Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0006826 (cancer)
 1,092,456 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Hormone replacement therapy (HRT) was initially given to protect women against osteoporosis and alleviate menopausal symptoms, such as hot flashes, depression, sleep disturbances, and vaginal dryness. In view of the understanding of oestrogen deficiency as a major trigger for the acceleration of cardiovascular risk after menopause, HRT may also be proposed as a substantial beneficial cardioprotective agent. Progestins, which may be added to oestrogen in combined HRT to reduce the risk of uterine malignancy, have a number of potential adverse effects on the cardiovascular system which could even attenuate the benefit of unopposed oestrogen replacement therapy in post-menopausal women.
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PMID:The relative effects of progesterone and progestins in hormone replacement therapy. 1092 19

Postmenopausal women have sought nonestrogen alternatives to hormone replacement in order to avoid possible risks and side effects of the therapy. Selective estrogen receptor modulators have been developed to tailor therapy to a specific risk/benefit profile that will best fit the patient. More women have looked to phytoestrogens, such as the isoflavones found in the soy plant, to tailor their menopausal therapy in a "natural" way. This review examines the evidence regarding the risks and benefits of isoflavones as hormone replacement therapy. Controlled trials have shown a reduction in postmenopausal hot flashes when subjects' diets were supplemented with soy. There is less evidence for a benefit in vaginal dryness symptoms. Furthermore, dietary supplementation also appears to lower total and low-density lipoprotein cholesterol in hypercholesterolemic subjects. A synthetic isoflavone, ipriflavone, has been shown in controlled trials to prevent postmenopausal bone loss, though there is much less evidence that soy isoflavones will accomplish this goal. Finally, although unopposed estrogen replacement may promote breast and endometrial cancer, there is no evidence that phytoestrogens will do the same. In contrast, great interest has been taken in the potential cancer-protective effects of phytoestrogens, though prospective evidence in postmenopausal women is not available. Although data regarding the use of isoflavone extracts are incomplete, dietary supplementation with soy foods appears to be a safe and possibly beneficial option for postmenopausal women.
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PMID:Phytoestrogens as hormone replacement therapy: an evidence-based approach. 1107 39

The purpose of this study was to ascertain whether acute menopause symptoms experienced by women with breast cancer differed from those of women experiencing a natural menopause. For the study, 200 women younger than 65 years of age receiving adjuvant systemic treatment for breast cancer were invited to complete a self-report questionnaire incorporating a previously validated tool: the Greene Climacteric Scale. The control group consisted of 200 women 50 to 64 years of age who did not have a breast cancer diagnosis. An overall response rate of 59.5% was obtained. The majority of the respondents were peri- or postmenopause at the time of the study, reporting either "irregular periods" or "no periods." Findings demonstrated that women receiving adjuvant systemic breast cancer treatment were more likely than the control group to report a current experience of menopause symptoms. Women with breast cancer also reported a higher incidence and severity of specific menopause symptoms (tiredness, hot flushes, night sweats) than control subjects. These differences remained statistically significant when controls were used for potential confounding variables such as age, menopause status, and time since last period. Hot flushes ranked second only to tiredness as side effects attributed to cancer treatments. Because of the intimate and supportive nature of their role, nurses are in a key position to conduct future research relating to women's experiences of menopause symptoms and potential therapeutic interventions. Within the specific context of breast cancer care, oncology nurses are recognized as having a central role in informing and supporting women throughout the breast cancer trajectory. Thus they are ideally placed to address menopause as a particular survivorship issue.
Cancer Nurs 2000 Dec
PMID:Acute menopause symptoms during adjuvant systemic treatment for breast cancer: a case-control study. 1112 22

Menopausal symptoms are important concerns for breast cancer survivors, which may influence daily activities, physical comfort and sexual health. Incidence and severity ratings of menopausal symptoms contribute to our knowledge about menopause in women with cancer, but fail to fully describe the symptom experience. The purpose of this article is to broaden our understanding by describing variation in menopausal symptom distress and how women interpret and manage symptoms within the context of breast cancer. From a larger grounded theory study that explored women's responses to the experience of premature induced menopause within the context of breast cancer, the constant comparative method of analysis was used to generate a detailed contextually grounded description of the menopausal symptom experience in a sample of 27 women with breast cancer who received adjuvant therapy. Women identified a symptom profile of menstrual cycle changes, hot flashes, insomnia, vaginal dryness, dyspareunia, alterations in mood, cognition and libido, and weight gain. The majority of women reported menopausal symptoms but some women were distress free while others reported moderate to severe distress. The context of breast cancer influenced women's response to symptoms and their decision making about menopausal symptom management.
Cancer Nurs 2001 Jun
PMID:The menopausal symptom experience in young mid-life women with breast cancer. 1140 64

Female hormones, especially estrogens, play an important role in the pathogenesis of breast neoplasms and are a principal determinant of their biological behavior. Endocrine manipulation through medical or surgical means can often lead to objective shrinkage of breast tumors. Tamoxifen, a triphenylethylene estrogen receptor modulator, is currently the most widely used hormonal treatment for breast cancer. It has been conclusively demonstrated to reduce the risk of relapse following definitive local therapy (and systemic chemotherapy, when indicated) of invasive or noninvasive breast cancer. Recently, it has also been shown to reduce the incidence of breast cancer in healthy women who are at high risk of developing the disease. In addition, it can prevent osteoporosis and reduce the risk of fractures in postmenopausal women. However, its use is also complicated by an increased incidence of endometrial hyperplasia/carcinoma, venous thromboembolism, cataracts, and in some cases, emergence of tamoxifen-dependent clones of breast cancer. These side effects (except cataracts) are believed to be related to estrogen-agonist effects of tamoxifen. Newer drugs, which are "pure antiestrogens" or inhibitors of estrogen biosynthesis, are devoid of such estrogen-agonist activity and may not have the liability of many of these side effects. However, these agents would also be expected to lack the potentially beneficial effects of tamoxifen on lipids and skeletal system. The ability of tamoxifen to act as an estrogen-agonist or estrogen-antagonist in a tissue-specific fashion has led to the concept of selective estrogen-receptor modulation. Selective estrogen receptor modulators (SERMs), which are devoid of estrogen-agonist effects on the uterus or breast cancer cells but retain potentially beneficial effects on bones and lipids, have been described as "ideal" SERMs. A number of such compounds are currently being tested. Raloxifene is already approved for prevention of osteoporosis and has potential efficacy for prevention and treatment of breast cancer. An analogue of raloxifene, LY353381, is currently in Phase II clinical trials for treatment of breast cancer, with promising early results. EM800 and CP336156 are other promising ideal SERMs in clinical trials. These compounds may provide better treatment and chemoprevention alternatives for breast cancer as compared to tamoxifen, aromatase inhibitors, and pure antiestrogens. In addition, they may also prove to be useful for the treatment and prevention of prostate cancer as well as for treating benign gynecological diseases such as fibroids and endometriosis. Future laboratory efforts should focus on further broadening the efficacy profile of SERMs (e.g., prevention of Alzheimer's disease and elevation of high-density lipoproteins to improve the likelihood of cardiovascular benefit) and narrowing their side-effect profile (e.g., risk of thromboembolism and hot flashes).
Cancer Invest 2001
PMID:Selective estrogen receptor modulation: the search for an ideal hormonal therapy for breast cancer. 1148 8

This article reviews the symptoms and everyday problems associated with tamoxifen adjuvant therapy and their impact on patients' quality of life. In addition, the purported toxic effects of tamoxifen therapy (e.g., premature menopause, weight gain, and depression) are discussed, and data are presented that refute claims of the toxicity of tamoxifen therapy. From randomized controlled trials of adjuvant therapy, we know that tamoxifen therapy increases the rate of hot flashes, night sweats, and vaginal discharge; however, in observational studies these symptoms do not have a statistically significant impact on patients' quality of life as measured by standardized, self-report questionnaires. The Breast Cancer Prevention Trial found no evidence of excessive rates of depression or clinically significant differences in sexual functioning between women receiving placebo and those receiving tamoxifen therapy. Although several serious medical risks from tamoxifen therapy exist (e.g., uterine cancer, blood clots, stroke, and cataracts), there are additional benefits from tamoxifen therapy in addition to an increase in disease-free survival rates and overall survival rates, including a decrease in contralateral breast cancer and fractures. Ultimately, the decision to receive tamoxifen therapy is a personal choice for each woman to make on the basis of the evidence of tamoxifen therapy's benefits and risks, along with her own motivation to receive therapy. When the benefits of such therapy are small, some women may choose to avoid treatment, but others may wish to try therapy to determine whether possible side effects are relevant. For women in whom the absolute survival benefits are large, there may be less difficulty in making this decision.
J Natl Cancer Inst Monogr 2001
PMID:Impact of tamoxifen adjuvant therapy on symptoms, functioning, and quality of life. 1177 6

Selective estrogen receptor modulators (SERMs) are drugs that bind to the estrogen receptor (ER); in some tissues they act like estrogen (agonists), while in other tissues they oppose the action of estrogen (antagonists). The SERM tamoxifen acts as an estrogen antagonist in the breast in that it prevents and treats breast cancer, but it acts as an estrogen agonist in the endometrium, where it can induce cancer. Estrogen, and to a lesser extent SERMs, are effective in preventing and treating osteoporosis. Contrary to the prevalent hypothesis that estrogen provides benefit to women with regard to secondary prevention of coronary heart disease (CHD), randomized clinical trials have demonstrated that estrogen is associated with an increased risk of CHD in this population of women. Conflicting results have been reported on the effect of estrogens on cognitive function. The latest and largest randomized clinical trials have demonstrated a beneficial role in short-term memory in nondemented women, in contrast to the absence of such benefit in improving symptoms in women with Alzheimer's disease. Although estrogens have been used successfully to treat some menopausal symptoms such as hot flashes, the SERMs tamoxifen and raloxifene actually induce or increase hot flashes. Data on the beneficial and adverse effects of estrogen and SERMs are reported along with an elaboration of the constellation of properties that would characterize an ideal SERM working through the ER.
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PMID:What would be the properties of an ideal SERM? 1179 62

Menopause can be experienced prematurely by women with cancer and, as such, is often accompanied by symptoms that are becoming salient management issues. It is common practice to avoid estrogen replacement therapy in women with estrogen-sensitive tumors. Therefore, the effective management of vasomotor symptoms, urogenital problems, and the prevention of osteoporosis and cardiac disease requires knowledge of nonhormonal interventions. This article discusses the changes women experience during menopause and the symptoms to which these changes can contribute. Pharmacologic options without estrogen, as well as nonpharmacologic interventions, are presented for the treatment of hot flashes, vaginal dryness, and urinary incontinence, and the maintenance of skin, bone, and heart health. The issue of cognitive dysfunction is also addressed. For most of the problems associated with menopause, viable, effective options are available for cancer survivors.
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PMID:Current management of menopausal symptoms in cancer patients. 1183 12

The purpose of this randomized placebo-controlled crossover pilot study was to evaluate the effectiveness and acceptability of magnetic therapy for hot flashes among breast cancer survivors. Participants completed a 24-hour baseline hot-flash monitoring session, wore the magnetic devices or placebo for 3 days, completed an after-treatment hot-flash monitoring session, experienced a 10-day washout period, and then crossed over to the opposite study arm. Magnetic devices and placebos were placed on 6 acupressure sites corresponding to hot-flash relief. Complete data were available from 11 survivors of breast cancer. Results indicated magnetic therapy was no more effective than placebo in decreasing hot-flash severity, and contrary to expectations, placebo was significantly more effective than magnets in decreasing hot-flash frequency, bother, interference with daily activities, and overall quality of life. Implications for clinical practice and future research include the need to explore alternative interventions aimed at alleviating hot flashes in this population.
Cancer Nurs 2002 Apr
PMID:A pilot study of magnetic therapy for hot flashes after breast cancer. 1198 98

Abrupt onset of hot flashes poses a significant problem for women treated with chemotherapy for breast cancer. Alternatives to hormone replacement, such as the use of the selective serotonin re-uptake inhibitor (SSRI) paroxetine hydrochloride, are being explored as therapies for hot flashes in this patient population. The present study investigated the efficacy of paroxetine for the treatment of hot flashes and associated symptoms in women with breast cancer. This study included 13 patients who were seen in the Psychosocial Clinic at Moffitt Cancer Center. They were referred by their medical oncologist after reporting complaints of significant difficulty with hot flashes. Baseline questionnaires were completed and a structured diagnostic interview for clinical depression was conducted, all of which were repeated 5 weeks after the paroxetine 20 mg daily was started. Significant improvements were seen in the ratings of hot flash severity (P = 0.002). In addition, significant improvements were observed in general, emotional, and mental fatigue. Rates of clinically significant depressive symptomatology also decreased and sleep quality improved significantly as well. Finally, the incidence of clinical depression improved from 39% at baseline to 8% after treatment. These preliminary data suggest that the antidepressant paroxetine can be helpful in the treatment of hot flashes and associated fatigue, sleep disturbance, and depression in women with breast cancer treated with chemotherapy. Further controlled studies are needed to more fully evaluate the efficacy of the SSRIs for hot flashes in women with breast cancer.
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PMID:A pilot trial of paroxetine for the treatment of hot flashes and associated symptoms in women with breast cancer. 1199 3


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