Treatment of climacteric symptoms in breast cancer patients: a retrospective study from a medication databank.
BACKGROUND
Women affected by breast cancer (BC) will often go through menopause at an earlier age and display more frequent and severe symptoms than women who have a natural menopause. The safety of hormone replacement therapy (HRT) and vaginal estrogens for BC survivors has been debated over time and remains unclear. Non hormonal therapies such as antidepressants, gabapentine and clonidine may be useful for those patients but there are few data about their safety.


OBJECTIVE
This retrospective study analyses the use by BC patients of treatments known to alleviate climacteric symptoms.


METHODS
Post-menopausal Estrogen Receptors positive (ER+) BC patients, aged 45-69, were identified as having bought, at least once, an aromatase inhibitor (AI) or tamoxifen between the years 2000 and 2012 through a pharmaceutical databank in Belgium. Among them, we defined users of a climacteric treatment those who bought, at least once, HRT, vaginal topical estrogens, antidepressants, clonidine and gabapentine.


RESULTS
We identified 2530 BC patients. Among them, 45% were buying a treatment known to alleviate menopausal symptoms. The majority of these treatments were non-HRT therapies. HRT and vaginal estrogens were seldom bought (respectively 1.1% and 6%), but 3% bought vaginal estrogens while buying AI. About 9.2% of tamoxifen users patients bought antidepressants implicated in tamoxifen metabolism at the same time as tamoxifen.


CONCLUSIONS
Most BC patients follow current guidelines contra-indicating the use of HRT after BC, they use non hormonal therapies. In some cases they use unfortunately antidepressants that may alter the metabolism of tamoxifen.
Department of Obstetrics and Gynaecology, Free Universities of Brussels (ULB-VUB), CHU Saint-Pierre, Rue Haute 322, 1000 Brussels, Belgium. Electronic address: caroline_antoine@stpierre-bru.be.
Caroline
C
Antoine
Data Centre, Free Universities of Brussels (ULB-VUB), Institut Jules Bordet, Boulevard de Waterloo 121, 1000 Brussels, Belgium.
Lieveke
L
Ameye
Data Centre, Free Universities of Brussels (ULB-VUB), Institut Jules Bordet, Boulevard de Waterloo 121, 1000 Brussels, Belgium.
Marianne
M
Paesmans
Department of Obstetrics and Gynaecology, Free Universities of Brussels (ULB-VUB), CHU Saint-Pierre, Rue Haute 322, 1000 Brussels, Belgium.
Serge
S
Rozenberg
D000368:Aged; D000588:Amines / Q000627:therapeutic use; D000928:Antidepressive Agents / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D047072:Aromatase Inhibitors / Q000627:therapeutic use; D001530:Belgium; D001943:Breast Neoplasms / Q000150:complications*; D002979:Climacteric; D003000:Clonidine / Q000627:therapeutic use; D003509:Cyclohexanecarboxylic Acids / Q000627:therapeutic use; D016208:Databases, Factual; D004347:Drug Interactions; D015914:Estrogen Replacement Therapy / Q000706:statistics & numerical data*; D004967:Estrogens / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D000077206:Gabapentin; D006801:Humans; D008594:Menopause, Premature; D008875:Middle Aged; D012189:Retrospective Studies; D012651:Self Medication; D017741:Survivors; D013629:Tamoxifen / Q000378:metabolism / Q000627:therapeutic use; D014622:Vaginal Creams, Foams, and Jellies; D005680:gamma-Aminobutyric Acid / Q000627:therapeutic use
D000588:Amines; D000928:Antidepressive Agents; D000970:Antineoplastic Agents; D047072:Aromatase Inhibitors; D003509:Cyclohexanecarboxylic Acids; D004967:Estrogens; D014622:Vaginal Creams, Foams, and Jellies; D013629:Tamoxifen; D005680:gamma-Aminobutyric Acid; D000077206:Gabapentin; D003000:Clonidine
Breast cancer; Breast cancer survivors; Climacteric symptoms and treatment; Menopause