135P Hot flashes during adjuvant hormone therapy predict treatment discontinuation and outcome among breast cancer patients

OBJECTIVES/SPECIFIC AIMS: (1) To evaluate the association of patient and clinical factors with adherence to adjuvant hormone therapy (HT). (2) To examine the association of HT-related symptoms and the extent of remediation with early discontinuation of hormone therapy. METHODS/STUDY POPULATION: Retrospective cohort study of risk factors for interruption and early discontinuation of adjuvant hormone therapy in hormone receptor-positive nonmetastatic breast cancer patients diagnosed between 2009 and 2015. This study will include incident hormone receptor-positive breast cancer patients who initiated their HT and were followed at Tufts MC until Dec 31, 2016. Primary data source is electronic medical records (EMRs) RESULTS/ANTICIPATED RESULTS: The primary outcome of this study is early discontinuation to HT, defined as the first treatment gap of greater than or equal to 180 days following the initiation of HT. Treatment interruption, defined as any patient- or provider-initiated treatment gap of ≥ 2 weeks, will be examined as the secondary endpoint. Any HT-related symptoms occurred during a follow-up interval will be captured and categorized into five major types (i.e., vasomotor, neuropsychological, gastrointestinal, gynecological, and musculoskeletal symptoms). Onset and duration of a HT-related symptom will be recorded. Severity of the symptoms will also be rated by clinical oncologists. Remediations in response to HT- related symptoms will be collected and categorized into to two groups (pharmacological or non-pharmacological) and whether they were patient- or provider-initiated. Response to a remediation is defined as complete relief, partial relied, no relief, or with worsening symptoms. Response to a treatment change (i.e., HT switch or hold) was collected separately but using the same criteria. Analyses will be performed on the association between patient and clinical factors with rates of nonadherence (unplanned treatment interruption and/or early discontinuation) of hormone therapy, respectively. We also will explore whether patients with elevated symptoms and/or incomplete remediation will have earlier discontinuation of hormone therapy. DISCUSSION/SIGNIFICANCE OF IMPACT: Through formal chart review, we will establish a dataset that contains highly detailed information about treatment-emergent symptoms and remediations, which will enable us to quantitatively assess the impact of these treatment factors on adherence to hormone therapy for breast cancer. The in-depth analysis of risk factors associated with nonadherence to hormone therapy will inform development of interventions to improve cancer outcomes.

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Adjuvant hormone therapy use in early-stage breast cancer patients insured by the New York State Medicaid program.

Journal of Clinical Oncology ◽

10.1200/jco.2011.29.15_suppl.6031 ◽

2011 ◽

Vol 29 (15_suppl) ◽

pp. 6031-6031

Author(s):

R. L. Yung ◽

M. J. Hassett ◽

K. Chen ◽

F. C. Gesten ◽

P. R. Roohan ◽

...

Keyword(s):

Breast Cancer ◽

New York ◽

Hormone Therapy ◽

Cancer Patients ◽

Early Stage ◽

New York State ◽

Breast Cancer Patients ◽

Medicaid Program ◽

Adjuvant Hormone Therapy ◽

York State

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Early-stage breast cancer patients reporting difficulty sleeping, mood issues, or pain are more likely to refuse adjuvant hormone therapy.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.15_suppl.e12065 ◽

2017 ◽

Vol 35 (15_suppl) ◽

pp. e12065-e12065

Author(s):

Christian A. Thomas

Keyword(s):

Breast Cancer ◽

Adjuvant Therapy ◽

Hormone Therapy ◽

Cancer Patients ◽

Adjuvant Treatment ◽

Early Stage ◽

Stage I ◽

Early Stage Breast Cancer ◽

Breast Cancer Patients ◽

Adjuvant Hormone Therapy

e12065 Background: Adjuvant hormone therapy is a crucial part of the treatment for patients with early stage breast cancer and an important quality measure for programs such as QOPI and the oncology care model (OCM). However, it is not known which factors influence some patients with early stage breast cancer to decline adjuvant hormone therapy. We hypothesized that specific self-reported symptoms might impact a patient’s decision to accept or decline adjuvant hormone therapy. Methods: Patients with stage 0 or I breast cancer were identified by chart review from 2011-2016 and de-identified. On the day patients received a recommendation for adjuvant treatment the following patient reported outcome measures (PROs) were analyzed: difficulty sleeping (DS), fatigue (F), mood (M such as anxiety and depression), and pain (P) on a 0-4 symptom scale based on CTCAE v. 4. PROs were then linked with a patient’s decision to accept or decline adjuvant therapy. Results: A total of 287 patients with stage 0 (n = 80) or stage I (n = 207) breast cancer were identified. 38 stage O and 103 stage I patients had evaluable PROs on the same day a recommendation for adjuvant hormone therapy was made. Overall 18/38 (47.4%) of stage 0 patients and 90 of 103 (87.4%) of stage I patients accepted adjuvant treatment. Stage 0 patients declining adjuvant therapy reported any grade of PROs: DS (40%, n = 8), F (35%, n = 7), M (35%, n = 7), P (20%, n = 4). Stage 0 patients accepting treatment reported: DS (22%, n = 4), F (44%, n = 8), M (6%, n = 1), P (20%, n = 4). Stage I patients who declined treatment reported: DS (54%, n = 7), F (46%, n = 6), M (38%, n = 5), P (62%, n = 8). Stage I patients accepting treatment reported: DS (41%, n = 37), F (49%, n = 44), M (31%, n = 28), P (36%, n = 32). Conclusions: Early stage breast cancer patients declining adjuvant hormone therapy are more likely to self report symptoms such as difficulty sleeping, mood disturbances (anxiety, depression), and pain than those accepting treatment.

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Meta-analysis of effect of hormone therapies on lipid levels in breast cancer patients.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.e18243 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. e18243-e18243

Author(s):

Hsin-Hui Huang ◽

Marnie Bertolet ◽

Emma Barinas-Mitchell ◽

Brenda Diergaarde ◽

Chung-Chou Chang

Keyword(s):

Breast Cancer ◽

Hormone Therapy ◽

Cancer Patients ◽

Randomized Clinical Trials ◽

Disease Risk ◽

Meta Analysis ◽

Cardiovascular Disease Risk ◽

Breast Cancer Patients ◽

Lipid Levels ◽

Adjuvant Hormone Therapy

e18243 Background: Breast cancer (BC) patients with hormone-sensitive tumors often receive adjuvant hormone therapy for an extended period. How this affects lipid levels is not known. This study evaluated the relationship between dyslipidemia, a cardiovascular disease risk factor, and use of adjuvant hormone therapy among breast cancer patients. Methods: Randomized clinical trials for adjuvant hormone treatment in post-menopausal BC patients without residual cancer after primary treatment that reported lipid levels were identified in PubMed and EMBASE (N = 13). Bayesian network meta-analysis for longitudinal data was used to evaluate each drug’s effect on the mean changes in lipid levels from baseline. Key covariates were examined to determine heterogeneity of treatment effects; consistency of estimates was assessed using the arm-based method. Results: Toremifene improved all lipids more than any other hormone drug studied (see Table). Most aromatase inhibitors (AIs) did not significantly impact lipids. Age, baseline lipid value, and prior usage of Tamoxifen modified the drug effects on most lipids. However, these modifications do not change the overall conclusion. Conclusions: Selective estrogen receptor modulators (SERMs) are beneficial to most lipid profiles, but AIs do not have consistent impacts on lipids. Tailoring hormone drug prescriptions based on medical conditions of BC patients is recommended. [Table: see text]

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Discontinuation of adjuvant hormone therapy among breast cancer patients not previously attending mammography screening

BMC Medicine ◽

10.1186/s12916-019-1252-6 ◽

2019 ◽

Vol 17 (1) ◽

Cited By ~ 1

Author(s):

Wei He ◽

Louise Eriksson ◽

Sven Törnberg ◽

Fredrik Strand ◽

Per Hall ◽

...

Keyword(s):

Breast Cancer ◽

Hormone Therapy ◽

Cancer Patients ◽

Mammography Screening ◽

Breast Cancer Patients ◽

Adjuvant Hormone Therapy

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Is monitoring mean platelet volume necessary in breast cancer patients?

Open Medicine ◽

10.1515/med-2018-0067 ◽

2018 ◽

Vol 13 (1) ◽

pp. 450-455

Author(s):

Halil Taskaynatan ◽

Ahmet Alacacioglu ◽

Yuksel Kucukzeybek ◽

Umut Varol ◽

Yasar Yildiz ◽

...

Keyword(s):

Breast Cancer ◽

Side Effects ◽

Hormone Therapy ◽

Cancer Patients ◽

Mean Platelet Volume ◽

Breast Cancer Patients ◽

Platelet Volume ◽

Adjuvant Hormone Therapy ◽

Relationship Of ◽

The Relationship

AbstractBackgroundMean platelet volume (MPV) is a parameter that increases during thrombotic and cardiovascular events. Tamoxifen (Tmx) and aromatase inhibitors (AIs), which are adjuvant endocrine therapies, may cause serious side effects, such as vascular thrombosis. The present study investigated the changes in MPV values of breast cancer patients receiving long-term adjuvant hormone therapy and the relationship of MPV with adverse effects of hormonotherapy.MethodsData of 261 patients who had pathologically confirmed estrogen or progesterone receptor positive invasive breast cancer and had received hormonotherapy for at least a 5-year period were retrospectively analyzed. MPV levels were measured at baseline and at the first and fifth year of hormone therapy.ResultsAll patients were females and their median age was 50 years (range, 27–78 years). The mean MPV value was significantly increased in all patients in the Tmx, AI, and switch groups over time (p<0.001).ConclusionThis is the first study evaluating the relationship between the 5-year adjuvant endocrine therapy and changes in MPV values in breast cancer patients. Monitoring changes in MPV values may be predictive for severe side effects in breast cancer patients receiving hormone therapy.

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Increasing adherence to adjuvant hormone therapy among breast cancer patients: A smart phone app-based pilot study.

Journal of Clinical Oncology ◽

10.1200/jco.2018.36.15_suppl.e12523 ◽

2018 ◽

Vol 36 (15_suppl) ◽

pp. e12523-e12523 ◽

Cited By ~ 1

Author(s):

Jessica L. Krok-Schoen ◽

Michelle Joy Naughton ◽

Gregory S. Young ◽

Jennifer Moon ◽

Electra D. Paskett ◽

...

Keyword(s):

Breast Cancer ◽

Pilot Study ◽

Hormone Therapy ◽

Cancer Patients ◽

Smart Phone ◽

Breast Cancer Patients ◽

Adjuvant Hormone Therapy

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Acupuncture for Hormone Therapy–Related Side Effects in Breast Cancer Patients: A GRADE-Assessed Systematic Review and Updated Meta-Analysis

Integrative Cancer Therapies ◽

10.1177/1534735420940394 ◽

2020 ◽

Vol 19 ◽

pp. 153473542094039

Author(s):

Pan Yuanqing ◽

Tang Yong ◽

Liang Haiqian ◽

Chen Gen ◽

Xiping Shen ◽

...

Keyword(s):

Breast Cancer ◽

Side Effects ◽

Hormone Therapy ◽

Cancer Patients ◽

Hot Flashes ◽

Gastrointestinal Symptoms ◽

Risk Of Bias ◽

Cochrane Library ◽

Breast Cancer Patients

Purpose: To determine the efficacy of acupuncture on the management of hormone therapy–related side effects in breast cancer patients. Methods: Randomized controlled trials of acupuncture versus a control or placebo in breast cancer patients that examined reductions in therapy-related side effects were retrieved from PubMed, EMBASE, Web of Science, and the Cochrane Library through April 2020. Data on patient symptoms (hot flashes, fatigue, pain, stiffness, and gastrointestinal symptoms), physical capacity, cytokines, and general psychosomatic well-being were analyzed. We evaluated and analyzed the quality of all included studies with the 5.2 Cochrane Handbook standards using Stata software (version 10.0) and Revman software (version 5.2), respectively. We assessed the risk of bias using the Cochrane Risk of Bias tool and evaluated the quality of evidence using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) approach. Results: The pooled results suggested that acupuncture led to moderate improvements in hot flashes, fatigue, and stiffness. No significant differences were observed in pain, gastrointestinal symptoms, Kupperman index scores, Overall quality of life, tumor necrosis factor levels, and interleukin levels. Conclusions: Evidence for outcome indicators of symptom management were downgraded by the GRADE system for inconsistency, indirectness, and imprecision in the included RCTs. Nonetheless, acupuncture is a moderately appropriate alternative therapy for hormone therapy–related side effects in breast cancer patients. However, it still lacks large-sample, multicenter, prospective RCTs. Future research should focus on standardizing comparison groups and treatment methods, be at least single-blinded, assess biologic mechanisms, have adequate statistical power, and involve multiple acupuncturists.

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