Take the Full Course!
Posted 9/9/2010
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We all know how powerful and effective the hormonal/endocrine/anti-estrogen therapies can be for women who have ER positive breast cancers. As we also should know, they work the best when we take them for the full course of time. The length of time has been expanding from a standard five years to ten or even more. There continues to be research into the sequence and duration of treatment as different doctors use somewhat different combinations of first tamoxifen and then an AI or just an AI or even more than one AI.
I have known a number of women who discontinued their therapy before the prescribed time had passed. Sometimes this was due to unpleasant side effects from the drugs (usually joint aches and pains) or to expense or to a decision to be done with medications. If side effects are problematic, do talk with your doctor about the possibility of trying a different medication. There are three AIs, all equally effective, and women do have different reactions to different ones. I have known a number of people who were miserable on, for example, arimidex and switched to femera and had no problems. If expense is the concern, talk to your doctor about possible assistance from the pharmaceutical company or other sources. Actually, ask your doctor whom you can speak with about these financial resources. At BIDMC, we are fortunate to have an Oncology Community Resource Specialist who knows all about these programs. Another money-saving option may be to take tamoxifen, which is available as a generic and quite cheap, rather than a more expensive AI. Let me be clear: I am not a doctor and certainly am not advocating a medical treatment. However, I know that studies have indicated a very small percentage difference among these treatments, and some women have opted for the drug that is affordable.
All of that is background to this study that emphasizes the importance of taking the full course of medication. Here is the abstract and then a link to read more:
Early discontinuation and non-adherence to adjuvant hormonal therapy are associated with increased mortality in women with breast cancer
Dawn L. Hershman, Theresa Shao, Lawrence H. Kushi, Donna Buono and Wei Yann Tsai, et al.
Breast Cancer Research and Treatment, Online Firstâ„¢, 27 August 2010
Despite the benefit of adjuvant hormonal therapy (HT) on mortality among women with breast cancer (BC), many women are non-adherent with its use. We investigated the effects of early discontinuation and non- adherence to HT on mortality in women enrolled in Kaiser Permanente of Northern California (KPNC). We identified women diagnosed with hormone-sensitive stage I-III BC, 1996-2007, and used automated pharmacy records to identify prescriptions and dates of refill. We categorized patients as having discontinued HT early if 180 days elapsed from the prior prescription. For those who continued, we categorized patients as adherent if the medication possession ratio was ≥80%. We used Cox proportional hazards models to estimate the association between discontinuation and non-adherence with all-cause mortality. Among 8,769 women who filled at least one prescription for HT, 2,761 (31%) discontinued therapy. Of those who continued HT, 1,684 (28%) were non-adherent. During a median follow-up of 4.4 years, 813 women died. Estimated survival at 10 years was 80.7% for women who continued HT versus 73.6% for those who discontinued (P < 0.001). Of those who continued, survival at 10 years was 81.7 and 77.8% in women who adhered and non-adhered, respectively (P < 0.001). Adjusting for clinical and demographic variables, both early discontinuation (HR 1.26, 95% CI 1.09-1.46) and non-adherence (HR 1.49,95% CI 1.23-1.81), among those who continued, were independent predictors of mortality. Both early discontinuation and non-adherence to HT were common and
associated with increased mortality. Interventions to improve continuation of and adherence to HT may be critical to improve BC survival.
http://tinyurl.com/2c3ksve
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