Breaking the Myths: Hormone Therapy in Cancer Treatment

Misconceptions continue to shroud hormone-related care in oncology, shaping clinical decisions in ways that can impact patient experience and outcomes.

Hormone-related treatments in cancer care are often misunderstood, which can influence decisions for select hormone-receptor–positive gynecologic cancers. Here, we use "oncologic endocrine therapy" to refer to anti-hormonal treatments for cancer (such as progestins or aromatase inhibitors) and "HRT" for menopausal symptom management in survivors. Importantly, hormone-related care spans two arenas—endocrine therapy as part of cancer treatment and HRT to address survivorship symptoms—and confusion between them can misguide decisions in both.

HRT may improve quality of life for some survivors, but it is not a cancer treatment and its use must be individualized based on cancer type, receptor status, and risk profile. For example, symptomatic patients earlier in the menopausal transition (such as those under 60 or within about 10 years of menopause) may benefit more, as suggested by a review on timing and symptom burden from Springer, though decisions should always be individualized.

In stark contrast, traditional chemotherapy acts by targeting rapidly dividing cells, both cancerous and healthy, leading to systemic side effects. Oncologic endocrine therapy, however, targets hormone-driven pathways, providing a more nuanced and often less invasive approach. Hormone-directed therapies can have different—and sometimes more favorable—side-effect profiles than cytotoxic chemotherapy, which may translate to better quality of life in selected settings. An AACR abstract on immunologic features in hormone-responsive tumors provides mechanistic context but does not address quality-of-life or adverse-event comparisons.

Despite growing knowledge, misconceptions remain widespread among healthcare professionals. A revealing survey published by MDPI indicates that many gynecologists and oncologists lack confidence in when and how to use hormone therapies—both oncologic endocrine therapy and HRT—contributing to underutilization or inappropriate avoidance.

The implications are significant; without proper understanding, patients may miss out on therapies that could alleviate symptoms and enhance their quality of life, but potential benefits must be weighed against risks and contraindications through shared decision-making. This balanced approach also guards against overgeneralization—what is appropriate for one cancer type or receptor status may be inadvisable for another.

Putting clarity into practice starts with precise terminology and intent. When oncologic endocrine therapy is being considered, teams should explicitly define the therapeutic goal (disease control or palliation), confirm hormone-receptor status where relevant, and align choices with institutional pathways. When HRT is considered for survivorship symptoms, clinicians should document indications (e.g., vasomotor symptoms, genitourinary syndrome of menopause), discuss risks and alternatives, and set expectations around monitoring and duration.

Implementation also benefits from structured communication. Multidisciplinary discussions can surface areas where endocrine therapy and HRT are conflated, allowing teams to correct course. Patient-facing materials should separate sections on cancer-directed endocrine therapy from those on HRT, using consistent language that reinforces the distinction.

Evidence communication matters. When discussing endocrine therapy mechanisms or potential immune effects, cite mechanistic sources appropriately and avoid implying comparative advantages not supported by outcomes data. Conversely, when discussing quality of life with HRT, acknowledge symptom relief alongside known risks and uncertainties, and emphasize individualized decision-making informed by menopausal timing hypotheses referenced in reviews like the one hosted by Springer.

As the field evolves, integrating a clear distinction between endocrine therapy and HRT, aligning choices with receptor status and available guidance, and balancing quality-of-life gains against risks can help correct prior misconceptions and improve care. Clinicians can act on these opportunities by clearly distinguishing endocrine therapy from HRT, aligning decisions with receptor status and guidelines, and closing knowledge gaps highlighted by recent surveys.

Key Takeaways:

• Use precise terms: "oncologic endocrine therapy" for cancer treatment versus "HRT" for survivorship symptom relief.
• HRT is not a cancer treatment; consider it selectively for symptom control after weighing risks, timing, and patient preferences.
• Endocrine therapies act on hormone-driven pathways and may have different side-effect profiles than chemotherapy.
• Clinician knowledge gaps persist; structured communication and guideline-aligned decisions can reduce underuse or inappropriate avoidance.
• Shared decision-making is essential to balance benefits and risks in both endocrine therapy and HRT decisions.