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The multidisciplinary management of menopausal symptoms after breast cancer: a unique model of care

Hickey, Martha MD1; Emery, Laura I. BSci2; Gregson, Jane BA1; Doherty, Dorota A. PhD1; Saunders, Christobel M. MD2

doi: 10.1097/gme.0b013e3181d672f6

Objective: The aim of this study was to describe a unique model of multidisciplinary care for women with menopausal symptoms after breast cancer and present preliminary data for 653 women.

Methods: The nature and severity of menopausal symptoms in women with breast cancer were measured using a standardized scale.

Results: A total of 578 women with breast cancer were managed at the Menopausal Symptoms After Cancer Clinic between January 2003 and December 2008. The most common reasons for these women to seek treatment were hot flushes (41%), night sweats (36%), loss of interest in sex (30%), difficulty sleeping (25%), and fatigue (22%). Extreme vaginal dryness was also reported in 19% of these women. Chemotherapy-induced ovarian failure was reported by 29% of the breast cancer patients seen. A range of management approaches were offered, with 55% of the women prescribed nonhormonal pharmacological therapies for vasomotor symptoms, including vitamin E 400 IU twice daily (21%), venlafaxine 75 mg CR once daily (13%), clonidine 50 μg twice daily (11%), or gabapentin 300 mg three times daily (4%).

Conclusions: Vasomotor symptoms, sexual dysfunction, and sleep disturbance are the most distressing menopausal symptoms requiring management after breast cancer. Menopausal symptom management after breast cancer may be complex, and we present a novel model of care using a multidisciplinary approach. Additional benefits of this multidisciplinary approach include education opportunities, improved communication and networking opportunities, and decision making in line with evidence-based guidelines.

This article describes a unique model of multidisciplinary care for women with menopausal symptoms after breast cancer and presents preliminary data on the nature and severity of menopausal symptoms. This multidisciplinary approach ensures that women are given the opportunity to make informed and evidence-based treatment choices and are not given conflicting messages from different healthcare providers.

From the 1School of Women's and Infants' Health, King Edward Memorial Hospital, and 2School of Surgery, The University of Western Australia, Crawley, WA, Australia.

Received November 11, 2009; revised and accepted January 4, 2010.

Funding/support: King Edward Memorial Hospital provided the facilities to house the MSAC clinic and database and AstraZeneca provided an educational grant to help establish the MSAC clinic. The National Breast and Ovarian Cancer Centre and National Breast Cancer Foundation provided financial assistance with clinic projects and research, including a National Breast Cancer Foundation Concept Award for Professors Hickey and Saunders.

Financial disclosure/conflicts of interest: Professors Hickey and Saunders are members of the AstraZeneca Advisory Board. AstraZeneca has had no role in the running of the clinic or in the preparation of this article.

Address correspondence to: Christobel M. Saunders, MD, School of Surgery, The University of Western Australia, QEII Medical Centre (M507), 35 Stirling Highway, Crawley, Western Australia 6009. E-mail:

©2010The North American Menopause Society