pharmacists. Therefore, we conducted a retrospective chart review to determine the adequacy of ovarian failure and osteoporosis assessment and management in premenopausal breast cancer survivors.


RESULTS
The charts of 20 women diagnosed with early stage breast cancer treated with cyclophosphamide over a 4.5-year timespan were included. Their median age was 36.7 years (range 29.8-41). The median cyclophosphamide cumulative dose was 9 g/m(2) (range 2.4-14.45), with a median duration of follow-up being 4.62 years. The assessment of ovarian failure mainly occurred by documenting menstrual periods, which has been questioned as a reliable method for assessing ovarian failure. Menses stopped while or shortly after receiving chemotherapy in 11 women. Prior to and during cyclophosphamide administration, osteoporosis screening or counselling was not documented for any patient. After completion of chemotherapy administration, eight patients were counselled regarding osteoporosis and seven women were screened for osteoporosis with a dual X-ray absorptimetry (DXA) scan. Five women had DXA scans indicative of osteopenia according to World Health Organization guidelines.


CONCLUSIONS
Improvements are needed in the documentation and potentially also the management of ovarian failure and osteoporosis in premenopausal breast cancer survivors receiving cyclophosphamide-based regimens. This represents a potential opportunity for pharmacists to manage long-term chemotherapy toxicity.
McCune
Jeannine S
JS
Department of Pharmacy, University of Washington, Seattle, 91895-7630, USA. jmccune@u.washington.edu
Games
Dona M
DM
Espirito
Janet L
JL
D015502:Absorptiometry, Photon / Q000706:statistics & numerical data; D000284:Administration, Oral; D000328:Adult; D000367:Age Factors; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D015519:Bone Density; D001943:Breast Neoplasms / Q000150:complications / Q000188:drug therapy*; D002118:Calcium / Q000097:blood; D003276:Contraceptives, Oral / Q000008:administration & dosage; D003520:Cyclophosphamide / Q000008:administration & dosage / Q000009:adverse effects; D004317:Doxorubicin / Q000008:administration & dosage; D004334:Drug Administration Schedule; D017723:Drug Utilization Review / Q000379:methods / Q000706:statistics & numerical data; D004958:Estradiol / Q000097:blood; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D005640:Follicle Stimulating Hormone / Q000097:blood; D005500:Follow-Up Studies; D017273:Goserelin / Q000008:administration & dosage; D006801:Humans; D008499:Medical Records / Q000706:statistics & numerical data; D008599:Menstruation Disturbances / Q000209:etiology; D008727:Methotrexate / Q000008:administration & dosage; D015663:Osteoporosis, Postmenopausal / Q000175:diagnosis* / Q000209:etiology; D017697:Premenopause; D016649:Primary Ovarian Insufficiency / Q000175:diagnosis* / Q000209:etiology; D017064:Process Assessment, Health Care / Q000379:methods; D012189:Retrospective Studies; D017741:Survivors / Q000706:statistics & numerical data*; D013629:Tamoxifen / Q000008:administration & dosage / Q000009:adverse effects; D013997:Time Factors
D003276:Contraceptives, Oral; D013629:Tamoxifen; D017273:Goserelin; D004958:Estradiol; D004317:Doxorubicin; D003520:Cyclophosphamide; D005640:Follicle Stimulating Hormone; D002118:Calcium; D005472:Fluorouracil; D008727:Methotrexate