Hormonal consequences, replacement therapy, and lost workdays after cervical cancer treatment

Abstract: Background: Uterine cervical cancer affects women of all ages and has a generally favorable prognosis. Many survivors live long with the consequences of the disease and its treatment, and therefore it is important to characterize potential treatment-induced morbidity. Aims: To investigate different hormonal aspects and work loss among cervical cancer survivors, by treatment modality. Methods: In a pilot study, we analyzed serum levels of anti-Müllerian hormone (AMH) and follicle-stimulating hormone (FSH) as measurements of ovarian function, as well as estradiol and androgens in serum, and assessed sexual function before and after treatments in a one-year cohort of cervical cancer patients (N = 71). We also used Swedish national registers to investigate use of hormone therapy after cervical cancer treatment, and lost workdays due to sick leave and disability pension among 837 and 1971 patients, respectively. Results: Serum levels of AMH were undetectable one year after salpingooophorectomy or radiotherapy among patients < 45 years of age at diagnosis. After radical hysterectomy and pelvic lymphadenectomy with ovarian preservation, AMH declined, whereas no change was found in serum levels of FSH. Circulating levels of total and free testosterone decreased after pelvic radiotherapy among pre- as well as postmenopausal women. No correlations were found between androgen levels and female sexual function index (FSFI) scores following treatment. Among women with estrogen deprivation due to salpingo-oophorectomy or radiotherapy, 67% had at least one dispensing of hormone therapy during the period 0.5 to 1 year after diagnosis, and 46% dispensed at least 75% of the recommended dose. The proportion of users decreased during follow-up. Relapse-free cervical cancer patients had more lost workdays than matched comparators from the general population for 4 years following diagnosis, and were at increased risk of disability pension following hysterectomy or chemo/radiotherapy. Women treated with fertilitysparing surgery did not have more lost workdays than the comparators beyond the first year and were not at increased risk of disability pension. Conclusions: Serum levels of AMH were reduced after radical hysterectomy with ovarian preservation, indicating a possible risk of early ovarian failure. Testosterone in serum was reduced after radiotherapy, but was not associated with sexual function in this pilot setting. Less than half of cervical cancer survivors likely to have therapy-induced early menopause used hormone therapy at, or close to, the recommended dose, and the use decreased during follow-up. All treatment modalities for cervical cancer except fertility-sparing surgery were associated with long-term work disability.