345

was absent. Plasma levels of vasoactive intestinal polypeptide and systemic cardiovascular effects were

identical in the two groups.

91089663 Hormone replacement ltherrpy and survival after surgery for ovarian cancer

Eeles R.A.; Tan S.: Wiltshaw E.; Fryatt I.: A’Hern R.P : Shepherd J.H.; Harmer C.L.; Blake P.R.; Chilvers C.E.D.

Department 01 Medicine. Royal Mursden Hospitul. London S W3 655

BR. MED. J. 1991 30216771 (259-262)

Objective - TO evaluate whether hormone replacement therapy al&cts survival in women who have undergone, bilateral salpingo-oophorectomy because of epithelial ovarian cancer. Design - Retrospective analysis by review of patients’ notes and questionnaires completed by general practitioners to compare the overall survival and disease free survival in patients with ovarian cancer who did or did not receive hormone replace- ment therapy after diagnosis. Data were analysed by Cox regression, with hormone replacement therapy as a time dependent covariate because patients who received hormone replacement did so at different times aRer diagnosis. Setting - Gynaecological oncology unit of Royal Marsden Hospital. Patients - 373 Pa- tients aged SO years or younger who attended the hospital from I972 to 1988. All of the women had undergone bilateral salpingo-oophorectomy for epithelial ovarian cancer. In all. 78 had received hormone replace-

‘ment therapy starting at a median of four months after diagnosis. Intervention - A questionnaire was sent to the general practitioners of all patients who were not recorded as having received hormone replacement therapy. Main outcome measures - Overall survival and disease h-ee survival. Results - There was no sign& cant difference in survival between women receiving hormone replacement therapy and those not receiv- ing it after accounting for the effects of other known prognostic factors (stage of cancer, differentiation of tumor?. histological results, and time to relapse). The relative risk of dying in those who received hor- mone replacement therapy was 0.73 (9% confidence interval 0.44 IO I .20). In addition. there was no signifi- cant diNerence in disease free survival (relative risk in those receiving hormone replacement therapy was

0.90; 95% confidence interval 0.52 lo 1.54). Conclusions - This study shows that hormone replacement therapy is unlikely to have a detrimental effect on the prognosis of patients with ovarian cancer. hut this would be shown conclusively only by a randomised controlled trial.

91089669 Study of general practice consultations and menopausal problems Barlow D.H.; Brockie J.A.; Rees C.M.P. Nufleid Department of Obstetrics und Gynaetology. Universi/_v of 0.~ford0 John Radcl@ Marerni(s Hospilal,

Headington, Oxford OX3 9DU BR. MED. J. 1991 302/6771 (274-276)

Objective - To investigate Ihe nature of work related to the menopause in general practice. Design - Ques- tionnaire study over six months among general practitioners after each consultation with a woman aged 40-69 at which issues related to the climacteric had bsen discussed. Setting - 9 General practices in the Oxford area. Subjects - 416 Women who had 572 consultations. Main outcome measures - Age, menopausal state, and !irst or subsequent consultation. Symptoms were classified together with the treatment and the outcome of the consultation. Results - The consultation rate varied greatly between practices. the overall rale being4.4%. There were many premenopausal women and women in their 60s presenting: women with hysterectomies presented more often -36% (37/103) of women with hysterectomies had more than one con- sultation compared with 26% (38/144) for premenopausal women and 24% (38/155) for postmenopausal

WOIIIOYI. 4oF women had symptoms and 218 were prescribed oestrogen treatment. I56 of the consultations involved discussion and advice only. Only four women were referred to a local specialist clinic. Conclu- sion - There is a low overall use of hormone replacement therapy in the general postmenopausal popula-

tion despite the recent media coverage of its benefits in the prevention of osteoporosis and subsequent

fractures.