Younger Women and Hormonal Therapies
This is another one of those interesting studies that shouldn't surprise anyone and seem overdue in terms of identifying research and data that supports thoughtful common sense. Researches at Columbia and Kaiser Permanente looked at younger women who were taking hormonal therapies (likely, mostly Tamoxifen) and found a higher rate of non-compliance or stopping the meds before the prescribed five years. Naturally.
My observation has always been that this is true. Certainly, young women are not more confident or less worried about their health, but they particularly struggle with with being developmentally out of sync with their medical issues. It is rotten to be in your 30s and having hot flashes. More seriously, many younger women are concerned with fertility, and decide that trying to have a baby trumps everything else. Here is a summary from the Women's Health Policy Report:
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THE DAILY REPORT
Younger Breast Cancer Patients Most Likely To
Discontinue Treatment, Study Finds
June 30, 2010 — About half of breast cancer patients do not take their medication for the recommended period of time, according to a study published Tuesday in the Journal of Clinical Oncology, USA Today reports (Szabo, USA Today, 6/29).
Researchers at Columbia University Medical Center and Kaiser Permanente in Northern California examined the pharmacy records of 8,769 women with breast cancer who were prescribed tamoxifen, aromatase inhibitors or both. The women involved in the study were insured through Kaiser Permanente and diagnosed with Stage I, II or III hormone-sensitive breast cancer between 1997 and 2007 (Schiewe, "Booster Shots," Los Angeles Times, 6/28). Hormone therapy drugs, such as those in the study, can prevent estrogen from stimulating tumor growth, reduce the risk of relapse by 40% and lower the risk of death by 10%, according to USA Today.
Forty-nine percent of women took the prescribed drugs for at least four-and-one-half of the recommended five years (USA Today, 6/29). Women younger than age 40 were the most likely to discontinue treatment ("Booster Shots," Los Angeles Times, 6/28).
CUMC's Dawn Hershman, an author of the report, said it is understandable why some women discontinue their prescriptions because "[a]s you move further out from your diagnosis, it becomes a distant memory. Some women don't want to be reminded." Hershman added that the side effects of tamoxifen can be severe, particularly in younger women who have not gone through menopause.
Younger women also are more likely to be caring for children, which could decrease the likelihood that they will focus on their own care, according to Eric Winer of the Dana-Faber Cancer Institute. Because women are advised to avoid pregnancy while taking the hormone therapy drugs, continuing treatment can disrupt women's plans to have children, according to USA Today.
The findings underscore the need for doctors to work with patients to decrease side effects of cancer treatments, particularly when patients are responsible for their adherence, Jennifer Obel, a breast cancer expert with the American Society of Clinical Oncology, said (USA Today, 6/29).