In a study published, in June 2010 (in the Journal of Clinical Oncology) investigators have found that over 50% of breast cancer patients, who have been prescribed hormonal therapy medications (“aromatase inhibitors” or “Tamoxifen”) for preventing recurrence of breast cancer, either prematurely discontinue or do not take their medication as prescribed (“non-adherence” was defined in this study as, taking <80% of the prescribed pills.) All patients in this study (8,769 patients) had “estrogen positive”, invasive breast cancers (stages 1-3) and were therefore recommended to take hormonal therapy for a total of 5-years. Previous studies have demonstrated that patients who take less than 5-years of hormonal therapy have higher recurrence and lower survival rates.
During the 4.5-year follow-up period of the study, the authors reported that 32% of the patients in this study prematurely discontinued their hormonal therapy, and of those who continued taking their medication 28% were non-adherent (19% of the total.) Among the age groups analyzed in this study (<40, 40-55, 55-65, 65-76, >75), the patients who were the most non-adherent were those in the <40 and >75 age groups. Prior studies have shown that younger patients more commonly have aggressive breast cancers, so it was particularly worisome that the <40 age group was found to be the most non-compliant of the age groups (i.e. they were 50% more likely to discontinued their therapy prematurely and 40% more likely to be non-adherent.)
The authors of this study did not investigate the reasons for why so many of these patients were non-adherent to the hormonal therapy regimens. Aromatase inhibitors and Tamoxifen are frequently associated with side effects (i.e. hot flashes, muscle and joint aches, weight gain, etc.) Previous studies have reported that among breast cancer patients who discontinue hormonal therapy, >80% do so because of their untoward side effects. Additionally, the cost of these medications may have been a burden for some patients (although, all patients in this study were enrolled in an equal-access health care system and had a prescription medication plan with Kasier Permanente of Northern California.)
As an oncologist, I spend a fair amount of time helping to educate my patients on the importance of adherence to hormonal therapy regimens, as well as discussing with them any issues they may have in maintaining compliance with this recommendation (i.e. side effects, cost, etc.) The side effects of these medications can often be managed through he use of various non-pharmacologic therapies (i.e. acupuncture, meditation, yoga, etc.) In my role as an integrative oncologist, I often recommend these complementary therapies for my patients based on the latest evidence from published studies. Implementing complementary therapies along with conventional therapies (i.e. hormonal therapy) has helped many of my patients to be able to complete their entire course of conventional therapy with less side effects and higher quality of life.
