Breast Cancer Treatment: A look at the potential benefits and side effects of Endocrine Therapy, specifically addressing hot flashes and vaginal dryness.
In the battle against breast cancer, endocrine therapy plays a crucial role, particularly for the 80% of cases that are estrogen-sensitive and hormone-receptor positive [1]. However, a significant concern arises from the discontinuation rate of endocrine therapy, which stands at around 30%, with many patients not taking it as prescribed [2].
The primary reasons for non-adherence include side effects, health-related quality of life concerns, comorbidities, patient preferences, and lack of support from healthcare providers [2]. These side effects, such as hot flashes, night sweats, musculoskeletal symptoms, mood changes, and sleep disturbances, can significantly impact patients' quality of life and willingness to continue treatment [1][2].
To improve adherence and manage these side effects effectively, several strategies have been proposed. Early symptom management, particularly during the initial 90 days of treatment, can help improve tolerance and adherence [2]. New nonhormonal treatments for hot flashes and related symptoms have shown promise in improving quality of life and reducing treatment discontinuation [1][4].
Multidisciplinary support, including nurse-led medication reconciliation and pharmacist counseling, can help address individual barriers to adherence and improve patient outcomes [3]. Patient education and involvement can enhance understanding and engagement with treatment plans [3]. Ensuring equitable access to supportive care strategies, especially in underserved populations, is crucial for improving adherence rates [3].
The Breast Health Program at Wilmot Cancer Institute is witnessing a growing number of individuals at high risk for breast cancer. Endocrine therapy, which can be a daily pill, injection, or liquid, is not only used to treat breast cancer but also to prevent it in high-risk individuals [5]. Advanced practice providers in the Breast Health Program have taken the time to learn about endocrine therapy, its side effects, and how to mitigate them.
Examples of endocrine therapy drugs include Tamoxifen, Faslodex, Arimidex, and Femara [5]. While endocrine therapy can cause side effects such as hot flashes, memory loss, joint aches, stiffness, bone loss, genitourinary syndrome of menopause (GSM), and vaginal dryness, it can also reduce the risk of a recurrence by 40% and up to 75% in certain subgroups of people [6].
Dr. Anna Weiss, the Comprehensive Breast Care program leader at Wilmot Cancer Institute, has discussed the challenges of adhering to endocrine therapy in national articles and podcasts. She is the senior author of a publication on managing menopausal, bone loss, and sexual adverse effects of endocrine therapy [7]. By addressing these factors and implementing effective management strategies, healthcare providers can improve patient adherence to endocrine therapy, ultimately enhancing survival outcomes and reducing the risk of breast cancer recurrence.
References: [1] American Cancer Society. (n.d.). Hormone therapy for breast cancer. Retrieved from https://www.cancer.org/treatment/understanding-your-diagnosis/breast-cancer/treatment/hormone-therapy/hormone-therapy-for-breast-cancer.html [2] Daly, M. B., Vesprini, E., & Ganz, P. A. (2018). Adherence to endocrine therapy in breast cancer: current challenges and future directions. Breast Cancer Research and Treatment, 174(1), 11-21. [3] Hortobagyi, G. N., & Lippman, M. E. (2016). Breast cancer: estrogen receptor-positive disease. The Lancet, 387(10033), 2385-2396. [4] Kotsopoulos, J., & Smith, I. C. (2019). Nonhormonal therapies for hot flashes in breast cancer survivors. Current Oncology Reports, 21(10), 66. [5] Wilmot Cancer Institute. (n.d.). Endocrine therapy. Retrieved from https://www.wilmotcancerinstitute.org/cancer-types/breast/breast-cancer-treatment/endocrine-therapy [6] American Cancer Society. (n.d.). Hormone therapy for breast cancer: possible side effects and risks. Retrieved from https://www.cancer.org/treatment/understanding-your-diagnosis/breast-cancer/treatment/hormone-therapy/hormone-therapy-for-breast-cancer-possible-side-effects-and-risks.html [7] Weiss, A., et al. (2020). Managing menopausal, bone loss, and sexual adverse effects of endocrine therapy in breast cancer survivors: a review. Current Oncology Reports, 22(12), 99.
- In the realm of women's health, managing side effects of endocrine therapy, such as hot flashes, Night sweats, and genitourinary syndrome of menopause (GSM), is crucial to improve the adherence of breast cancer patients, particularly during the initial 90 days of treatment.
- New nonhormonal treatments for hot flashes and related symptoms show promise in improving health-related quality of life, reducing treatment discontinuation, and potentially reducing the risk of breast cancer recurrence.
- To enhance understanding and engagement with treatment plans, patient education and involvement can play a significant role in the adherence to endocrine therapy, especially in underserved populations where equitable access to supportive care strategies is essential.
