Patient experience of menopause care after breast cancer in the UK: a cross-sectional study.

Abstract

Objectives: This study aimed to explore women's experience of menopause care after breast cancer in the UK.

Methods: An online survey incorporating the validated Shared Decision Making SDM-Q-9 questionnaire was disseminated via social media to breast cancer survivors in the UK.

Results: A total of 1,195 women completed the survey. The menopause symptom burden was high (99.7%). Fear of recurrence was the dominant concern for 55.6% of women, but 44.4% were more concerned about quality of life and future risk of long-term conditions associated with estrogen deficiency. Women further from diagnosis were less concerned about recurrence (fear of recurrence was the dominant concern for 58.6% of women within 2 y of diagnosis vs. 43.1% of women more than 15 y from diagnosis, P = 0.001). Of all women, 68.3% were offered treatment (nonhormone treatment, 58.5%; vaginal hormones, 35.5%; menopause hormone therapy, 13.1%; testosterone, 10.1%). Menopause specialists were more likely to prescribe MHT versus nonmenopause specialists (68.2% vs. 31.8%, P < 0.0001); GP menopause specialists were more likely to prescribe testosterone versus gynecologist menopause specialists (60.8% vs. 39.2%, P < 0.0001). Of all women, 49.6% who were not offered menopause hormone therapy were willing to consider it, and 83.7% wanted more information about menopause hormone therapy. Information provision and time allocated to menopause-related discussion were poor (<10 min for 73.52% of women). Involvement in menopause-related treatment decisions was low (SDM-Q-9 median score, 11.1/100; IQR, 0.0-28.9). Women who consulted a menopause specialist (30.2%) were significantly more able to discuss their concerns (P < 0.001), were given significantly more time (>10 min for 75.6%, P < 0.001), and felt significantly more involved in menopause-related treatment decisions (P < 0.001). Overall, 96% of women wanted more support for menopausal symptoms.

Conclusions: Many women in the study cohort had unmet menopause-related health needs after breast cancer, and the quality of menopause care received was poor. Most women felt uninvolved in menopause-related treatment decisions. Women experienced higher quality menopause care if they had access to a menopause specialist.