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High Percentage of Women Don’t Complete Recommended Breast Cancer Treatment

Side effects cited as most common reason for quitting therapy (Apr. 9)

One-quarter of women who should take hormone-blocking therapies as part of their breast cancer treatment either do not start or do not complete the 5-year course, according to a new study from the University of Michigan Comprehensive Cancer Center.

Five years of daily tamoxifen or aromatase inhibitors — two types of endocrine therapy that are taken as a pill — are recommended for many women whose breast cancer expresses the hormones estrogen or progesterone. These drugs have been shown to reduce cancer recurrence and to increase survival. Recent data also suggest that some women may derive additional benefit from continuing treatment for 10 years.

Nevertheless, the new study of 743 women eligible for endocrine therapy found that about 11% never initiated the recommended treatments and that 15% stopped taking therapy early. The results were published online in Breast Cancer Research and Treatment.

“We’re doing well with women taking endocrine therapy, but there’s work to do,” said lead author Christopher Friese, PhD, RN. “If guidelines begin to shift so that some women at high risk of breast cancer recurring need 10 years of endocrine therapy, then the number of women who persist with treatment will likely worsen. We need to develop better ways of supporting women through this therapy.”

The most common reason patients said they either discontinued or never started endocrine therapy was side effects. Many women experience menopause-like symptoms, such as hot flashes or vaginal dryness, and both types of drugs — more commonly the aromatase inhibitors — can cause joint pains.

The study surveyed women in the Detroit and Los Angeles areas who were diagnosed with breast cancer and who reported to Surveillance, Epidemiology and End Results (SEER) tumor registries. The women were surveyed at about 9 months after their diagnosis and again about 4 years later with questions about their use of tamoxifen or any type of aromatase inhibitor.

Women who reported receiving less information about endocrine therapy were less likely to begin taking it, suggesting that doctors need to address patient education before treatment starts. Moreover, women who saw a breast surgeon as their primary follow-up, rather than a medical oncologist, were also less likely to begin endocrine therapy.

Source: University of Michigan; April 9, 2013.

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