Abstract P1-12-07: Management of genitourinary symptoms in breast cancer patients: An updated systematic review of available evidence from randomized trials
Notice bibliographique
Résumé
Abstract Background: Genitourinary symptoms (GUS) such as vaginal dryness, dyspareunia, itching, urinary incontinence, urinary tract infections and discharge are common in patients with breast cancer (BC). Optimal management of GUS remains unclear. Our group previously published a systematic review (SR) on GUS management in 2014 which showed a paucity of RCT evidence addressing this knowledge gap (Mazzarello et al. 2015). We performed an updated SR to assess if more prospective trial data had been published in the past 7 years to inform management of this common complication of BC. Methods: EMBASE, Ovid Medline and the Cochrane Library were searched for RCTs evaluating treatments for GUS in BC patients from September 2014 to December 2021. A PICOS (population, intervention/comparators, outcomes and study design) framework was utilized. Population: women with breast cancer. Intervention/comparators: all forms of oral, intra-vaginal and topical hormonal and non-hormonal treatments. Outcomes of interest: improvements in vaginal symptoms (e.g., dryness, pain, dyspareunia, itching); vaginal hormone response, measured by validated scales [e.g., Vaginal Health Index (VHI) and Vaginal Maturation Index (VMI)] and quality of life [e.g., Female Sexual Function Index (FSFI)]. Study design: only RCTs were included. Two independent reviewers performed the tasks of study selection, data collection, and risk of bias assessment. Results: Of 842 unique citations identified (412 from this update, 430 from previous SR), eight studies (n = 539 patients) met inclusion criteria. Interventions included 0.005% estriol gel (EG; n=50 patients), intravaginal testosterone (IVT; n=21), intravaginal prebiotic (n=13), hyaluronic acid (HA; n=12), polyacrylic acid (PA; n=25), pH-balanced gel (two studies; n=118), Replens(n=24) and Lidocaine gel (n=22). These interventions were compared to placebo/saline/usual care (n=254). One study had three arms comparing prebiotics, HA and usual care. Study sample sizes ranged from 44 to 136 patients. Given the heterogeneity of the studies, a narrative synthesis was performed. Compared to placebo, FSFI total score was significantly improved by all interventions except IVT (which demonstrated significant improvement in only the satisfaction domain) and 4% aqueous lidocaine before vaginal penetration (which improved significantly all domains except for orgasm). FSFI changes were not reported for Replens. Significant improvements in vaginal hormone responses (VHI and VMI) were reported for 0.005% EG and pH-balanced gel; however, no significant effects were found for IVT, HA or prebiotics. Vaginal symptoms (vaginal dryness, dyspareunia and pruritis) were significantly improved by EG, IVT, and PA. Vaginal symptoms were significantly improved in the single study of pH-balanced gel that reported this outcome. Conclusion: GUS is reported in 75% of BC patients but despite its frequency, the management of GUS remains a challenging issue for patients and health care providers. Due to study heterogenicity, there remains insufficient RCT evidence to define optimal therapy. More prospective trials comparing commonly used interventions are needed. Keywords: Genitourinary symptoms, Topical moisturizers, Intra-vaginal testosterone Citation Format: Parvaneh Fallah, Dianna M. Wolfe, Brian Hutton, Mark Clemons, Risa Shorr, Lisa Vandermeer, Moira Rushton-Marovac. Management of genitourinary symptoms in breast cancer patients: An updated systematic review of available evidence from randomized trials [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P1-12-07.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,020 | 0,079 |
| Méta-épidémiologie (sens strict) | 0,002 | 0,002 |
| Méta-épidémiologie (sens large) | 0,014 | 0,012 |
| Bibliométrie | 0,016 | 0,014 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,004 | 0,005 |
| Science ouverte | 0,003 | 0,003 |
| Intégrité de la recherche | 0,003 | 0,002 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,011 | 0,001 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».