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Published in:

01-06-2018

Predictors of vasomotor symptoms among breast cancer survivors

Authors: Katherine W. Reeves, Michael Pennell, Randi E. Foraker, Carolyn J. Crandall, Marcia Stefanick, Electra D. Paskett

Published in: Journal of Cancer Survivorship | Issue 3/2018

Abstract

Purpose

Vasomotor symptoms (VMS) are a common side effect of breast cancer treatment, yet modifiable factors that may predict VMS among breast cancer survivors are unknown.

Methods

We estimated multivariable-adjusted odds ratios and 95% confidence intervals (aOR, 95% CI) for predictors of VMS among 3595 breast cancer survivors enrolled in the Life and Longevity after Cancer (LILAC) study, an ancillary study of the Women’s Health Initiative (WHI).

Results

VMS post-diagnosis were reported by 790 (22.0%) participants. Risk of VMS after diagnosis was positively associated with prior chemotherapy (aOR 1.80, 95% CI 1.21–2.68) and adjuvant hormone therapy (aOR 2.73, 95% CI 2.08–3.58), postmenopausal hormone therapy use (aOR 1.67, 95% CI 1.30–2.13), prior VMS (aOR 2.20, 95% CI 1.73–2.80), bilateral oophorectomy (aOR 1.77, 95% CI 1.37–2.27), and baseline antidepressant use (aOR 1.49, 1.06–2.09). VMS post-diagnosis were less likely among younger women (aOR 0.94, 95% CI 0.93–0.96), women younger at menopause (aOR 0.98, 95% CI 0.97–1.00), women with more time since diagnosis (aOR 0.92, 95% CI 0.90–0.94), and diabetics (aOR 0.45, 95% CI 0.21–0.95). Metabolic syndrome was not associated with post-diagnosis VMS (aOR 0.76, 95% CI 0.45–1.28).

Conclusions

VMS following breast cancer diagnosis was related to a number of modifiable factors, but was unrelated to metabolic syndrome.

Implications for Cancer Survivors

Identification of factors that predispose women to VMS following a breast cancer diagnosis may allow clinicians to recognize and address VMS in the subset of women who are most likely to experience such symptoms.

North American Menopause Society. Menopause practice: a clinician’s guide. 3rd ed. Cleveland: North American Menopause Society; 2007.

Carpenter JS, Andrykowski MA. Menopausal symptoms in breast cancer survivors. Oncol Nurs Forum. 1999;26(8):1311–7.PubMed

Gold EB, Sternfeld B, Kelsey JL, Brown C, Mouton C, Reame N, et al. Relation of demographic and lifestyle factors to symptoms in a multi-racial/ethnic population of women 40-55 years of age. Am J Epidemiol. 2000;152(5):463–73. https://doi.org/10.1093/aje/152.5.463.CrossRefPubMed

Carpenter JS, Johnson D, Wagner L, et al. Hot flashes and related outcomes in breast cancer survivors and matched comparison women. Oncol Nurs Forum. 2002;29(3):E16–25. https://doi.org/10.1188/02.ONF.E16-E25.CrossRefPubMed

Gast GC, Samsioe GN, Grobbee DE, et al. Vasomotor symptoms, estradiol levels and cardiovascular risk profile in women. Maturitas. 2010;66(3):285–90. https://doi.org/10.1016/j.maturitas.2010.03.015.CrossRefPubMed

Thurston RC, Sowers MR, Chang Y, Sternfeld B, Gold EB, Johnston JM, et al. Adiposity and reporting of vasomotor symptoms among midlife women: the study of women’s health across the nation. Am J Epidemiol. 2008;167(1):78–85. https://doi.org/10.1093/aje/kwm244.CrossRefPubMed

Thurston RC, Sutton-Tyrrell K, Everson-Rose SA, Hess R, Matthews KA. Hot flashes and subclinical cardiovascular disease: findings from the Study of Women’s Health Across the Nation Heart Study. Circulation. 2008;118(12):1234–40. https://doi.org/10.1161/CIRCULATIONAHA.108.776823.CrossRefPubMedPubMedCentral

Szmuilowicz ED, Manson JE, Rossouw JE, et al. Vasomotor symptoms and cardiovascular events in postmenopausal women. Menopause. 2011;18(6):603–10. https://doi.org/10.1097/gme.0b013e3182014849.CrossRefPubMedPubMedCentral

Crandall CJ, Zheng Y, Crawford SL, Thurston RC, Gold EB, Johnston JM, et al. Presence of vasomotor symptoms is associated with lower bone mineral density: a longitudinal analysis. Menopause. 2009;16(2):239–46. https://doi.org/10.1097/gme.0b013e3181857964.CrossRefPubMedPubMedCentral

10.

Crandall CJ, Tseng CH, Crawford SL, Thurston RC, Gold EB, Johnston JM, et al. Association of menopausal vasomotor symptoms with increased bone turnover during the menopausal transition. J Bone Miner Res. 2011;26(4):840–9. https://doi.org/10.1002/jbmr.259.CrossRefPubMed

11.

Brennan ME, Houssami N. Overview of long term care of breast cancer survivors. Maturitas. 2011;69(2):106–12. https://doi.org/10.1016/j.maturitas.2011.03.010.CrossRefPubMed

12.

Otte JL, Flockhart D, Hayes D, Storniolo AM, Stearns V, Schneider B, et al. Comparison of subjective and objective hot flash measures over time among breast cancer survivors initiating aromatase inhibitor therapy. Menopause. 2009;16(4):653–9. https://doi.org/10.1097/gme.0b013e3181a5d0d6.CrossRefPubMedPubMedCentral

13.

Gold EB, Block G, Crawford S, Lachance L, FitzGerald G, Miracle H, et al. Lifestyle and demographic factors in relation to vasomotor symptoms: baseline results from the Study of Women’s Health Across the Nation. Am J Epidemiol. 2004;159(12):1189–99. https://doi.org/10.1093/aje/kwh168.CrossRefPubMed

14.

Gold EB, Colvin A, Avis N, Bromberger J, Greendale GA, Powell L, et al. Longitudinal analysis of the association between vasomotor symptoms and race/ethnicity across the menopausal transition: study of women’s health across the nation. Am J Public Health. 2006;96(7):1226–35. https://doi.org/10.2105/AJPH.2005.066936.CrossRefPubMedPubMedCentral

15.

Thurston RC, Sowers MR, Sternfeld B, Gold EB, Bromberger J, Chang Y, et al. Gains in body fat and vasomotor symptom reporting over the menopausal transition: the study of women’s health across the nation. Am J Epidemiol. 2009;170(6):766–74. https://doi.org/10.1093/aje/kwp203.CrossRefPubMedPubMedCentral

16.

Lee SW, Jo HH, Kim MR, Kwon DJ, You YO, Kim JH. Association between menopausal symptoms and metabolic syndrome in postmenopausal women. Arch Gynecol Obstet. 2012;285(2):541–8. https://doi.org/10.1007/s00404-011-2016-5.CrossRefPubMed

17.

Paskett ED, Caan BJ, Johnson L, et al. The Women’s Health Initiative (WHI) Life and Longevity after Cancer (LILAC) Study: description and baseline characteristics of participants. Cancer Epidemiol Biomark Prev. 2018. https://doi.org/10.1158/1055-9965.EPI-17-0581

18.

Design of the Women’s Health Initiative clinical trial and observational study. The Women’s Health Initiative Study Group. Control Clin Trials. 1998;19:61–109.

19.

Reeves KW, McLaughlin V, Fredman L, Ensrud K, Cauley JA. Components of metabolic syndrome and risk of breast cancer by prognostic features in the study of osteoporotic fractures cohort. Cancer Causes Control. 2012;23(8):1241–51. https://doi.org/10.1007/s10552-012-0002-2.CrossRefPubMedPubMedCentral

20.

Alberti KG, Eckel RH, Grundy SM, Zimmet PZ, Cleeman JI, Donato KA, et al. Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation. 2009;120(16):1640–5. https://doi.org/10.1161/CIRCULATIONAHA.109.192644.CrossRefPubMed

21.

Austin PC, Stuart EA. Moving towards best practice when using inverse probability of treatment weighting (IPTW) using the propensity score to estimate causal treatment effects in observational studies. Stat Med. 2015;34(28):3661–79. https://doi.org/10.1002/sim.6607.CrossRefPubMedPubMedCentral

22.

Ibrahim JG, Chu H, Chen MH. Missing data in clinical studies: issues and methods. J Clin Oncol. 2012;30(26):3297–303. https://doi.org/10.1200/JCO.2011.38.7589.CrossRefPubMedPubMedCentral

23.

van Buuren S. Multiple imputation of discrete and continuous data by fully conditional specification. Stat Methods Med Res. 2007;16(3):219–42. https://doi.org/10.1177/0962280206074463.CrossRefPubMed

24.

Wood AM, White IR, Royston P. How should variable selection be performed with multiply imputed data? Stat Med. 2008;27(17):3227–46. https://doi.org/10.1002/sim.3177.CrossRefPubMed

25.

Carpenter JS, Andrykowski MA, Cordova M, Cunningham L, Studts J, McGrath P, et al. Hot flashes in postmenopausal women treated for breast carcinoma: prevalence, severity, correlates, management, and relation to quality of life. Cancer. 1998;82(9):1682–91. https://doi.org/10.1002/(SICI)1097-0142(19980501)82:9<1682::AID-CNCR14>3.0.CO;2-0.CrossRefPubMed

26.

Chandwani KD, Heckler CE, Mohile SG, Mustian KM, Janelsins M, Peppone LJ, et al. Hot flashes severity, complementary and alternative medicine use, and self-rated health in women with breast cancer. Explore (NY). 2014;10(4):241–7. https://doi.org/10.1016/j.explore.2014.04.003.CrossRef

27.

Chang HY, Jotwani AC, Lai YH, Jensen MP, Syrjala KL, Fann JR, et al. Hot flashes in breast cancer survivors: frequency, severity and impact. Breast. 2016;27:116–21. https://doi.org/10.1016/j.breast.2016.02.013.CrossRefPubMedPubMedCentral

28.

Ganz PA, Petersen L, Bower JE, Crespi CM. Impact of adjuvant endocrine therapy on quality of life and symptoms: observational data over 12 months from the mind-body study. J Clin Oncol. 2016;34(8):816–24. https://doi.org/10.1200/JCO.2015.64.3866.CrossRefPubMedPubMedCentral

29.

Gupta P, Sturdee DW, Palin SL, Majumder K, Fear R, Marshall T, et al. Menopausal symptoms in women treated for breast cancer: the prevalence and severity of symptoms and their perceived effects on quality of life. Climacteric. 2006;9(1):49–58. https://doi.org/10.1080/13697130500487224.CrossRefPubMed

30.

Gallicchio L, MacDonald R, Wood B, Rushovich E, Helzlsouer KJ. Menopausal-type symptoms among breast cancer patients on aromatase inhibitor therapy. Climacteric. 2012;15(4):339–49. https://doi.org/10.3109/13697137.2011.620658.CrossRefPubMed

31.

van Dijk GM, Maneva M, Colpani V, Dhana K, Muka T, Jaspers L, et al. The association between vasomotor symptoms and metabolic health in peri- and postmenopausal women: a systematic review. Maturitas. 2015;80(2):140–7. https://doi.org/10.1016/j.maturitas.2014.11.016.CrossRefPubMed

32.

Thurston RC, El Khoudary SR, Sutton-Tyrrell K, et al. Vasomotor symptoms and lipid profiles in women transitioning through menopause. Obstet Gynecol. 2012;119(4):753–61. https://doi.org/10.1097/AOG.0b013e31824a09ec.CrossRefPubMedPubMedCentral

33.

Thurston RC, El Khoudary SR, Sutton-Tyrrell K, et al. Vasomotor symptoms and insulin resistance in the study of women’s health across the nation. J Clin Endocrinol Metab. 2012;97(10):3487–94. https://doi.org/10.1210/jc.2012-1410.CrossRefPubMedPubMedCentral

34.

Gallicchio L, Visvanathan K, Miller SR, Babus J, Lewis LM, Zacur H, et al. Body mass, estrogen levels, and hot flashes in midlife women. Am J Obstet Gynecol. 2005;193(4):1353–60. https://doi.org/10.1016/j.ajog.2005.04.001.CrossRefPubMed

35.

Huang AJ, Grady D, Jacoby VL, Blackwell TL, Bauer DC, Sawaya GF. Persistent hot flushes in older postmenopausal women. Arch Intern Med. 2008;168(8):840–6. https://doi.org/10.1001/archinte.168.8.840.CrossRefPubMed

36.

Schilling C, Gallicchio L, Miller SR, Langenberg P, Zacur H, Flaws JA. Relation of body mass and sex steroid hormone levels to hot flushes in a sample of mid-life women. Climacteric. 2007;10(1):27–37. https://doi.org/10.1080/13697130601164755.CrossRefPubMed

37.

Antonopoulos AS, Margaritis M, Lee R, et al. Statins as anti-inflammatory agents in atherogenesis: molecular mechanisms and lessons from the recent clinical trials. Curr Pharm Des. 2012;18(11):1519–30. https://doi.org/10.2174/138161212799504803.CrossRefPubMedPubMedCentral

38.

Thurston RC, El Khoudary SR, Sutton-Tyrrell K, et al. Are vasomotor symptoms associated with alterations in hemostatic and inflammatory markers? Findings from the Study of Women’s Health Across the Nation. Menopause. 2011;18(10):1044–51. https://doi.org/10.1097/gme.0b013e31821f5d39.CrossRefPubMedPubMedCentral

39.

Kemp A, Preen DB, Saunders C, Boyle F, Bulsara M, Malacova E, et al. Early discontinuation of endocrine therapy for breast cancer: who is at risk in clinical practice? Spring. 2014;3(1):282. https://doi.org/10.1186/2193-1801-3-282.CrossRef

Title: Predictors of vasomotor symptoms among breast cancer survivors
Authors: Katherine W. Reeves
Michael Pennell
Randi E. Foraker
Carolyn J. Crandall
Marcia Stefanick
Electra D. Paskett
Publication date: 01-06-2018
Publisher: Springer US
Published in: Journal of Cancer Survivorship / Issue 3/2018
Print ISSN: 1932-2259
Electronic ISSN: 1932-2267
DOI: https://doi.org/10.1007/s11764-018-0677-9

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Abstract

Purpose

Methods

Results

Conclusions

Implications for Cancer Survivors

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