Women's Public Health Research, Monash Applied Research Stream, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia.
Climacteric. 2013 Aug;16(4):479-89. doi: 10.3109/13697137.2013.765842. Epub 2013 Feb 12.
Investigation of clinicians' understanding of early menopause diagnosis/management in women with breast cancer.
A cross-sectional study of 176 randomly recruited Australian clinicians (35 gynecologists, 35 endocrinologists, 36 oncologists, 35 breast surgeons and 35 general practitioners (GPs)) involved in the care of women with breast cancer. This questionnaire study utilized an index case to assess understanding of early menopause diagnosis and management. Analysis involved descriptive statistics, χ² tests and Student's t-test.
Significant differences between clinician groups regarding diagnostic criteria for early menopause were observed; gynecologists, endocrinologists and GPs selected amenorrhea > 12 months, whereas oncologists and breast surgeons selected elevated serum follicle stimulating hormone level (p < 0.05). Non-hormonal treatment was preferred by most clinician groups. Complementary/alternative medicines were more commonly prescribed by breast surgeons (57%), gynecologists (54%) and endocrinologists (49%) compared to oncologists (28%) or GPs (9%) (p = 0.0001). Exercise (63%) and nutrition (66%) were selected by most gynecologists for treatment of hot flushes, whereas endocrinologists (91%), oncologists (94%), breast surgeons (69%) and GPs (63%) prescribed venlafaxine. Hormone therapy was mainly prescribed by breast surgeons (43%) compared to other groups (p = 0.001). Most clinicians reported that the main problem with menopausal therapies was failure to resolve hot flushes. Exercise, lifestyle and stress management were recommended by all clinician groups for treatment of anxiety/depression.
This exploratory study demonstrated a lack of consensus between clinician groups in their investigation, diagnosis and management of early menopause in women with breast cancer, with implications for both diagnosis and treatment.
调查临床医生对乳腺癌女性早期绝经诊断/管理的理解。
对 176 名随机招募的澳大利亚临床医生（35 名妇科医生、35 名内分泌医生、36 名肿瘤医生、35 名乳腺外科医生和 35 名全科医生（GP））进行横断面研究，这些医生参与了乳腺癌女性的治疗。这项问卷调查研究利用一个索引病例来评估对早期绝经诊断和管理的理解。分析包括描述性统计、卡方检验和学生 t 检验。
临床医生组之间关于早期绝经的诊断标准存在显著差异；妇科医生、内分泌医生和全科医生选择闭经>12 个月，而肿瘤医生和乳腺外科医生选择血清卵泡刺激素水平升高（p<0.05）。大多数临床医生组更倾向于非激素治疗。与肿瘤医生（28%）或全科医生（9%）相比，乳腺外科医生（57%）、妇科医生（54%）和内分泌医生（49%）更常开补充/替代药物（p=0.0001）。大多数妇科医生选择运动（63%）和营养（66%）来治疗热潮红，而内分泌医生（91%）、肿瘤医生（94%）、乳腺外科医生（69%）和全科医生（63%）则开文拉法辛。激素治疗主要由乳腺外科医生（43%）开具，而其他组则较少（p=0.001）。大多数临床医生报告说，绝经治疗的主要问题是无法解决热潮红。所有临床医生组都建议运动、生活方式和压力管理来治疗焦虑/抑郁。
这项探索性研究表明，乳腺癌女性早期绝经的调查、诊断和管理在临床医生群体之间缺乏共识，这对诊断和治疗都有影响。
