Evidence-based approaches for the management of side-effects of adjuvant endocrine therapy in patients with breast cancer

2021 ◽  
Author(s):  
Maria Alice Franzoi ◽  
Elisa Agostinetto ◽  
Marta Perachino ◽  
Lucia Del Mastro ◽  
Evandro de Azambuja ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Side Effects ◽  
Endocrine Therapy ◽  
Adjuvant Endocrine Therapy ◽  
Evidence Based

scholarly journals Study protocol for a randomised controlled feasibility trial of a virtual intervention (STRIDE) for symptom management, distress and adherence to adjuvant endocrine therapy after breast cancer

BMJ Open ◽  
2021 ◽  
Vol 11 (1) ◽  
pp. e041626
Author(s):  
Jamie M Jacobs ◽  
Chelsea S Rapoport ◽  
Arielle Horenstein ◽  
Madison Clay ◽  
Emily A Walsh ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Endocrine Therapy ◽  
Symptom Management ◽  
Adjuvant Endocrine Therapy ◽  
Feasibility Trial ◽  
Cancer Center ◽  
Control Group ◽  
Evidence Based ◽  
Pill Bottle ◽  
Randomised Controlled

IntroductionPatient adherence to adjuvant endocrine therapy (AET) after a diagnosis of hormone-sensitive breast cancer is poor. Previous interventions have failed to produce changes in adherence, address patient preferences or include theoretically informed and evidence-based components. Therefore, we iteratively developed a patient-centred, evidence-based, small-group, videoconference intervention to improve adherence and symptom management as well as reduce distress for patients taking AET after breast cancer (Symptom-Targeted Randomised Intervention for Distress and Adherence to Adjuvant Endocrine Therapy, STRIDE).Methods and analysisThe current study is a non-blinded, randomised, controlled, feasibility trial of STRIDE compared with a medication monitoring control group. The primary objective is to examine the feasibility and acceptability of STRIDE, while secondary objectives are to assess changes in objective and subjective adherence, symptom distress and satisfaction with AET. Patients will be recruited from the Massachusetts General Hospital Cancer Center in Boston, Massachusetts. The total number of patients accrued will be 75, with ≥60 patients completing the study. All patients will store their AET in an electronic pill bottle for objective adherence monitoring. Patients randomly assigned to the STRIDE intervention will receive 6 weekly 1-hour sessions, in small groups of two, delivered via videoconferencing by a trained mental health professional. Patients assigned to the control group will store their medication in the electronic pill bottle and receive follow-up oncology care as usual. All participants will complete self-report psychosocial measures at baseline, 12 weeks and 24 weeks postbaseline.Ethics and disseminationThe study is funded by the National Cancer Institute of the National Institutes of Health and is approved by the Dana-Farber/Harvard Cancer Center Institutional Review Board (Protocol #18–603, V.1.2, first approval date 1 February 2019). The study will be reported in accordance with the Consolidated Standards of Reporting Trials statement for non-pharmacological trials. Results will be published in peer-reviewed academic journals, presented at scientific meetings and disseminated to patient organisations and media outlets.Trial registration numberNCT03837496; Pre-results.

scholarly journals A clinical guide to the management of genitourinary symptoms in breast cancer survivors on endocrine therapy

2017 ◽  
Vol 9 (4) ◽  
pp. 269-285 ◽  
Author(s):  
Mariana S. Sousa ◽  
Michelle Peate ◽  
Sherin Jarvis ◽  
Martha Hickey ◽  
Michael Friedlander
Keyword(s):  
Breast Cancer ◽  
Side Effects ◽  
Endocrine Therapy ◽  
Breast Cancer Survivors ◽  
Early Recognition ◽  
Adjuvant Endocrine Therapy ◽  
Estrogen Deprivation ◽  
Natural Menopause ◽  
Appropriate Treatment ◽  
Multiple Domains

There is increasing attention and concern about managing the adverse effects of adjuvant endocrine therapy for women with early breast cancer as the side effects of therapy influence compliance and can impair quality of life (QoL). Most side effects associated with tamoxifen (TAM) and aromatase inhibitors (AIs) are directly related to estrogen deprivation, and the symptoms are similar to those experienced during natural menopause but appear to be more severe than that seen in the general population. Prolonged estrogen deprivation may lead to atrophy of the vulva, vagina, lower urinary tract and supporting pelvic structures, resulting in a range of genitourinary symptoms that can in turn lead to pain, discomfort, impairment of sexual function and negatively impact on multiple domains of QoL. The genitourinary side effects may be prevented, reduced and managed in most cases but this requires early recognition and appropriate treatment. We provide an overview of practical clinical approaches to understanding the pathophysiology and the management of genitourinary symptoms in postmenopausal women receiving adjuvant endocrine therapy for breast cancer.

Barriers to patient adherence with adjuvant endocrine therapy.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 6605-6605 ◽  
Author(s):  
Jennifer Michelle Duff ◽  
Hui Yan ◽  
Myron Chang ◽  
Eric Rosenberg ◽  
Karen Colleen Daily
Keyword(s):  
Breast Cancer ◽  
Side Effects ◽  
Endocrine Therapy ◽  
Text Messaging ◽  
Patient Adherence ◽  
Adjuvant Endocrine Therapy ◽  
Pharmacy Records ◽  
Electronic Reminder ◽  
Patient Reported ◽  
The Impact

6605 Background: Adjuvant endocrine therapy for hormone receptor positive breast cancer is essential to decreasing recurrence and improving survival. However, adherence to these drugs has been reported to be suboptimal, the impact of which on breast cancer outcomes is unknown. Multiple non-modifiable risk factors have been associated with nonadherence. Identifying patients’ self-reported reasons for not taking these drugs as prescribed may be crucial to improving adherence. Methods: We obtained data from 49 women prescribed tamoxifen, letrozole, anastrozole, or exemestane for stage I-III invasive breast cancer. Written surveys were provided during the patients’ medical oncology visits. Our study collected demographic data on patient characteristics associated with nonadherence. Patients were asked to report reasons for missing doses including forgetting to take the drug, side effects, cost, and barriers to refill. Patients described their degree of adherence by identifying how often they miss a dose as never, once per month, once per week, or more than once per week. We compared their self-reported adherence to pharmacy refill records. Results: More than half the women (26 of 49) report regularly missing doses of their drug over the last year. Of these, 22 miss once per month, 3 miss once per week, and 1 misses more than once per week. Despite this, pharmacy records verified consistent refills in all 26 less adherent patients over the past year. The most common reason identified for missed doses (21 of 26) was forgetting to take the drug, followed by barriers to refill and side effects. 57% of all patients favored receiving an electronic reminder via text messaging or email. Nonadherence was associated with polypharmacy and lower levels of education, income, and activity. Conclusions: Our study provides insight into patient reported reasons for nonadherence to adjuvant endocrine therapy. Our patients reported forgetting to take their drug as most problematic. Patients’ self-reported adherence was confirmed (96%) by pharmacy records. Most patients are interested in an electronic reminder system via e-mail or text messaging, even if they report complete adherence. This has potential to be a cost effective intervention.

scholarly journals Adverse effects of adjuvant endocrine therapy

2018 ◽  
pp. 64-69
Author(s):  
E. I. Kovalenko ◽  
I. B. Kononenko ◽  
A. V. Snegovoi ◽  
O. P. Grebennikova ◽  
L. V. Manzyuk
Keyword(s):  
Breast Cancer ◽  
Quality Of Life ◽  
Side Effects ◽  
Adverse Effects ◽  
Adverse Events ◽  
Endocrine Therapy ◽  
Aromatase Inhibitors ◽  
Hormonal Therapy ◽  
Adjuvant Endocrine Therapy

Hormonal therapy is a highly effective and well tolerable treatment of hormone-responsive breast cancer. However, it has some side effects that can affect quality of life and lead to treatment discontinuation. Common side effects of tamoxifen and aromatase inhibitors are discussed in this article: menopausal, gynecological symptoms, cardiovascular and musculoskeletal adverse events. Some of them are preventable and manageable. In order to maintain good quality of life during treatment the oncologists should pay more attention to the side effects that lead to it’s deterioration and not be too anxious about insignificant ones.

scholarly journals Trajectories of adherence to adjuvant endocrine therapy for 5 years in women with breast cancer

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
V Memoli ◽  
G Lailler ◽  
C Le-Bihan ◽  
M K Bendiane ◽  
S Lauzier ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Side Effects ◽  
Endocrine Therapy ◽  
Adjuvant Endocrine Therapy ◽  
Factors Associated ◽  
High Adherence ◽  
Hormone Sensitive ◽  
Logistic Regressions ◽  
Optimal Adherence ◽  
Statistical Criteria

Abstract Background Adjuvant endocrine therapy (AET) is a daily oral medication prescribed for women with hormone-sensitive breast cancer (BC) to reduce recurrence and mortality risks. However, many women do not take AET daily or do not persist with AET for the recommended duration of at least 5 years. Our aims were to identify: 1) trajectories of AET adherence for the 5 years; 2) factors associated with these trajectories. Methods The French Cancer Cohort includes data on hospitalizations, ambulatory care and drug claims for all cancers diagnosed in France (SNDS database). Women diagnosed with a 1st non-metastatic BC in 2011 who had ≥ 1 AET claim within 12 months of surgery were included. For each woman, we estimated the monthly proportion of days covered (PDC) by an AET for 5 years after the first AET. Monthly PDCs were used to model AET adherence trajectories using group-based trajectory modeling. Statistical criteria were used to assess the suitability of the selected model. The factors associated with the trajectories were identified using multinomial logistic regressions. Results 33,260 women were included. A 6-trajectory model was selected: 1) Stop of AET in the 1st year (6.6%), 2) Adherence for 1 year and stop (5.7%), 3) Adherence for 2.5y and stop (6.3%), 4) High adherence for 4.5y and stop (8.3%), 5) Sub-optimal adherence for 5y (4.3%), 6) Very high adherence for 5y (68.8%). Factors associated with non-adherence trajectories are mainly extreme age (>70y) and switch in AET. Conclusions About 70% of women had an optimal adherence for 5 years. Our results showed that women who changed AET during the treatment course were at higher risk of non-adherence. Among non-adherent women, the switch in AET is frequent and probably often related to the management of side effects. Interventions to detect and manage these side effects may help to support women with AET use. Effective management of these effects during all the 5 years could be needed to maintain adherence. Key messages About 70% of women had an optimal adherence for 5 years. Women who changed AET during the treatment course were at higher risk of non-adherence.

Adjuvant endocrine therapy side-effects among postmenopausal breast cancer patients in Malaysia

Climacteric ◽  
2018 ◽  
Vol 22 (2) ◽  
pp. 175-181
Author(s):  
S. B. Choo ◽  
A. Saifulbahri ◽  
S. N. Zullkifli ◽  
M. L. Fadzil ◽  
A. Md. Redzuan ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Side Effects ◽  
Cancer Patients ◽  
Endocrine Therapy ◽  
Postmenopausal Breast Cancer ◽  
Adjuvant Endocrine Therapy ◽  
Breast Cancer Patients
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