QResearch Logo
Menu

Use of hormone replacement therapy and survival from cancer

Status

Completed

Title

Use of hormone replacement therapy and survival from cancer

What were the objectives of the study?

The aim of the study is to determine the association between HRT use after cancer diagnosis and cancer-specific mortality in patients with common female cancers, excluding breast cancer. Hormone replacement therapy (HRT) is widely used. HRT is proven to reduce menopausal related vasomotor symptoms (hot flashes, flushing, and night sweats) and urogenital atrophy. HRT preserves bone mass and is approved by the Food and Drug Administration to prevent postmenopausal osteoporosis. It has also been shown to reduce joint pain, mood swings, sleep disturbances and improve quality of life and, consequently, it has been acknowledged that a reluctance to teat menopausal symptoms can cause unnecessary suffering. However, the role of oestrogen in cancer development and progression is complex. Recent studies have suggested HRT could be protective in women with melanoma, colorectal and liver cancer. In contrast, there have been concerns that HRT could accelerate cancer progression in women with lung, bladder, gastric, and brain cancer. Consequently, some researchers have recommended against using HRT in women with these cancers. However, epidemiological studies have not investigated the survival of women using HRT after diagnosis of most cancers and therefore the safety of HRT use in cancer patients remains unclear.

How was the research done?

In QResearch, cohorts of women newly diagnosed with common cancers from 1998 to 2016 will be identified from English cancer registries. Women with breast cancer will be excluded. HRT use will be determined from GP records. The primary outcome will be time to death from cancer from national mortality records. Time to death from cancer will be determined in cancer patients who used HRT and compared with cancer patients who did not use HRT. Similar analyses will be conducted in Wales using SAIL databank and Scotland based upon the national Prescribing Information System. The findings will then be pooled across the 3 countries.

Chief Investigator

Dr Chris Cardwell (Belfast) Julia Hippisley-Cox (Oxford)

Lead Applicant Organisation Name

Sponsor

Oxford

Location of research

Oxford

Date on which research approved

05-Mar-2020

Project reference ID

OX24

Generic ethics approval reference

18/EM/0400

Are all data accessed are in anonymised form?

Yes

Brief summary of the dataset to be released (including any sensitive data)

Women newly diagnosed with common cancers from 1998 to 2016 will be identified from English cancer registries linked to QResearch. The primary outcome of death from cancer will be determined from ONS mortality records. Information of relevance to cancer survival will be determined including: age, year of diagnosis, cancer specific data (including stage, treatments and grade from cancer registry records), comorbidities (including Charlson comorbidity conditions, prior hysterectomy/oophorectomy from GP records), medication use (including HRT, aspirin, statins and other medications from GP records), deprivation, smoking and BMI (from GP records).

What were the main findings?

Why did we do this study?

Women who have had cancer can also experience menopausal symptoms, such as hot flashes, brain fog, and difficulty sleeping, among others. These symptoms can effectively be treated with hormone replacement therapy (HRT, such as oestrogen containing oral tablets, gels and patches).

HRT is not advised for some types of cancer (for example breast cancer) because the cancer is affected by one of the hormones in HRT. However, we do not know whether HRT is safe for people with other types of cancer. Knowing more about this could help women make informed choices about whether they want to take HRT for menopausal symptoms.

What did we set out to do?

To compare the survival of women who use HRT after their cancer diagnosis to the survival of women who do not use HRT after their cancer diagnosis.

How did we do this?

In our study we analysed medical records from 183,000 cancer patients across 17 cancer types. The cancer types we investigated were: colorectal, oesophageal, stomach, liver, pancreas, lung, melanoma, cervical, ovarian, uterine, kidney, bladder, brain, oral, non-Hodgkin lymphoma, myeloma and leukaemia.

Overall 7% of cancer patients used HRT after their cancer diagnosis. We compared the survival of cancer patients who used HRT to the survival experience of cancer patients who did not use HRT after cancer diagnosis. This analysis was based upon data from the medical records of cancer patients from England, Scotland and Wales.

We identified cancer patients from cancer registry records and death from national mortality records. We determined HRT use in these patients from General Practice prescriptions or dispensed medications from pharmacies. In our analysis we accounted for other characteristics of cancer patients including age, year, stage, cancer treatments and other medical conditions.

What did we find?

We found no evidence that cancer patients using HRT had increased mortality in any of the 17 cancer types studied. These findings should provide some reassurance to cancer patients using HRT and clinicians prescribing HRT to cancer patients.

Implications and Impact

The goal of our study is to provide female cancer patients with information to allow them to make an informed decision on whether to use HRT or switch to alternatives (such as selective serotonin reuptake inhibitors and clonidine). Our study will also provide mechanistic insights into the role of oestrogen in cancer progression.

Funding Source

Cancer Research UK

Public Benefit Statement

Research Team

Dr Chris Cardwell, Professor Julia Hippisley-Cox, Dr Bland Hicks, Dr Una McMenamin, Professor carol Coupland

Publications

Press Releases

Access Type

Trusted Research Environment (TRE)

Share this

›