Presentation on theme: "The current management of vasomotor symptoms in breast cancer patients in the UK: Clinician versus Patient perspective. Mei-Lin Ah-See 1,Charlotte Coles."— Presentation transcript:
The current management of vasomotor symptoms in breast cancer patients in the UK: Clinician versus Patient perspective. Mei-Lin Ah-See 1,Charlotte Coles 2, Deborah Fenlon 3, Emma Pennery 4, Janet Dunn 5 & Adrienne Morgan 6 on behalf of the NCRI Breast CSG Working Party on Symptom Management (Vasomotor) 1 Mount Vernon Cancer Centre, London, UK, 2 Cambridge University Hospitals NHS Foundation Trust< Cambridge, UK, 3 Faculty of Health Sciences, University of Southampton, Southampton, UK, 4 Breast Cancer Care, UK, 5 University of Warwick, Coventry, UK, 6 Independent Cancer Patients’ Voice, London UK. Background Patient advocate members of the National Cancer Research Institute UK Breast Clinical Studies Group and UK Breast Intergroup identified that there is very little research into the management of symptoms after breast cancer treatment and that this constituted a lack in the current portfolio. Members of the group all have a particular interest in the management of hot flushes and include patient advocates, clinical and academic partners, representing oncology, psychology, gynaecology, complementary therapies and the voluntary sector. On the initiative of the patient advocate members of the NCRI Breast Clinical Studies Group, a Working Group on Symptom Management has been established. The group agreed to work on the management of hot flushes in the first instance, due to its prevalence, distressing nature and intractability. Hot Flushes (vasomotor symptoms) are a serious problem. They impact significantly on daily life and sleep quality, affecting employment, relationships and quality of life. The only effective treatment for hot flushes is oestrogen which is contraindicated in the 75% of breast cancer patients who’s cancer is oestrogen driven. There are an estimated 550,000 people living in the UK today who have been diagnosed with breast cancer and up to 70% women experience disabling hot flushes after treatment for breast cancer. That’s a lot of hot flushes. These can continue for years after treatment and probably contribute to the 50% of patients who have stopping taking their life-saving antioestrogen drugs before 5 years. Here we present a Clinician versus Patient Perspective on hot flushes Patient Perspective 666 patients responded to BCC questionnaire Median age 50 years (range 25-69) In Conclusion: What Do We Want? Despite the size of this problem, within the UK there are no nationally agreed guidelines for managing hot flushes after breast cancer, which may limit the access and availability of currently available and appropriate interventions. There is limited evidence to support a variety of interventions, none of which are entirely effective at eliminating hot flushes, other than hormone replacement therapy, which is contraindicated. All the available pharmacological interventions can have severe side-effects and few are widely acceptable. Our surveys have confirmed the size of the problem but also show that there is patchy and inequitable management of this problem (data not shown), which continues to be a cause of considerable distress to many women after breast cancer. There is an urgent need for research across the field to understand the physiology of flushing and to develop and test new interventions. Roughly what percentage of your breast cancer patients have severe hot flushes that affect daily living and quality of sleep If you treat hot flushes medically what do you use? Which complementary treatments would you recommend to your breast cancer patients for hot flushes? I believe treatment of hot flushes is an unmet need Clinician Perspective 185 respondents questionnaire Abstract: Background: The vasomotor symptom of hot flushes (or flashes) is a well recognised, commonly reported side-effect in breast cancer (BC) patients treated with chemotherapy & endocrine therapy. It can significantly impact on quality of life &, for some patients, leads to the discontinuation of treatment resulting in worse BC outcomes. Managing this symptom is challenging & there is currently no consensus on best practise. In response to this challenge, & on the initiative of patient advocate members, the UK National Cancer Research Institute Breast Clinical Studies Group (NCRI Breast CSG) has established a multi-disciplinary working party to evaluate & improve vasomotor symptom management. A starting point for the group was to establish the current opinions & practise of UK clinicians & their patients. Materials & Methods: A short questionnaire was circulated to the members of the NCRI UK Breast Intergroup (BC healthcare professionals). A Separate patient survey was opened on the Breast Cancer Care website & advertised via the BCC Facebook &Twitter Social media accounts. Results: There were 185 respondents to the Healthcare professional survey & as yet, 625 respondents to the patient survey (still ‘live’). 95% of healthcare professional respondents ‘agreed’ or ‘strongly agreed’ that the treatment & management of hot flushes is currently an unmet need. Treatments vary across the UK & include pharmacological & non-pharmacological interventions. The most commonly prescribed drugs are the selective serotonin reuptake inhibitors (58%), such as venlafaxine, followed by clonidine (18%) & gabapentin (11%). Hormone replacement therapy & progesterone preparations are used by a small number (6.7% & 4.7% respectively). Complementary therapies are commonly recommended, in particular, evening primrose oil & acupuncture. Access to dedicated Cancer-related menopaus clinics is poor. The results of the patient survey will be presented at the meeting along with the final results from the Healthcare Professional survey. Conclusion: There is currently no consensus regarding best practise for the management of hot flushes in BC patients within the UK. Lead by patient advocates, the NCRI Breast CSG has established a multi-disciplinary working party with the aim of addressing this unmet need by increasing awareness, promoting clinical studies & contributing to the establishment of evidence-based clinical guidelines for BC patients within the planned NICE guidance on diagnosis & management of menopause.