A new study examined the question of why many postmenopausal women treated for estrogen-sensitive breast cancer quit using drugs that can help prevent recurrence.
The study by researchers with Northwestern University in Evanston, Ill., found that 36% of women quit early because of the medications' side effects, which are more severe and widespread than previously known. The research also revealed a big gap between what women tell their doctors about side effects and what they actually experience.
"Clinicians consistently underestimate the side effects associated with treatment," said lead investigator Lynne Wagner, PhD, an associate professor in medical social sciences at Northwestern University Feinberg School of Medicine and a clinical psychologist at Robert H. Lurie Comprehensive Cancer Center of Northwestern University.
"They give patients a drug they hope will help them, so they have a motivation to underrate the negative effects. Patients don't want to be complainers and don't want their doctor to discontinue treatment. So no one knew how bad it really was for patients."
The symptom most likely to cause women to stop using aromatase inhibitors was joint pain. Other side effects women reported as compromising their quality of life were hot flashes, decreased libido, weight gain, feeling bloated, breast sensitivity, mood swings, irritability and nausea.
Wagner's research was scheduled be presented last week at the 34th Annual San Antonio Breast Cancer Symposium.
The women at highest risk for quitting the medications before the recommended five years are those who continue to experience residual side effects from recent chemotherapy or radiation therapy when they start the aromatase therapy, according to the study. Women who had surgery for breast cancer but not chemotherapy or radiation therapy, or who weren't taking many other medications, were more likely to keep taking the aromatase medication.
The study by researchers with Northwestern University in Evanston, Ill., found that 36% of women quit early because of the medications' side effects, which are more severe and widespread than previously known. The research also revealed a big gap between what women tell their doctors about side effects and what they actually experience.
"Clinicians consistently underestimate the side effects associated with treatment," said lead investigator Lynne Wagner, PhD, an associate professor in medical social sciences at Northwestern University Feinberg School of Medicine and a clinical psychologist at Robert H. Lurie Comprehensive Cancer Center of Northwestern University.
"They give patients a drug they hope will help them, so they have a motivation to underrate the negative effects. Patients don't want to be complainers and don't want their doctor to discontinue treatment. So no one knew how bad it really was for patients."
The symptom most likely to cause women to stop using aromatase inhibitors was joint pain. Other side effects women reported as compromising their quality of life were hot flashes, decreased libido, weight gain, feeling bloated, breast sensitivity, mood swings, irritability and nausea.
Wagner's research was scheduled be presented last week at the 34th Annual San Antonio Breast Cancer Symposium.
The women at highest risk for quitting the medications before the recommended five years are those who continue to experience residual side effects from recent chemotherapy or radiation therapy when they start the aromatase therapy, according to the study. Women who had surgery for breast cancer but not chemotherapy or radiation therapy, or who weren't taking many other medications, were more likely to keep taking the aromatase medication.
Reporting of side effects
The new research exposes the disparity between clinicians' reporting of side effects and women's actual experiences. In a previous study, clinicians reported 5% of their patients experienced moderate to severe symptoms as a result of taking aromatase inhibitors.
The new Northwestern study surveyed 686 women with a detailed questionnaire about their symptoms before treatment and at three, six, 12 and 24 months after starting treatment. The researchers found after three months of treatment that 33% to 35% of women had severe joint pain, 28% to 29% had hot flashes, 24% had decreased libido, 15% to 24% had fatigue, 16% to 17% had night sweats and 14% to 17% had anxiety. These numbers increased as women were on treatment longer.
Earlier studies asked women to recall their symptoms after treatment ended, which is less accurate than reporting them at regular intervals while taking the drugs.
As a result of the side effects, 36% of women ended treatment before an average of 4.1 years. After two years, 10% had quit; the remainder quit between 25 months and 4.1 years (a little more than 49 months).
For the study, patients who had postmenopausal breast cancer filled out a 46-question survey rating their quality of life and symptoms associated with breast cancer and endocrine treatment. The survey included an item asking how much they were bothered by side effects of treatment from zero (not bothered) to four (severely bothered). For each additional one-point increase on this item, the patient's risk of quitting treatment early rose 29%. The patients were randomized to take one of two hormonal treatments (anastrozole or exemestane) daily for five years.
The new research exposes the disparity between clinicians' reporting of side effects and women's actual experiences. In a previous study, clinicians reported 5% of their patients experienced moderate to severe symptoms as a result of taking aromatase inhibitors.
The new Northwestern study surveyed 686 women with a detailed questionnaire about their symptoms before treatment and at three, six, 12 and 24 months after starting treatment. The researchers found after three months of treatment that 33% to 35% of women had severe joint pain, 28% to 29% had hot flashes, 24% had decreased libido, 15% to 24% had fatigue, 16% to 17% had night sweats and 14% to 17% had anxiety. These numbers increased as women were on treatment longer.
Earlier studies asked women to recall their symptoms after treatment ended, which is less accurate than reporting them at regular intervals while taking the drugs.
As a result of the side effects, 36% of women ended treatment before an average of 4.1 years. After two years, 10% had quit; the remainder quit between 25 months and 4.1 years (a little more than 49 months).
For the study, patients who had postmenopausal breast cancer filled out a 46-question survey rating their quality of life and symptoms associated with breast cancer and endocrine treatment. The survey included an item asking how much they were bothered by side effects of treatment from zero (not bothered) to four (severely bothered). For each additional one-point increase on this item, the patient's risk of quitting treatment early rose 29%. The patients were randomized to take one of two hormonal treatments (anastrozole or exemestane) daily for five years.
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