A cross-sectional survey exploring experiences in accessing hormone replacement therapy following risk-reducing surgery for individuals with hereditary ovarian cancer risk

OBJECTIVES: To describe the current landscape of hormone replacement therapy (HRT) to treat surgical menopause following bilateral salpingo-oophorectomy (BSO) in individuals with hereditary ovarian cancer risk in British Columbia, Canada. We aimed to describe current use of HRT, identify factors associated with HRT use and identify potential barriers for uptake and access. METHODS: Individuals with germline pathogenic/likely pathogenic variants in an ovarian cancer susceptibility gene were identified through the BC Cancer Hereditary Cancer Program (HCP) Progeny database. A cross-sectional survey was administered to collect participant demographics, personal and family cancer history, and participant experiences with HRT. Descriptive statistics were used to characterize the sample and logistic regression used to explore associations between sociodemographic variables and reported HRT use. Open text fields were analyzed using inductive quantitative content analysis. RESULTS: In total, 374 responses were received from 1284 potential participants (29.1% response rate). Of participants who have had a BSO, 41% (101/245) report HRT use. In open-text responses, 22% of participants reported lack of support by healthcare professionals and 26% described gaps in counselling about HRT and surgical menopause. In the regression analysis, HRT use was less likely in individuals who: were of increasing age, reported a history of any cancer type and who reported receiving no counselling about HRT (all p < 0.0011 after Bonferroni correction). CONCLUSION: Barriers to HRT access and uptake exist for individuals at increased risk of ovarian cancer. Together this data indicates that patients require additional support in this area particularly as it relates to education and resources.