The impact of chemotherapy-induced menopause on quality of life 30 months following treatment among young women with non-metastatic breast cancer: results from the prospective multicentre MENOCOR clinical trial

Abstract

Breast cancer is the most common cancer among women in France and worldwide, with about one quarter of cases occurring before 50 years old. These younger women often present more aggressive tumours, requiring intensive treatments. However, chemotherapy frequently causes ovarian toxicity, leading to amenorrhea or Chemotherapy-Induced Menopause (CIM), which affects up to 60% of women aged 40–50. It has been demonstrated that CIM causes more severe symptoms than natural menopause and can thus have a strong impact on quality of life (QoL). The MENOCOR study is a multicentre, prospective, clinical trial assessing the impact of CIM on QoL among women aged from 18 to 45 with non-metastatic breast cancer. Participants were included at chemotherapy initiation and they had to complete clinical examinations, hormonal assessments (AMH, FSH, oestradiol) and QoL questionnaires at baseline and end of treatment. QoL questionnaires were administered at 6-, 18-, and 30-months post chemotherapy. Patients were then classified as CIM or non-CIM at 30 months according to their amenorrhea status. The primary endpoint was the change in the QLQ-C30 functional score at 30 months between groups. Secondary endpoints included CIM incidence, hormonal and amenorrhea changes, specific QoL dimensions, pain, physical activity, weight variation, and progression-free survival. A total of 129 patients were included in the analysis (46 CIM group and 83 non-CIM). No statistically significant difference was observed in QoL at 30 months between the two groups, as assessed by the QLQ-C30 questionnaire. At baseline, AMH levels were significantly higher in the non-CIM group compared to the CIM group, whereas no significant differences were found for FSH and oestradiol. At 30 months, anxiety levels were significantly lower in the CIM-group compared to the non-CIM group. Regarding menopausal symptoms, women in the CIM group reported significantly more hot flushes and sweating, and significantly less nervousness than those in the non-CIM group. These findings suggest that, while CIM does not seem to significantly impair functional QoL, psychological support addressing uncertainty and anxiety should be prioritized for young breast-cancer patients facing potential premature menopause. The trial was registered on ClinicalTrials.gov on 31st March, 2014 (NCT02102568).