Nasir Yusoff, PhD
Women Health Development Unit, School of Medical Science, Health Campus
University of Science Kubang Kerian

Low Wah Yun, PhD
Medical Education and Research Development Unit, Faculty of Medicine
University of Malaya

Menopausal issue, in breast cancer, has also been explored previously by many researchers (e.g. Crandall et al., 2004; Schultz et al., 2005). Menopausal symptoms such as hot flashes and sweats were observed to have significant impacts on the overall quality of life among women who received the treatment for breast cancer (e.g. Gupta et al., 2006).

Crandall et al. (2004) observed that during breast cancer treatment, pre-menopausal women had more menopausal symptoms as compared to those who were not in the therapy. Other important results yielded in the same study revealed that the post-menopausal women (with or without therapy) experienced more menopausal symptoms as compared to the pre-menopausal group (Crandall et al., 2004). Ever-use of HRT was associated with an increased risk of ovarian cancer of 1.38 (95% confidence interval (CI) 1.26–1.51). The risk declined with years since last use and had disappeared after 2 years. The risk of epithelial ovarian cancer was 1.44 (95% CI 1.30–1.58).

Symptoms, associated with menopause, have also emerged as a significant problem among women who had gone through the treatment of breast cancer (e.g. Carpenter and Andrykowski, 1999; Tchen et al., 2003; Young Mc-Caughan, 1996). In addition, Mc Phail and Smith (2000) demonstrated that chemotherapy recipients were more likely to exhibit menopausal symptoms such as tiredness, hot flashes and night sweats, as compared to the control group in their study. In breast cancer treatment, the prevalence of hot flashes was high, with 17%, 51% and 71% occurring in the pre-, peri-, and post- menopausal women, respectively (Crandall et al., 2004). At the same time, vaginal dryness and pain during intercourse were among the symptoms observed to be more severe in post-menopausal women, as compared to peri-menopausal breast cancer patients who had gone through cancer therapy (Crandall et al., 2004). Similarly, it was discovered that adjuvant therapy was associated with a significant worsening of menopause-related symptoms among post-menopausal women (Biglia et al., 2003). Furthermore, Biglia et al. (2003) explained that the incidences of vasomotor and dystrophic symptoms were significantly higher in the pre-menopausal women. Weight gain was also detected among pre-menopausal women who had received chemotherapy treatment (Demark-Wahnefried et al., 1993; McInnes and Knobf, 2001).

However, according to Fan et al. (2005), menopausal symptoms could be improved over time. As such, the impairment of physical function and other functional domains, among post-menopausal women, during adjuvant chemotherapy, could also be subsequently recovered (Watters et al., 2003). In comparison to this, the feelings of concerns and worries about recurrence and the quality of life impairment were found to be higher among pre-menopausal women who had undergone cancer therapy than older women (Biglia et al., 2003).

Moreover, it was also found that the majority of breast cancer patients, who had been treated with chemotherapy, experienced disturbances in their menstrual cycles (Ketiku and Ajekigbe, 1990; Kumar et al., 2004). The disturbances in the menstrual cycle (also termed as chemotherapy–induced menopause by the medical specialist) caused the menopausal symptoms to be more common and severe as compared to the natural menopause situation (McPhail and Smith, 2000; Young McCaughan, 1996). In addition, chemotherapy treatment has also been associated with the ovarian damage among pre-menopausal women with breast cancer; the condition which is suggested as a long-term consequence of the adjuvant chemotherapy treatment (Bines et al., 1996). A study by Mehta et al. (1991) on the endocrine profile among breast cancer patient, who received the regimen of Cyclophosphamide, Methotrexate and Fluorouracil (CMF), exhibited the suppression of the ovarian function.

Therefore, it can be stated that chemotherapy treatment may cause different effects on the psychosocial aspect of women, depending on their menopausal status. The treatment may also result in more common and severe menopausal symptoms.

Many studies especially when determining the influence of the bio/socio-demographic aspect on breast cancer patients’ quality of life, the factor which has been given focal attention is the menopausal status of the patients (pre- menopausal or post-menopausal); this factor is found to be important in the psychosocial issue of breast cancer. In a comparison study, a group of women who were pre- menopausal were found to be different from the post-menopausal women because the later group of women were older. In this case, a difference could particularly be seen in the body composition, whereby the most noticeable change would be the degeneration of muscle quality (Kallman et al., 1990; Forrest et al. 2007; Landers et al., 2001; Newman et al., 2003). The major differences were also observed in the area of bone density (Trotter et al., 1960), and the ratio of the body K to total body water (Bruce et al., 1980; Cohn et al., 1980; Pierson et al., 1982). The decrement of the estimated ratio of muscle mass to visceral mass is also exhibited (Tzankoff and Norris, 1978). Similarly, older patients were found to be much weaker than the younger ones after major surgery, and they faced more problems in recovery (Watters et al., 1993). Health expectation (i.e. the expectation that one has on her own health) is also affected by age (Carr et al., 2001).
 

References:

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Full list available upon request from editorial team