Endocrine therapy for breast cancer induces menopausal symptoms but mitigates depression

Breast cancer patients undergoing adjuvant endocrine therapy appear to experience symptoms similar in type and intensity to those of symptomatic menopausal women, according to a retrospective study. However, the use of aromatase inhibitors is associated with less severe depressive symptoms.

The study included 99 breast cancer survivors (45 on tamoxifen, 54 on aromatase inhibitors; case) and 554 women in the late perimenopause (n=173) or in surgical (n=28) or in natural (n=353) menopause who were not on hormone replacement therapy (control).

Menopausal symptoms, including vasomotor, anxiety, depressive, somatization, and sexuality symptoms, were assessed using the Greene's Climacteric Scale and its subscales. Weighted and nonweighted t-tests, chi-square tests, and linear or logistic regressions were used in the analyses.

The mean scores on the Greene's Climacteric Scale did not significantly differ between cases and controls (21.3 vs 22.8; p=0.199), as were the subscale scores for vasomotor symptoms, anxiety, and somatization.

On the other hand, cases on adjuvant endocrine therapy had a significantly lower depression score than controls (4.63 vs 5.98; p=0.001), driven by lower scores for users of aromatase inhibitors (−2.132, 95 percent confidence interval, −3.858 to −0.407; p=0.016). Additionally, cases had a much higher sexuality score than controls (1.76 vs 1.50; p=0.011). These differences remained significant despite adjustments for age, menarche, BMI, menopausal status (peri- or post-), type of menopause (natural or surgical), use of gonadotrophin-releasing hormone analogues, years of amenorrhea, smoking, alcohol use, and for breast radiotherapy, chemotherapy, tamoxifen, or aromatase inhibitors.

Among breast cancer survivors, women on aromatase inhibitors vs tamoxifen had lower scores for anxiety (p=0.045) and depression (p=0.046).