Jeanne Carter1,2,3, Raymond E Baser4, Deborah J Goldfrank5,6, Barbara Seidel7, Lisania Milli7, Cara Stabile8, Jocelyn Canty5, Sally Saban5, Shari Goldfarb4,9,10, Maura N Dickler11, Ginger J Gardner5,6, Elizabeth L Jewell5,6, Yukio Sonoda5,6, Marisa A Kollmeier12, Kaled M Alektiar12. 1. Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 641 Lexington Avenue, Floor 7, New York, NY, 10022, USA. carterj@mskcc.org. 2. Psychiatry Service, Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Avenue, Floor 7, New York, NY, 10022, USA. carterj@mskcc.org. 3. Department of Psychology, Weill Cornell Medical College, New York, NY, USA. carterj@mskcc.org. 4. Biostatistics Service, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA. 5. Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 641 Lexington Avenue, Floor 7, New York, NY, 10022, USA. 6. Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY, USA. 7. Nursing, Memorial Sloan Kettering Cancer Center, New York, NY, USA. 8. Plastic and Reconstructive Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA. 9. Breast Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA. 10. Department of Medicine, Weill Cornell Medical College, New York, NY, USA. 11. Lilly Oncology, Eli Lilly and Company, New York, NY, USA. 12. Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Abstract
PURPOSE: To assess the feasibility and efficacy of a non-hormonal hyaluronic acid (HLA) vaginal gel in improving vulvovaginal estrogen-deprivation symptoms in postmenopausal women with a history of hormone receptor-positive (HR+) cancer. METHODS: For this single-arm, prospective longitudinal trial, we identified disease-free patients with a history of HR+ breast cancer treated with aromatase inhibitors or HR+ endometrial cancer treated with surgery and postoperative radiation. Participants used HLA daily for the first 2 weeks, and then 3×/week until weeks 12-14; dosage was then increased to 5×/week for non-responders. Vulvovaginal symptoms and pH were assessed at 4 time points (baseline [T1], 4-6 weeks [T2], 12-14 weeks [T3], 22-24 weeks [T4]) with clinical evaluation, the Vaginal Assessment Scale (VAS), Vulvar Assessment Scale (VuAS), Female Sexual Function Index (FSFI), and Menopausal Symptom Checklist (MSCL). RESULTS: Of 101 patients, mean age was 55 years (range, 31-78), 68% (n = 69) were partnered, and 60% (n = 61) were sexually active. In linear mixed models, VAS/VuAS scores significantly improved at all assessment points (all p < 0.001). MSCL scores similarly improved (all p < 0.001). FSFI scores significantly improved from T1 to T2 (p < 0.03), T3 (p < 0.001), and T4 (p < 0.001). Severe vaginal pH (> 6.5) decreased from 26% at T1 to 19% at T4 (p = 0.18). CONCLUSIONS: HLA moisturization improved vulvovaginal health/sexual function of cancer survivors. While HLA administration 1-2×/week is recommended for women in natural menopause, a 3-5×/week schedule appears to be more effective for symptom relief in cancer survivors.
PURPOSE: To assess the feasibility and efficacy of a non-hormonal hyaluronic acid (HLA) vaginal gel in improving vulvovaginal estrogen-deprivation symptoms in postmenopausal women with a history of hormone receptor-positive (HR+) cancer. METHODS: For this single-arm, prospective longitudinal trial, we identified disease-free patients with a history of HR+ breast cancer treated with aromatase inhibitors or HR+ endometrial cancer treated with surgery and postoperative radiation. Participants used HLA daily for the first 2 weeks, and then 3×/week until weeks 12-14; dosage was then increased to 5×/week for non-responders. Vulvovaginal symptoms and pH were assessed at 4 time points (baseline [T1], 4-6 weeks [T2], 12-14 weeks [T3], 22-24 weeks [T4]) with clinical evaluation, the Vaginal Assessment Scale (VAS), Vulvar Assessment Scale (VuAS), Female Sexual Function Index (FSFI), and Menopausal Symptom Checklist (MSCL). RESULTS: Of 101 patients, mean age was 55 years (range, 31-78), 68% (n = 69) were partnered, and 60% (n = 61) were sexually active. In linear mixed models, VAS/VuAS scores significantly improved at all assessment points (all p < 0.001). MSCL scores similarly improved (all p < 0.001). FSFI scores significantly improved from T1 to T2 (p < 0.03), T3 (p < 0.001), and T4 (p < 0.001). Severe vaginal pH (> 6.5) decreased from 26% at T1 to 19% at T4 (p = 0.18). CONCLUSIONS: HLA moisturization improved vulvovaginal health/sexual function of cancer survivors. While HLA administration 1-2×/week is recommended for women in natural menopause, a 3-5×/week schedule appears to be more effective for symptom relief in cancer survivors.
Entities:
Keywords:
Breast cancer; Cancer survivorship; Endometrial cancer; Hyaluronic acid; Sexual function; Vaginal health
Authors: Kathryn E Flynn; Li Lin; Jeanne Carter; Raymond E Baser; Shari Goldfarb; Sally Saban; Kevin P Weinfurt Journal: J Sex Med Date: 2021-08-24 Impact factor: 3.937
Authors: Pamela E Smith; Eric M McLaughlin; Lopa K Pandya; Erinn M Hade; Courtney D Lynch; Catherine O Hudson Journal: Int Urogynecol J Date: 2022-04-20 Impact factor: 1.932