Estrogen therapy in patients with gynecologic cancer: a survey of gynecologists and oncologists in the United States.

A majority of surveyed providers reported willingness to prescribe estrogen therapy for endometrial cancer and epithelial ovarian cancer patients, with near-universal willingness for cervical cancer patients.

• 293 participants answered questions about at least one type of cancer.
• 63.82% (187/293) were willing to provide ET for patients with a history of endometrial cancer.
• 65.19% (176/270) were willing to provide ET for patients with a history of epithelial ovarian cancer.
• 96.8% (274/283) were willing to provide ET for patients with a history of cervical cancer.
• Due to lack of heterogeneity in cervical cancer responses, cervical cancer was omitted from further analysis.

Gynecologic oncology providers were significantly more likely than OBGYNs to prescribe estrogen therapy for both endometrial cancer and epithelial ovarian cancer patients.

• The difference in ET prescribing for endometrial cancer patients was statistically significant (P = 0.0006).
• The difference in ET prescribing for epithelial ovarian cancer patients was also statistically significant (P = 0.0009).
• The survey was administered in 2024 to members of the Society of Gynecologic Oncology and the American College of Obstetricians and Gynecologists.

Providers in practice for 10 or more years and those who identified as male were more likely to prescribe estrogen therapy to endometrial cancer patients.

• Providers with 10 or more years in practice were more likely to prescribe ET to EC patients (P = 0.022).
• Providers who identified as male were more likely to prescribe ET to EC patients (P = 0.019).

Among providers who do not prescribe estrogen therapy, the most common reasons cited were belief that hormones are contraindicated, belief that better options exist, and belief that risk outweighs benefits.

• These reasons were selected more frequently by OBGYNs than by gynecologic oncologists.
• The survey was web-based and administered through email or postcard mailer.
• The study hypothesized that ET is underused in the gynecologic cancer population.

The study identified a gap between evidence supporting estrogen therapy safety and actual clinical practice, particularly among general gynecologists.

• The authors note that evidence suggests ET is safe in patients with endometrial and epithelial ovarian cancer.
• The authors conclude there is a need for clinician education to ensure patients are counseled appropriately about options for treating menopausal symptoms.
• The incidence of endometrial cancer in premenopausal women is described as rising.
• Menopause is characterized as potentially detrimental to longevity and quality of life.