Hormonal Contraceptive Use in Oncology Patients: Pharmacists Role in Counseling




Obioma, Jessica


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Objective: Over 70 million women in the United States are currently using a contraceptive method. In addition, there were 1.7 million new cancer cases reported in 2018. A concise and timely conversation about contraceptive options and use is pertinent to the care of a cancer patient. Some studies have shown concerns for hormonal contraceptive use in cancer patients. The primary objective of this systematic review was to evaluate evidence on effective hormonal contraceptive use in cancer patients. A second objective was to describe pharmacist counseling points for cancer patients. Methods: A systematic review of the literature was conducted from 1975 to 2022 using PubMed with keywords such as "contraceptive use," "oncology patients," "counseling," and "role of a pharmacist." A PRISMA flow diagram was used to analyze the process. Studies that did not meet the inclusion criteria of focusing on the effects of hormonal contraceptives in cancer patients and patient counseling were excluded. Articles were summarized in a table classified by the author, year published, title, study design, intervention, pros and cons of contraceptive methods, and major findings. The quality of the articles was assessed via the Oxford for Evidence-based Medicine scale. Results: Seventy-four articles were eligible for review. The majority of studies conducted were randomized clinical trials and comparative studies. Trends in literature have shown insufficient data in regard to medication counseling on the effects of hormonal contraceptive use in cancer patients. There are 6 classes of contraceptive methods: (1) behavioral methods, (2) barrier methods, (3) estrogen-containing methods, (4) progestin-only methods, (5) intrauterine devices (IUDs), and (6) surgical sterilization. Several studies suggest the copper IUD, a highly effective, reversible, long-acting, hormone-free method should be considered a first-line contraceptive option for women with a history of hormonally mediated cancer. Women with IUDs can undergo all forms of imaging, including computed tomography and magnetic resonance imaging. Conclusion: Hormonal contraceptives are one of the most prescribed medications in the United States which provide pharmacists the opportunities to counsel and practice through state protocol or collaborative practice agreements. While pharmacists are poised to provide this service, cancer patients represent a unique population to seek contraceptive advice before and after treatment. As the pharmacist's scope of practice continues to expand, future research is needed to address the pros and cons of available contraceptives.