Breast Cancer Treatment: Weighing the Benefits and Drawbacks of Endocrine Therapy for Hot Flashes and Vaginal Dryness
In a groundbreaking publication, Dr. Anna Weiss, the senior author, has shed light on the practical strategies for managing menopausal symptoms, bone loss, and sexual adverse effects associated with endocrine therapy (ET) for breast cancer patients. The publication, titled "Endocrine Therapy for Surgeons: Practical Pearls," was recently published in the Annals of Surgical Oncology.
Endocrine therapy, also known as hormonal therapy, plays a crucial role in reducing the chances of breast cancer recurrence. About 80% of all breast cancers are estrogen-sensitive and hormone-receptor positive, meaning they respond well to endocrine therapy. However, more than 30% of patients stop taking ET early, and many don't take it as prescribed, despite its life-saving benefits.
Common reasons for non-adherence to ET include limited access to initial and ongoing care, patient discomfort, distrust, fear of discrimination, high costs of ET medications, costs associated with managing side effects, and the considerable time and effort ("time toxicity") required to coordinate symptom management. These factors are particularly impactful among Black breast cancer survivors, highlighting disparities linked to race and socioeconomic status.
The side effects of ET, often resembling early menopause symptoms such as hot flashes and sexual dysfunction, contribute significantly to non-adherence. Managing these side effects effectively is crucial to improve adherence. Strategies to manage ET side effects include symptomatic treatments for menopausal symptoms, patient education, tailored counseling by healthcare providers, and multicomponent adherence interventions.
Research suggests that being physically active can help with a variety of side effects stemming from breast cancer and its treatment, including brain fog, pain, and fatigue. The Wilmot Cancer Institute's Comprehensive Breast Care program, led by Dr. Weiss, is a resource for managing side effects of ET. The integrative oncology center offers strategies for managing genitourinary syndrome of menopause (GSM), such as avoiding irritants, moisturizing with simple products, lubricating during sex, and considering pelvic floor exercises.
Endocrine therapy increases survival by reducing the risk of a recurrence by 40% and up to 75% in certain subgroups of people. It is typically taken as a daily pill, but can also be an injection or a liquid. For patients at a slightly higher risk of cancer returning, doctors may recommend 10 years of treatment.
The Wilmot Cancer Institute's Breast Health Program has formed strong relationships with specialists to refer patients to when needed. Advanced practice providers in the program have taken additional time to learn about ET, its side effects, and how to mitigate them. Common brand names of ET drugs include Tamoxifen, Faslodex, Arimidex, and Femara.
Dr. Weiss has recently discussed the challenges of adhering to ET in national articles and podcasts. She emphasised the need for comprehensive management strategies addressing symptom control, patient support, and system-level barriers to improve ET adherence in breast cancer patients. In conclusion, non-adherence often arises from a combination of socioeconomic factors, medication costs, distressing side effects, and logistical burdens. Addressing these issues is essential to ensure that breast cancer patients receive the full benefits of endocrine therapy.
[1] Reference omitted for brevity.
- Dr. Anna Weiss's research focuses on practical strategies for managing menopausal symptoms, bone loss, and sexual adverse effects in breast cancer patients undergoing endocrine therapy (ET), which is a crucial part of health-and-wellness for this patient group.
- The side effects of ET, such as hot flashes and sexual dysfunction, often resemble those of early menopause and can lead to non-adherence, particularly among women's-health populations like Black breast cancer survivors.
- To improve adherence, it's essential to employ strategies like symptomatic treatments for menopausal symptoms, patient education, counseling, and multicomponent adherence interventions, as well as address socioeconomic factors, medication costs, and logistical burdens associated with ET.
