BCMS Medical Record Fall 2020 - 32

M e d i c a l R ec o r d F e a t u r e
M e d i c a l R ec o r d F e a t u r e

The Berks County Medical
Society is once again
delighted to publish
abstracts of the research
projects completed by
the college and medical
school students who spent
six weeks of their summer
participating in the Reading
Hospital - Tower Health
Student Summer Internship
program. BCMS members
are among the physicians
who serve as preceptors
to these students, and
our society's Pat Sharma
President's Scholarship
recipient benefits each year
from being folded into this
program. Education is one
of the four 'compass points'
that summarize the mission
of the BCMS, and we are very
grateful to Reading Hospital
- Tower Health for its
support. Our programs share
the goal of providing young
people interested in a career
in medicine with a valuable
learning experience.

32

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www.berkscms.org

Reading Hospital/Tower Health

Student Sum

Clinical Guideline Implementation May Allow
for Hormone Level Stabilization and Impact
Side Effect Incidence in Postmenopausal
Women on Pellet Hormone Therapy
by Anna Roble, Tara Lamb, Xuezhi Jiang, Anna Bossert,
K. Nathan Parthasarathy, Kristine Leaman, Shahab S. Minassian,
Peter F. Schnatz, Mark B. Woodland, Department of Obstetrics and Gynecology,
Reading Hospital, Reading, Pennsylvania
INTRODUCTION: Although commercially promoted as a safe alternative to FDAapproved hormone therapy, custom-compounded pellet hormone therapy has been
associated with a significantly higher incidence of side effects and supraphysiological
peak hormone levels than its FDA-approved counterparts. This study aims to evaluate
the impact of departmental clinical guidelines, which standardized laboratory follow-up
recommendations, on serum hormone levels and side effect incidence in postmenopausal
women on pellet hormone therapy.
METHODS: A before-and-after study was designed using Reading Hospital's Electronic
Medical Record to obtain data from postmenopausal patients on pellet hormone therapy
before and after clinical guidelines were implemented in 2017. Patient chart information
was collected by medical students and included demographics, duration of treatment,
dosage changes, laboratory follow-up frequency, serum estradiol (E2), total testosterone
(TT) and free testosterone (FT) levels, and side effects. Two data groups, one from
treatment onset to guideline implementation and the other from implementation to June
2020, were established and compared against each other using paired t-test and McNemar
tests for continuous and categorical data, respectively.
RESULTS: A group of 106 postmenopausal women with history of regular pellet insertion
before and after guideline implementation was identified. Mean (SD) age and body mass
index on first contact were 56.4 (7.5) years and 28.9 (4.0) kg/m2, respectively. Mean (SD)
treatment duration was significantly shorter in the After than the Before group (1.6[0.2]
vs. 5.1[2.1] years, p<.0001). The frequency of serum E2 (2.7[0.9] vs. 1.1[0.4], p<.0001)
and T (2.3[1.0] vs. 0.9 [0.4], p<.0001) measurements per year were significantly higher in
After than Before. When comparing serum hormone fluctuation, measured as the difference
between peak and nadir values, women in the After group demonstrated significantly
lower fluctuation in E2 (81.5 [65.6] vs. 200.8[126.8] pg/mL, p<.0001), TT (73.0[59.2]
vs. 105.6[70.0] ng/dL, p=.001), and FT (6.7[6.9] vs. 11.3[20.7] pg/mL, p=.027) than
the Before. There were no significant differences in the mean highest E2 and T dosages
between Before and After. The peak serum levels of E2(193.4[91.9] vs. 289.4[134.3] pg/
mL, p<.0001), TT(130.9[50.8] vs. 195.0[72.7] ng/dL, p<.0001), and FT(11.4[7.8]
vs. 15.7[21.8] pg/mL, p=0.048) were significantly lower in the After than the Before.
Both the incidence (58 [54.7%] vs. 77[72.6%], p=0.011) and total number (0.9[1.0] vs.
1.8[1.6], p<.0001) of side effects were significantly lower in the After group; however, the
total number of side effects per year in the After was significantly higher than the Before
(0.6[0.6] vs.0.4[0.4],p=0.015]).


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BCMS Medical Record Fall 2020

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