Poster Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2022

Rate of menstruation history taking and counselling before, during and after anticancer treatments (#325)

Verity Chadwick 1 , Michaela Kim 2 , Georgia Mills 3 , Catherine Tang 4 , Antoinette Anazodo 2 5 6 , Rachel Dear 7 , Rachael Rodgers 8 9 , Orly Lavee 2 3 , Samuel Milliken 3 , John Moore 2 3 , Georgia McCaughan 3 , Nada Hamad 3 10 11 , Joshua Hurwitz 12
  1. Royal North Shore Hospital, St Leonards, NSW, Australia
  2. School of Medicine, University of New South Wales, Sydney, NSW, Australia
  3. Department of Haematology, St Vincent’s Hospital, Darlinghurst, NSW, Australia
  4. Department of Haematology and Flow Cytometry, Laverty Pathology, Macquarie Park, NSW, Australia
  5. Kids Cancer Centre, Sydney Children’s Hospital, Sydney, NSW, Australia
  6. Nelune Cancer Centre, Prince of Wales Hospital, Randwick, NSW, Australia
  7. Department of Oncology, St Vincent’s Hospital, Sydney, NSW, Australia
  8. Department of Reproductive Medicine, Royal Hospital for Women, Sydney, NSW, Australia
  9. School of Women’s and Children’s Health, University of New South Wales, Randwick, NSW, Australia
  10. St Vincent's Clinical School, University of New South Wales , Randwick, NSW, Australia
  11. School of Medicine, University of Notre Dame, Daringhurst, NSW, Australia
  12. Medical Oncology, The Kinghorn Cancer Centre, Darlinghurst, NSW, Australia

Introduction: Chemotherapy predisposes women to abnormal uterine bleeding, such as potentially life threatening menorrhagia and irregular menses, which may be associated with premature ovarian failure and infertility.

Aims: The purpose of this study was to explore the incidence of menstrual history documentation and counselling before, during and after cancer treatment.

Methods: Retrospective chart review of 143 consecutive women aged 18-49 receiving anticancer treatment at a major tertiary hospital between 2017 and 2020. Data collected included primary diagnosis, stage of cancer, treatment(s) received, rates of remission or progression, prior reproductive history, contraceptive use, thromboembolic complications, involvement of a specialist gynaecologist, menstruation advice received, and signs or diagnosis of premature ovarian failure.

Results: Only 15.4% had their menstrual history taken at the initial consult, and 47.0% at a subsequent consult with their treating oncologist or haematologist. Only one patient had menstrual disturbance documented by a gynaecologist. The majority (82.5%) of patients with a menstrual history documented experienced menstrual disturbance post-treatment, most commonly amenorrhoea (48.5%), irregular menses (22.3%), menorrhagia (12.6%), menopause (10.7%), dysmenorrhoea (4.9%) and iron deficiency secondary to bleeding (1.9%). Dysmenorrhoea and iron deficiency were more likely to be treated than other disturbances.

Conclusion: Menstruation disturbance is common in women receiving anticancer treatment. Menstrual care should be integral to cancer care for women, and higher engagement could be achieved through the education of medical staff and allied health professionals, information technology systems automating prompts and gynaecologist referral pathways, regular audits to ensure compliance, better alliances between cancer and fertility specialists, and the creation of accessible patient information to promote awareness and facilitate discussion.