Estrogen prescriptions after pelvic radiation for women with early-onset rectal cancer

Abstract

Rates of early-onset rectal cancer are increasing among women younger than 50. Multidisciplinary treatment often includes pelvic radiation, which can induce premature or early menopause. Estrogen replacement therapy can treat the vasomotor symptoms of menopause, but can also support bone and vaginal health. We aimed to report rates of estrogen replacement therapy at our institution. We reviewed the records of women with early-onset rectal cancer treated with pelvic radiation between January 1, 2000 and April 1, 2022. Patient characteristics, bone health, sexual activity and patient-reported sexual health outcomes were compared between those who received estrogen and those who did not. Of 183 women included, 106 (57.9%) were prescribed estrogen after pelvic radiation. Women prescribed estrogen post-RT were younger (43 [37-47] vs 44 [42-47]; P=.01) and were more often non-Hispanic or Latina (98 (92.5%) vs 63 (81.8%); P=.03). Eleven women (6.0%) developed insufficiency fractures. One hundred twenty-nine (70.5%) women reported being sexually active at last follow-up. There were no differences in bone or sexual function outcomes, but women who received estrogen were more likely to be sexually active (89 (84.0%) vs 40 (51.9%); P<.01). Fewer than two thirds of women under 50 years were prescribed estrogen after completing pelvic radiation for early-onset rectal cancer. Further work is needed to define best practices for supporting bone health, vaginal health and quality of life during survivorship. Survivors should seek consultation with a gynecologist familiar with cancer survivorship and discuss the individual risks versus benefits of estrogen replacement therapy.