title: Differences in clinician understanding and management of early menopause after breast cancer.
abstract: OBJECTIVE
  Investigation of clinicians' understanding of early menopause diagnosis/management in women with breast cancer.
  
  
  METHODS
  A cross-sectional study of 176 randomly recruited Australian clinicians (35 gynecologists, 35 endocrinologists, 36 oncologists, 35 breast surgeons and 35 general practitioners (GPs)) involved in the care of women with breast cancer. This questionnaire study utilized an index case to assess understanding of early menopause diagnosis and management. Analysis involved descriptive statistics, χ² tests and Student's t-test.
  
  
  RESULTS
  Significant differences between clinician groups regarding diagnostic criteria for early menopause were observed; gynecologists, endocrinologists and GPs selected amenorrhea > 12 months, whereas oncologists and breast surgeons selected elevated serum follicle stimulating hormone level (p < 0.05). Non-hormonal treatment was preferred by most clinician groups. Complementary/alternative medicines were more commonly prescribed by breast surgeons (57%), gynecologists (54%) and endocrinologists (49%) compared to oncologists (28%) or GPs (9%) (p = 0.0001). Exercise (63%) and nutrition (66%) were selected by most gynecologists for treatment of hot flushes, whereas endocrinologists (91%), oncologists (94%), breast surgeons (69%) and GPs (63%) prescribed venlafaxine. Hormone therapy was mainly prescribed by breast surgeons (43%) compared to other groups (p = 0.001). Most clinicians reported that the main problem with menopausal therapies was failure to resolve hot flushes. Exercise, lifestyle and stress management were recommended by all clinician groups for treatment of anxiety/depression.
  
  
  CONCLUSIONS
  This exploratory study demonstrated a lack of consensus between clinician groups in their investigation, diagnosis and management of early menopause in women with breast cancer, with implications for both diagnosis and treatment.
authors: Women's Public Health Research, Monash Applied Research Stream, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia.
authors: P
authors: P
authors: Sayakhot
authors: H J
authors: HJ
authors: Teede
authors: M
authors: M
authors: Gibson-Helm
authors: A
authors: A
authors: Vincent
mesh_terms: D001007:Anxiety; D001315:Australia; D001943:Breast Neoplasms; D003430:Cross-Sectional Studies; D003511:Cyclohexanols / Q000627:therapeutic use; D003863:Depression; D004704:Endocrinology; D015444:Exercise; D005260:Female; D005640:Follicle Stimulating Hormone / Q000097:blood; D058005:General Practitioners; D013502:General Surgery; D006176:Gynecology; D019584:Hot Flashes / Q000628:therapy; D006801:Humans; D008019:Life Style; D008495:Medical Oncology; D008594:Menopause, Premature; D010818:Practice Patterns, Physicians'; D011795:Surveys and Questionnaires; D000069470:Venlafaxine Hydrochloride
chemical_list: D003511:Cyclohexanols; D000069470:Venlafaxine Hydrochloride; D005640:Follicle Stimulating Hormone