Reviewing common effects of hormonal therapy in patients with breast cancer.

This article reviewed the common side effects of estrogen deprivation during hormonal therapy for women with breast cancer and provided an update on alternative therapies to manage these symptoms.

Breast cancer (BC) is one of the most common cancers affecting women worldwide. Some BC cells grow in response to female sex hormones such as estrogen, progesterone, or both. These are called hormone receptor-positive (HR+). HR+ tumors are likely to respond to hormonal therapy (HT). HT reduces the levels of hormones that fuel BC growth. However, HT may also have significant side effects including vasomotor symptoms such as hot flashes, sweating, vaginal dryness, and bone loss. These side-effects may affect the quality of life of patients.

There are many ways these side effects of HT can be controlled. This review discussed the common side effects of HT for the treatment of HR+ BC and provided an update on alternative therapies to manage these symptoms.

Women with breast cancer treated with ET can experience hot flashes and night sweats related to narrowing or expanding of blood vessels. These symptoms are called vasomotor symptoms (VMs). Hot flashes cause a sensation of intense warmth in the chest area, neck, and face and can cause feelings of anxiety. Antidepressants such as venlafaxine (Effexor) are effective in controlling VMs. A recent study found that gabapentin (Neurontin) reduced the frequency of hot flashes in women who received HT.

There is also evidence to support the use of non-hormonal treatment options like cognitive behavioral therapy (CBT; structured talk therapy with a therapist) and hypnosis (use of mind-body therapy to help create a deeply relaxed state) for reducing VMs in BC survivors.

Vulvovaginal atrophy (VVA) is the thinning, trying, and inflammation of the lining of the vagina. It is another side effect of HT. VVA involves genitourinary symptoms (GU) such as vaginal dryness, itching, pain during intercourse, frequent urination, burning during urination, and frequent urinary infections. Non-hormonal local treatments such as moisturizers and lubricants were shown to improve dryness and pain during intercourse compared to placebo. Local estrogen treatment showed improvements in VVA symptoms, however with contradictory safety results. Vaginal laser treatment helps restore blood flow to the vagina and helps the growth of healthy tissue. Laser treatment improved GU symptoms in the short term and had no reported side effects.

Aromatase inhibitors (AI) which reduce the production of estrogen are used in BC treatment. AIs are associated with musculoskeletal symptoms (MSS) including pain, aching or stiffness in the body, twitching of muscles, and fatigue, as well as a decrease in bone mineral density (osteoporosis) and increased fracture risk. Physical exercise and yoga are recommended to prevent and manage MSS.

Treatment with paracetamol, omega 3, and vitamin D have shown a reduction in pain, however, this approach still needs further validation. Calcium supplements, vitamin D, and regular physical activity showed an improvement in the bone mass density of these patients. Bisphosphonates like zoledronate (Zometa) have also shown improvements in increasing bone density in patients with BC using HT.

This article reviewed the common side effects of HT for the treatment of HR+ BC and provided an update on alternative therapies to manage these symptoms.