What Helps Women Stick to Hormonal Therapy Treatment Plans After Surgery?
Many women either don’t start or stop taking hormonal therapy medicine early, so researchers have been looking for strategies to help them stick to their treatment plans. A new study has found that policy changes lowering the cost of the medicines consistently improved treatment plan compliance, according to a study.
The research was published online on Aug. 2, 2023, by the Journal of Clinical Oncology. Read the abstract of “A Systematic Review and Meta-Analysis of Interventions to Promote Adjuvant Endocrine Therapy Adherence Among Breast Cancer Survivors.”
Why don’t women complete the full course of hormonal therapy?
Also called endocrine therapy or anti-estrogen therapy, hormonal therapy is commonly prescribed after surgery for early-stage breast cancer to reduce the risk of recurrence (the cancer coming back).
There are several types of hormonal therapy medicines. Tamoxifen, a selective estrogen receptor modulator (SERM), is one of the most well-known. Tamoxifen can be used to treat both pre-menopausal and post-menopausal women.
Research shows that aromatase inhibitors are more effective than tamoxifen in post-menopausal women. There are three aromatase inhibitors used to treat hormone receptor-positive breast cancer:
Arimidex (chemical name: anastrozole)
Aromasin (chemical name: exemestane)
Femara (chemical name: letrozole)
Most women take hormonal therapy for 5 to 10 years after breast cancer surgery.
Still, like most cancer medicines, both tamoxifen and aromatase inhibitors can cause side effects. Tamoxifen may cause hot flashes and increase the risk of blood clots and stroke. Aromatase inhibitors may cause muscle and joint aches and pains. Less common but more severe side effects of aromatase inhibitors are heart problems, osteoporosis, and broken bones.
Research has shown that about 25% of women who are prescribed hormonal therapy to reduce the risk of recurrence after surgery either don’t start taking the medicine or stop taking it early, in many cases because of side effects. Stopping the medicine early can increase the risk of recurrence.
Completing the full course of a treatment is called adherence by doctors.
Doctors are always looking for ways to help women stick to their hormonal therapy treatment plans. This study analyzed various treatment adherence strategies to see which ones worked the best.
About the study
This study was a meta-analysis. A meta-analysis combines and analyzes the results of many earlier studies. In this case, the researchers analyzed 25 studies on ways to improve hormonal therapy treatment adherence.
Overall, the studies included 367,873 women diagnosed with early-stage, hormone receptor-positive breast cancer who were prescribed hormonal therapy after surgery. Doctors call treatments given after surgery adjuvant treatments.
The studies looked at the effectiveness of one or more treatment adherence strategies, including:
educating women on the important role hormonal therapy plays in reducing recurrence risk
offering women ways to manage hormonal therapy side effects
helping women remember to take the medicine
teaching women coping skills to help change their attitudes about hormonal therapy
changing policy to lower the cost of the medicines
The researchers’ analysis found that:
educating women about hormonal therapy side effects and ways to manage side effects didn’t improve adherence
strategies lowering the cost of hormonal therapy medicines consistently improved adherence
reminders to take the medicine and psychological coping strategies had mixed results
The researchers pointed out that depression is a known risk factor for non-adherence. Still, only a small number of the studies targeted depression or anxiety. None of the studies looked at using social support or improving the relationship between a woman and her doctor as strategies to improve adherence. And aside from translating the materials, none of the strategies was tailored to different cultural norms. The researchers said that future studies should look at all these factors.
What this means for you
This study suggests that the cost of hormonal therapy medicines is a big reason why many women don’t complete the full treatment course.
As our Special Report: The Cost of Breast Cancer Care explained, breast cancer treatment can be expensive, even for people who have health insurance. It’s important to know there are resources that can help you cover the cost of your breast cancer care.
The first thing you can do is see if the company that makes the hormonal therapy medicine you’re taking offers some sort of discount card or coupons. Your cancer care team can help you find this information.
For more solutions to issues about paying for care, listen to The Breastcancer.org Podcast episode featuring Joanna Morales, of Triage Cancer, and Loriana Hernandez-Aldama, of ArmorUp for LIFE.
— Last updated on October 5, 2023 at 3:30 PM