# Self-Reported Outcomes of Endocrine Therapy with or Without Ovarian Suppression in Premenopausal Breast Cancer Patients: A Brazilian Quality-of-Life Prospective Cohort

## TL;DR

This study shows that adding ovarian suppression to endocrine therapy worsens quality of life, especially body image and sexual health, in young Brazilian breast cancer patients.

## Contribution

The study provides new insights into the long-term quality-of-life effects of combining endocrine therapy with ovarian suppression in premenopausal breast cancer patients.

## Key findings

- Patients receiving ovarian suppression reported worse body image and femininity compared to those on endocrine therapy alone.
- Sexual functioning and enjoyment declined in both groups but recovered in endocrine therapy-only patients by 24 months.
- Ovarian suppression was associated with a higher frequency of lack of sexual activity and persistent sexual health issues.

## Abstract

Breast cancer is increasingly affecting young women, and many require long periods of treatment that may influence their quality of life. One important therapy for this group is endocrine treatment, sometimes combined with ovarian suppression. While these treatments improve cancer outcomes, they can also cause menopausal symptoms, affect body image, and interfere with sexual health. In this study, we followed premenopausal women with breast cancer in Brazil and collected quality-of-life data every three months for two years using standardized questionnaires. We found that women who received ovarian suppression reported more persistent difficulties, especially related to body image, compared with those treated with endocrine therapy alone. These findings emphasize the importance of considering not only cancer control but also quality of life when making treatment decisions and highlight the need for supportive care strategies tailored to young women.

Background: Endocrine therapy (ET) with or without ovarian function suppression (OFS) is a cornerstone treatment for estrogen receptor-positive (ER+) breast cancer (BC) in premenopausal women, but its impact on quality of life (QoL) and sexual health remains a concern. Methods: We conducted a multicenter, prospective, observational study including premenopausal women (≤50 years) diagnosed with stage I–III ER+ BC and treated in private healthcare facilities in Brazil between 2013 and 2023. Patients received ET alone (ET-only) or combined with OFS (OFS-ET). QoL was assessed at baseline and 3, 6, 9, 12, and 24 months using the EORTC QLQ-BR23. Sexual functioning and sexual enjoyment were prespecified primary outcomes. Logistic regression identified factors associated with OFS use, and Fisher’s exact test was applied for categorical comparisons at 24 months. Results: Among 363 patients (80% ET-only, 20% ET + OFS), younger age, advanced stage, and chemotherapy were independently associated with OFS use. Both groups reported early declines in sexual functioning and enjoyment. By 24 months, ET-only patients had returned to baseline, whereas OFS patients remained below baseline. At the item level, no significant differences were observed in sexual desire (51.5% vs. 42.0%; p = 0.33) or enjoyment (26.0% vs. 13.5%; p = 0.20). Lack of sexual activity was more frequent in the OFS group (60.6% vs. 41.2%; p = 0.05). Body image was significantly more impaired with OFS, with a higher proportion of patients reporting feeling less attractive (38.2% vs. 19.9%; p = 0.04) and less feminine (26.5% vs. 11.7%; p = 0.05). Conclusions: ET impairs sexual health in young BC survivors, particularly when combined with OFS. These findings underscore the need for routine sexual health assessments and supportive interventions in survivorship care.