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Poor Quality of Life Linked to Stopping Hormonal Therapy Treatment Early

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Women who reported poor physical well-being, poor social well-being, and a history of depression were more likely to stop hormonal therapy treatment early, according to a study.

The research was published online on June 17, 2021, by the journal JAMA Oncology. Read the abstract of “Association of Modifiable Risk Factors With Early Discontinuation of Adjuvant Endocrine Therapy: A Post Hoc Analysis of a Randomized Clinical Trial.”

About hormonal therapy
About the study
What this means for you

About hormonal therapy

After surgery, people diagnosed with hormone-receptor-positive breast cancer usually take hormonal therapy medicine — also called endocrine therapy or anti-estrogen therapy — to reduce the risk of recurrence (the cancer coming back). Hormonal therapy given after surgery is called adjuvant hormonal therapy.

Hormonal therapy medicines treat hormone-receptor-positive breast cancers in two ways:

  • by lowering the amount of estrogen in the body
  • by blocking the action of estrogen on breast cancer cells

Estrogen makes hormone-receptor-positive breast cancers grow. Reducing the amount of estrogen or blocking its action can decrease the risk of early-stage hormone-receptor-positive breast cancers recurring after surgery. Hormonal therapy medicines also can be used to help shrink or slow the growth of advanced-stage or metastatic hormone-receptor-positive breast cancers.

Hormonal therapy medicines are not effective against hormone-receptor-negative breast cancers.

There are several types of hormonal therapy medicines used to treat hormone-receptor-positive breast cancer:

  • aromatase inhibitors: Arimidex (chemical name: anastrozole), Aromasin (chemical name: exemestane), and Femara (chemical name: letrozole)
  • selective estrogen receptor modulators (SERMs): tamoxifen, Evista (chemical name: raloxifene), and Fareston (chemical name: toremifene)
  • estrogen receptor downregulators (ERDs): Faslodex (chemical name: fulvestrant)

In most cases, you take hormonal therapy for 5 to 10 years after breast cancer surgery — usually tamoxifen or an aromatase inhibitor — depending on whether you’re premenopausal or postmenopausal.

Tamoxifen is effective at reducing recurrence risk in both premenopausal and postmenopausal women. Aromatase inhibitors are more effective at reducing recurrence risk in postmenopausal women and are now used more often than tamoxifen to treat women who’ve gone through menopause. Research also has shown that premenopausal women can take the aromatase inhibitor Aromasin as hormonal therapy as long as their ovarian function has been suppressed.

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 include heart problems, osteoporosis, and broken bones. Research has shown that about 52% of women prescribed tamoxifen and 47% of women prescribed Arimidex to reduce the risk of recurrence after breast cancer surgery stop taking the medicine early.

Research suggests that many women stop taking hormonal therapy early because of side effects.

The researchers who did this study wanted to see if there were any controllable factors linked to stopping hormonal therapy early.

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About the study

This analysis used information collected as part of the TAILORx (Trial Assigning IndividuaLized Options for Treatment) study. TAILORx included more than 10,000 women diagnosed with early-stage, hormone-receptor-positive, HER2-negative breast cancer that had not spread to the lymph nodes. The goal was to determine the range of Oncotype DX Breast Recurrence Scores that allowed a person to safely skip chemotherapy after surgery and only be treated with hormonal therapy.

This analysis included information on 954 women with an average age of about 57. Of the 954 women, 106 women (11%) stopped taking hormonal therapy early.

The initial results showed that women treated with both chemotherapy and hormonal therapy after surgery, and who were older than 40, were more likely to complete the full course of hormonal therapy. So the researchers adjusted their final analyses to take these factors into account.

The final results linked the following quality-of-life factors to women being more likely to stop taking hormonal therapy early:

  • worse physical well-being
  • worse social well-being
  • a history of depression

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What this means for you

If you’ve had surgery for hormone-receptor-positive breast cancer and plan to take hormonal therapy for the next 5 or 10 years, it’s very important that you take the medicine for as long as it’s prescribed. Compared with hormone-receptor-negative breast cancer, hormone-receptor-positive breast cancer is more likely to come back 5 or 10 years after surgery.

Side effects caused by hormonal therapy can be very troublesome for many women. It’s extremely important to talk to your doctor as soon as you start having any side effects, including hot flashes, joint pain, blood clots, trouble sleeping, fatigue, or difficulty concentrating. It’s not a good idea to wait until the symptoms are intolerable and you have to stop taking the medicine. There are steps you can take to ease these side effects, including switching to a different type of hormonal therapy.

Similarly, if you have other health conditions, including depression, that are affecting your physical well-being, it makes sense to talk to your doctors about them and ask how they can be treated.

Learn more about Staying on Track With Treatment. You can read about why it’s so important to stick to your treatment plan, as well as ways to manage side effects after radiation, chemotherapy, and hormonal therapy. If you’re taking hormonal therapy after surgery now, stick with it as prescribed. If you’re thinking of stopping early, talk to your doctor first. Together, you can find a solution that is best for you.

To talk with others about staying on track with hormonal therapy treatment, join the forum Hormonal Therapy - Before, During, and After.

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Written by: Jamie DePolo, senior editor

Reviewed by: Brian Wojciechowski, M.D., medical adviser


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