Endocrine therapy adherence of premenopausal Mexican breast cancer patients.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e12510-e12510
Author(s):  
Cynthia Villarreal-Garza ◽  
Fernanda Mesa-Chavez ◽  
Ana Sofia Ferrigno ◽  
Cynthia De la Garza-Ramos ◽  
Karen Villanueva-Tamez ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Adverse Effects ◽  
Endocrine Therapy ◽  
Ovarian Function ◽  
Hot Flashes ◽  
Self Report ◽  
Categorical Variables ◽  
Considerable Proportion ◽  
Ovarian Function Suppression ◽  
Age Related

e12510 Background: Among premenopausal women with breast cancer (BC), adherence to endocrine therapy (ET) has often been reported suboptimal due to age-related adverse effects, lack of understandable information and inadequate social support. The current increased use of ovarian function suppression (OFS) may lead to even lower adherence rates in this group due to its high adverse effects profile. This study aims to assess the extent to which premenopausal patients comply with ET and to identify factors that hinder optimal adherence in Mexico. Methods: Women aged ≤50 years with primary stage I-III hormone receptor-positive BC receiving adjuvant ET for ≥1year were invited to fill a survey regarding their attitude towards ET and self-reported adherence. Fisher’s exact test was used to explore associations between categorical variables. This study was funded by AstraZeneca Mexico. Results: From Sep 2019 to Jan 2020, 127 patients with a median age of 45 years (range: 25-50) were included. Most had at least high school education (64%) and were unemployed (61%). ET distribution was: 69% tamoxifen (TMX) alone; 2% TMX switch to aromatase inhibitor (AI); 29% OFS plus TMX/AI. All patients recognized ET as a necessary part of their treatment and 97% believed it reduced their recurrence risk, yet 14% considered they had not received enough information about ET. Adverse effects were reported by 98%, predominantly hot flashes (82%), arthralgias (59%) and fatigue (58%). A statistically significant higher proportion of patients treated with a switch strategy or OFS experienced hot flashes, headache, insomnia, decreased libido and dyspareunia than those with TMX alone. Only 59% claimed their physician had taken measures to reduce these symptoms. Overall, 93% reported complete ET adherence. Nonetheless, 22% of them subsequently acknowledged missing 1-6 doses in the last month, the most common reasons being forgetfulness (78%), adverse effects (27%) and unwillingness to take the medication (11%). Unemployed patients were more likely to report daily compliance than students/employees (79% vs 60%; p = 0.02). No significant differences in adherence were found according to other factors, including type of ET. Conclusions: Premenopausal Mexican women self-report remarkably high rates of ET adherence. However, a considerable proportion misses ≥1 doses/month, with forgetfulness as the most common cause particularly in students/employees. Interventions aimed at reminding this group to take their ET and managing adverse effects could be crucial to improve adherence and, consequently, disease outcomes.

scholarly journals Optimal Endocrine Therapy in Premenopausal Women: A Pragmatic Approach to Unanswered Questions

2021 ◽  
Author(s):  
Tal Sella ◽  
Kathryn J. Ruddy ◽  
Lisa A. Carey ◽  
Ann H. Partridge
Keyword(s):  
Breast Cancer ◽  
Endocrine Therapy ◽  
Ovarian Function ◽  
Growth Factor Receptor ◽  
Cancer Recurrence ◽  
Premenopausal Women ◽  
Ovarian Function Suppression ◽  
Hormone Receptor Positive ◽  
Disease Biology ◽  
Age Related

Recent epidemiologic data show an increasing incidence of breast cancer among premenopausal women in many higher-income countries. Among premenopausal women, those diagnosed under age 40 years experience inferior long-term outcomes, particularly in the setting of hormone receptor–positive, human epidermal growth factor receptor 2–negative disease. In addition to more advanced disease presentation and/or less favorable disease biology, suboptimal adjuvant endocrine therapy (ET) has emerged as an important driver of this age-related disparity. Historically, young women have been excluded from treatment with aromatase inhibitors (AIs), attained low rates of chemotherapy-related amenorrhea, and exhibited low adherence to ET. Recently, several studies have demonstrated treatment with ovarian function suppression (OFS) during the first 5 years postdiagnosis to be associated with improvements in breast cancer recurrence and mortality, with additional benefits achieved from pairing OFS with an AI. As the first 5 years of ET for premenopausal women has been transformed, extended ET, administered in years 5-10 postdiagnosis, has also become more common. However, the only studies of extending ET in premenopausal women have tested an additional 5 years of tamoxifen following an initial 5 years of tamoxifen and studies of AIs in the second 5 years have been limited to postmenopausal women. Herein, we review available data concerning potential benefits and risks to be considered when counseling premenopausal women on extended ET, including the continuation of OFS. We offer a pragmatic framework to support decision making given the current body of knowledge and call out the need for additional research into this issue.

Challenges in Treating Premenopausal Women with Endocrine-Sensitive Breast Cancer

2016 ◽  
pp. 23-32 ◽  
Author(s):  
Hatem A. Azim ◽  
Nancy E. Davidson ◽  
Kathryn J. Ruddy
Keyword(s):  
Breast Cancer ◽  
Decision Making ◽  
Side Effects ◽  
Sexual Dysfunction ◽  
Aromatase Inhibitor ◽  
Endocrine Therapy ◽  
Ovarian Function ◽  
Hot Flashes ◽  
Premenopausal Women ◽  
Ovarian Function Suppression

For the hundreds of thousands of premenopausal women who are diagnosed annually with endocrine-sensitive breast cancer, treatment strategies are complex. For many, chemotherapy may not be necessary, and endocrine therapy decision making is paramount. Options for adjuvant endocrine regimens include tamoxifen for 5 years, tamoxifen for 10 years, ovarian function suppression (OFS) plus tamoxifen for 5 years, and OFS plus an aromatase inhibitor for 5 years. There are modest differences in efficacy between these regimens, with a benefit from OFS most obvious among patients with higher-risk disease; therefore, choosing which should be used for a given patient requires consideration of expected toxicities and patient preferences. An aromatase inhibitor cannot be safely prescribed without OFS in this setting. Additional research is needed to determine whether genomic tests such as Prosigna and Endopredict can help with decision making about optimal duration of endocrine therapy for premenopausal patients. Endocrine therapy side effects can include hot flashes, sexual dysfunction, osteoporosis, and infertility, all of which may impair quality of life and can encourage nonadherence with treatment. Ovarian function suppression worsens menopausal side effects. Hot flashes tend to be worse with tamoxifen/OFS, whereas sexual dysfunction and osteoporosis tend to be worse with aromatase inhibitors/OFS. Pregnancy is safe after endocrine therapy, and some survivors can conceive naturally. Still, embryo or oocyte cryopreservation should be considered at the time of diagnosis for patients with endocrine-sensitive disease who desire future childbearing, particularly if they will undergo chemotherapy.

scholarly journals The Modern Landscape of Endocrine Therapy for Premenopausal Women with Breast Cancer

Breast Care ◽  
2015 ◽  
Vol 10 (5) ◽  
pp. 312-315 ◽  
Author(s):  
Lorenzo Rossi ◽  
Olivia Pagani
Keyword(s):  
Breast Cancer ◽  
Endocrine Therapy ◽  
Ovarian Function ◽  
Treatment Options ◽  
Endocrine Resistance ◽  
Premenopausal Women ◽  
New Drugs ◽  
Fine Tuning ◽  
Individual Risk ◽  
Ovarian Function Suppression

The optimal endocrine therapy for premenopausal women with early and advanced breast cancer still remains an important and controversial issue. For over 30 years, tamoxifen has been the gold standard in the adjuvant setting. New therapeutic options, such as the addition of ovarian function suppression to oral endocrine therapy (either tamoxifen or aromatase inhibitors), can improve outcomes over tamoxifen alone in well-selected patients. Treatment duration has also been revisited, and extended therapy is becoming a new standard of care, especially in high-risk patients. Endocrine therapy for advanced disease still represents a challenge and a research priority. New drugs and combinations able to overcome endocrine resistance are at the horizon, and their role in premenopausal women should be better elucidated. Side effects and quality of life (including family planning considerations) play an important role in treatment selection and in the patients' treatment adherence and should always be discussed before start of treatment. The paper will specifically focus on how to integrate all new treatment options in the current armamentarium of endocrine therapy of premenopausal women, with the aim of best fine-tuning treatment selections according to the individual risk/benefit evaluation.

Predictors of patient-reported toxicities from endocrine therapy: Importance of illness perceptions, treatment beliefs, and fear of recurrence.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 542-542
Author(s):  
Xinni Song ◽  
Susan Faye Dent ◽  
Shailendra Verma ◽  
Mark J. Clemons ◽  
Nadine A. Graham ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Side Effects ◽  
Adverse Effects ◽  
Endocrine Therapy ◽  
Symptom Management ◽  
Self Report ◽  
Fear Of Cancer Recurrence ◽  
Management Interventions ◽  
Patient Reported ◽  
The Impact

542 Background: Numerous studies have documented the toxicities of endocrine therapy (ET) for early breast cancer (EBC) and their deleterious impact on quality of life and adherence. However, little is known about the factors that underlie patient's susceptibility to report toxicities. The identification of risk factors for toxicities from ET is important as it would allow early targeting of symptom management interventions for women more vulnerable to adverse effects of ET. This prospective study aims to examine the impact of pre-treatment perceptions of EBC, ET beliefs and fear of breast cancer (BC) recurrence (FBCR) on toxicities reported after 6 months of ET. Methods: Women diagnosed with EBC completed a survey prior to initiating endocrine therapy, then at 3, 6 and 12 months. Standardized self-report instruments were used to assess EBC perceptions, ET beliefs, FBCR and toxicities. Clinical and treatment variables were also evaluated. Univariate analyses and mulitivariate regression were conducted to identify factors associated (p<0.1) with side effects at 6 months. Results: Since 9/2010, 173 patients have consented and 84 (mean age = 60 y) have completed the questionnaires at baseline and after 6 months of ET. Controlling for age, none of the clinical or treatment variables (stage of disease, type of surgery, receipt of chemotherapy and radiation therapy) were significant univariate predictors of toxicities. In multiple regression, stronger perceptions that BC has serious consequences on their lives (β=0.218, p<0.05), greater concerns about the adverse effects of ET (β=0.215, p<0.05) and higher levels of FBCR (β=0.316, p<0.01) at baseline were associated with higher levels of reported toxicities. Conclusions: Baseline psychological factors predicted level of patient-reported toxicities to a larger extent than clinical/treatment factors. How patients perceived their illness, their beliefs about ET side effects and their fear of cancer recurrence are strongly associated with side effects experienced after 6 months of ET. These results could facilitate the identification of a subgroup of patients for early interventions to improve symptom management.

scholarly journals The Effects of Endocrine Therapies on Lipid Profiles in Chinese Young Women With Early Breast Cancer

2021 ◽  
Vol 11 ◽  
Author(s):  
Yi-Kun Kang ◽  
Xue Wang ◽  
Nan-Lin Hu ◽  
Jian Yue ◽  
Yi-Ran Si ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Endocrine Therapy ◽  
Early Breast Cancer ◽  
Ovarian Function ◽  
Young Patients ◽  
Lipid Profiles ◽  
Breast Cancer Patients ◽  
Premenopausal Breast Cancer ◽  
Ovarian Function Suppression ◽  
Younger Age

This study aimed to evaluate and compare the effects of various endocrine therapies on lipid profiles in young patients with breast cancer. A retrospective, single-center study was performed to investigate the effects of tamoxifen (TAM), tamoxifen plus ovarian function suppression (TAM+OFS), and aromatase inhibitors plus ovarian function suppression (AI+OFS) on lipid profiles during the 60 months of endocrine therapy in hormone receptor-positive patients aged &lt;40 with early breast cancer. The primary endpoint was the cumulative incidence of lipid events, and the secondary endpoints were the changes in lipid profiles. A total of 230 young patients were included with the mean age of 35.7 years old. The patients in TAM group had significantly lower incidence of 5-year lipid events than those in TAM+OFS group (7.4% versus 21.3%; P=0.016) and AI+OFS group (7.4% versus 21.6%; P=0.009). The incidence of fatty liver was significantly higher in TAM+OFS group than TAM group (52.5%versus 30.9%; P=0.043). Lipid events were associated with younger age (odds ratio (OR)=0.865, 95% confidence interval (CI): 0.780-0960; P=0.006), higher baseline LDL-C (OR=14.959, 95% CI: 4.379-51.105; P&lt;0.001), and use of OFS (OR=3.557, 95% CI: 1.151-10.989; P=0.027). Therefore, application of OFS, with younger age and higher baseline LDL-C, may increase the incidence of lipid events in premenopausal breast cancer. More care should be taken for lipid profiles during the endocrine therapy for young breast cancer patients.

Management of hot flashes in women with breast cancer receiving ovarian function suppression

2017 ◽  
Vol 52 ◽  
pp. 82-90 ◽  
Author(s):  
Roberto A. Leon-Ferre ◽  
Neil Majithia ◽  
Charles L. Loprinzi
Keyword(s):  
Breast Cancer ◽  
Ovarian Function ◽  
Hot Flashes ◽  
Ovarian Function Suppression

scholarly journals Distribution of dyslipidemia in Chinese early breast cancer patients at diagnosis and comparison of dyslipidemia incidence following different endocrine therapies: a population-based cohort study

2021 ◽  
Author(s):  
Junren Wang ◽  
Jin Yin ◽  
Jiajun Qiu ◽  
Jingwen Jiang ◽  
Yao Hu ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Endocrine Therapy ◽  
Ovarian Function ◽  
Cox Regression ◽  
Absolute Risk ◽  
Concomitant Disease ◽  
Breast Cancer Patients ◽  
Ovarian Function Suppression ◽  
Abnormal Rate ◽  
Premenopausal Patients

Abstract Background Dyslipidemia increases the risk of cardiovascular disease death in breast cancer (BC). Based on the large West China Hospital (WCH) BC cohort, we aimed to clarify dyslipidemia prevalence at diagnosis and compare the risk of dyslipidemia induced by different endocrine and menopause status. Methods 5917 EBC female patients recorded in WCH BC cohort, diagnosed between 2008.10 and 2017.04, were included for baseline analysis. 1883 patients receiving endocrine therapy (selective estrogen receptor modulator (SERM) or aromatase inhibitor (AI), with or without ovarian function suppression) with initial normal blood lipids were included for comparison study. Dyslipidemia was defined as abnormality of cholesterol/LDL/ HDL/triglyceride. Risk accumulation function was used to calculate the incidence of dyslipidemia to assess absolute risk, and the multivariate COX regression model was used to calculate the relative risk of dyslipidemia between groups. Results 16.5% of EBC patients had dyslipidemia at diagnosis. Among EBC patients receiving endocrine therapy, the accumulated incidence of dyslipidemia within 5 years in menopausal patients was higher than that in premenopausal patients (Adjusted HR [95%CI], 1.29 [1.04–1.59], 42.6 % vs 32.6%, P = 0.0186). In premenopausal patients, the risk of abnormal TC in OFS + AI group was significantly higher than SERM group (adjusted HR, 3.50 [ 1.74–7.02], P < 0.001, 5-year abnormal rate 22.0% vs 3.5%), and that of abnormal LDL-C was also increased(adjusted HR, 6.71 [ 3.16–14.26], P < 0.001, 5-year abnormal rate 12.2% vs 1.4%). In menopausal patients, the risk of abnormal TC or LDL-C showed the similar trend in AI group compared to SERM group. Conclusions Dyslipidemia is common concomitant disease in Chinese BC patients and needs to be closely monitored. Irrespective of menopause, AIs treatment causes higher risk of TC/LDL-C dyslipidemia than SERM.

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