Half of Early-Stage Breast Cancer Survivors Don't Finish Therapy

After having early-stage breast cancer, I was prescribed hormone therapy.  Many of us take Tamoxifen - an estrogen blocker, or aromatase inhibitors like Aromasin, to prevent a recurrence of breast cancer.  I took Tamoxifen for 2 years but when my oncologist was certain that my medical menopause had turned into natural menopause, he switched me over to Aromasin.  Both hormone therapies have side effects - hot flashes, joint pain, fatigue, vaginal dryness, and osteoporosis.

  Those aren't pleasant, but neither were the side effects of chemo - something I would gladly avoid again!  When faced with the spectre of a possible recurrence, I thought I'd rather have 5 years of chemically-induced hot flashes than find another breast lump and face more surgery, chemo, radiation.  The trade-offs seemed like a no-brainer.  So I was surprised to read that just about half of all women who are supposed to take these therapies quit before their 5-year prescriptions expire.

Scientists in New York and California studied 8,769 early-stage breast cancer patients with estrogen-fueled tumors to see how well they stuck to their hormonal therapies after primary treatment was completed. The results of their study was published in the Journal of Clinical Oncology on June 28.  They looked at pharmacy records and refill dates for hormonal therapy prescriptions for these patients between the years of 1996 to 2007.

  Most patients are prescribed 5 years of hormonal therapy.  In this study, almost all patients ordered and refilled their hormone therapies for the first year after primary treatment.  Women under 40 - the very patients with the longest life expectancy - were the ones most likely to quit taking their medication before the 5 years were over.

  These accounted for about 49% of the total of all patients in this study.  Patients who were married, were treated with chemo or radiation, came from Asian families, and got their refills at 90-day intervals tended to complete their hormonal therapy.  Researchers would like to understand why younger women don't always finish their 5-year follow-up hormone therapies, because those patients should have the most success in avoiding a recurrence.

While I did finish my hormone therapy, it was a battle sometimes.  I wanted the hot flashes to stop, I wanted my bones to be healthy, and I wanted to feel more like a normal female again.  But I stuck to the pills because I felt there was still lots to live for.  I wanted to do whatever it took to continue to survive without another round of breast cancer.  The study's researchers found that in addition to avoiding the side effects of hormone therapy, women sometimes quit because they didn't really understand why they needed to take these medications, or the prescriptions cost too much, or insurance copayments got to be burdensome.  I can think of other reasons that a woman under 40 would skip these pills:  estrogen blockers can reduce fertility, lower libido, cause endometrical thickening, and contribute to the formation of cataracts.

  Even though none of those conditions is as bad as having breast cancer, what many patients really want is to get their life back after breast cancer - they don't want a daily pill to remind them that cancer may lurk in their future.

After primary treatment, breast cancer patients will visit their oncologists at regular intervals over that 5-year period when they are supposed to be taking their hormonal therapy.  During those visits, the doctor will check for signs of recurrence, take vital signs, and do bloodwork.  Perhaps they should also be asking if patients are taking their hormone pills.

  "Physicians are often unaware of patient compliance, and this is becoming an increasingly important issue in cancer," said the study's leader, Dr. Dawn Hershman.  While oncologists are doing all they can to help patients avoid a recurrence, it really is up to each of us to guard our own health. If the cost of hormone therapy or the side effects is getting you down before your 5 years are up, ask for help getting the medications or coping with the side effects.  Your future health is well worth taking those little pills.  Hormone therapy isn't magic and sure isn't a guarantee, but since it should protect you - please finish your therapy.  You could save your own life.

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