How clinicians can assist patients in managing a treatment side effect of sexual difficulties.

SOFT/TEXT Clinical Trial Follow-Up

Among premenopausal women with breast cancer, 80% have hormone-responsive breast cancer, where the hormone oestrogen can stimulate the growth of cancer cells.

To stop this from happening after the primary cancer has been removed, women may be treated with one or more drugs that either prevent the uptake of oestrogen by cells (oestrogen blockers like tamoxifen), switch off the production of oestrogen in the ovaries (ovarian function suppression), or block oestrogen production in body fat (aromatase inhibitors).

The SOFT and TEXT clinical trials investigated the effects of different treatment combinations in premenopausal women on survival and recurrence of cancer. Researchers also collected and analysed information about a common and distressing side effect of such treatments: sexual problems including low libido and difficulty becoming aroused.

The impact of treatment on sexual function can be so important for quality of life that it can affect adherence to treatment, says Associate Professor Prue Francis, Chair of the International Steering Committee responsible for the SOFT and TEXT clinical trials.

“Sometimes women just don’t want to take their treatment at all because they’re having problems and they just stop,” says Associate Professor Francis.

The researchers wanted to identify factors that, if present six months into the five-year treatment, predict whether a premenopausal woman will experience sexual difficulties later.

They found that women who reported vaginal dryness, sleep disturbance and bone or joint pain at the six-month mark were more likely to report sexual problems in the first two years.

Recognising these predictors in their patients may guide clinicians to ask about sexual problems, which patients may not otherwise bring up. These conversations might equip clinicians to take a more nuanced and individualised approach to treatment, she says.

Take, for example, a woman experiencing significant side effects from treatment with both aromatase inhibitor and ovarian suppression therapy. Clinicians might consider “the absolute benefit that they’re likely to obtain from having that more intense endocrine therapy,” says Associate Professor Francis.

“Should they really be encouraged to persevere because they have a very high-risk breast cancer and therefore they’re likely to derive more of a differential benefit from that maximal endocrine therapy? Or might their breast cancer not be at such high risk for recurrence, and perhaps it would be reasonable then to dial back to a less intense endocrine approach?”


Treatment-induced symptoms, depression and age as predictors of sexual problems in premenopausal women with early breast cancer receiving adjuvant endocrine therapy.

Ribi K, Luo W, Walley BA, Burstein HJ, Chirgwin J, Ansari RH, Salim M, van der Westhuizen A, Abdi E, Francis PA, Chia S, Harvey VJ, Giobbie-Hurder A, Fleming GF, Pagani O, Di Leo A, Colleoni M, Gelber RD, Goldhirsch A, Coates AS, Regan MM, Bernhard J. Breast Cancer Research and Treatment. 2020; 181(2):347-359, epub 09/04/20 doi.org/10.1007/s10549-020-05622-5.


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Professor Prue Francis

Breast Cancer Trials Researcher and Clinical Head of Breast Medical Oncology at the Peter MacCallum Cancer Centre.

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