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Biomedical subjects

J B Vasquez

Publications and source records attributed to J B Vasquez.

4 recordsLinked to original sources
PubMed2000

Estrogen replacement therapy in patients with endometrial cancer: prescription attitude of Belgian gynecologists.

BACKGROUND: Endometrial cancer is estrogen dependent and has been considered as a contraindication for HRT. Some uncontrolled studies reported no increase in recurrence in women who received ERT after they had suffered early stage endometrium cancer and many opinion leaders have mandated that early uterus cancer should not be considered as an absolute contraindication to HRT. AIM: We conducted a survey evaluating the prescription attitude of Belgian gynecologists (n=1363) towards a case describing a patient who presents indication for ERT (climacteric symptoms and osteoporosis) and a past history of early stage endometrium cancer. RESULTS: We obtained a 32% response rate. Overall, the physicians prescribed treatment in 67% of the cases. There was no difference in the prescription attitude in relation to gender or age of the physicians. Among the physicians who prescribed HRT, 49% stated that they would prescribe estrogen-only therapy (unopposed estrogens) and 27% would prescribe a combined estrogen-progestin therapy. CONCLUSION: Two out of three gynecologists, in Belgium, would accept, at least theoretically, to prescribe HRT to a woman with a history of early stage endometrial cancer, no signs of recurrence and recognized indications for HRT.

Attitude of Health Personnel↗
PubMed1998

Educating patients about the benefits and drawbacks of hormone replacement therapy.

Hormone replacement therapy (HRT) influences many aspects of health: climacteric symptoms, osteoporosis, cardiovascular disease, breast and endometrial cancer, thrombosis and emboli, and Alzheimer's disease. A decision to use HRT may depend on a woman's individual views of the menopausal transition, the postmenopause and its consequences. It is therefore useful that the health provider inquiries about and discusses these issues in a cultural and family context. Health providers and patients should be thoroughly informed about the symptoms associated with hormonal deprivation, the associated risks of osteoporosis and cardiovascular disease, and the potential of HRT to prevent these afflictions. Recent studies suggest that HRT might be particularly beneficial in women who have an increased risk for cardiovascular disease (because of left ventricular hypertrophy, diabetes mellitus, hypertension or hypercholesterolaemia, or because they smoke) or osteoporosis. In women who are undecided about HRT, a low bone mineral density measurement might help convince them to start using, or to continue using, HRT. There is also a need to discuss with the patient the effect of HRT on cancer risk. In most instances, women can be reassured about the risk of endometrial cancer. The risk of breast cancer should be carefully considered and discussed with each patient before beginning HRT. In most cases, HRT should not be withheld because of fears about breast cancer, because the protective effects of HRT against cardiovascular disease and osteoporosis outweigh the possible increased risk of breast cancer. When HRT is prescribed, individual regiments should be discussed with the patient, who must be warned of the possible adverse effects. In older women, HRT can be started at half the normal dosage and tolerability assessed before increasing the dosage further.

Age Factors↗
PubMedDate not supplied

Managing the climacteric.

HRT taken for a sufficient duration may reduce the occurrence of osteoporosis and of cardiovascular disease by up to 50% and possibly also reduce incidence and lessen severity of Alzheimer's disease. Nevertheless, it is often only prescribed when women request it to relieve climacteric symptoms. Furthermore, many physicians prescribe it for only limited periods of time and few are willing to prescribe it to women in their sixties. As with any long-term prevention strategy, the uptake of HRT is much lower than the prescription rate, since the medication is often abandoned due to side effects or due to lack of motivation. But HRT is often abandoned also due to fear of cancer. While physicians may be aware of some beneficial effects of HRT, they often have no time to inform their patients of them. Alternatively, some of the beneficial effects such as cardioprotection or a reduced incidence of Alzheimer's may be less known. Likewise, HRT-related side effects or risks such as breast cancer or thromboembolic diseases should be discussed prior to HRT prescription. Women need to be informed about these potential risks, and this should be done by their physician. Surveys have shown that many women feel that they receive insufficient information from their physician. The quality of the relationship between physician and patient probably has a large influence on HRT acceptance, but very few studies have been conducted to assess specifically factors influencing the prescription and the continuation rate of HRT. Simple strategies may be among the most effective ones; these include listening to patients' fears, complaints and questions, and taking the time to answer them. The role of a practice nurse in such a setting may be also very important.

Attitude to Health↗