Information coming from the Breast International Group (BIG) 1-98 Trial found that women who were not compliant with antihormonal therapy had poorer outcomes in overall disease-free survival (DFS).
The study analyzed the effects of early termination of treatment and compliance with treatment among 6,144 patients receiving at least one dose of study drug--compliance was defined as taking at least 80% of pills in a drug pack with no breaks longer than 1 week.1
The study group consisted of postmenopausal women who had estrogen-positive tumors and were receiving either/or combinations of tamoxifen and letrozole (Femara) over a 5-year period. As expected, the side effects of these treatments were the main causes of discontinuance such as vaginal bleeding, hot flushes, joint pain, and/or a thrombolytic event. While many of our patients complain about these factors, a frank conversation about the benefits must be included in every medical oncology consult.
The investigators concluded: “Both persistence and compliance are associated with disease-free survival. Toxicity management and, for sequential treatments, patient and physician awareness, may improve adherence.”2
Vital points to consider with recommending hormonal therapy to postmenopausal patients:
Early termination of treatment was associated with poorer disease-free survival in postmenopausal women with hormone receptor-positive breast cancer. Discuss the risks and benefits of this therapy and have the patient report difficulties in adherence.
Listen to the patient’s complaints and find mutual ways in which to stay on track for as long as possible. It has been noted in some studies that treatment should extend even beyond 5 years; patients need to clearly understand the benefit of reducing recurrence despite side effects.
For those of us in navigation, bringing the adherence factor into discussions with the care team can mean the difference in having an open communication with the patient for potentially better outcomes.
Chirgwin JH, Giobbie-Hurder A, Coates AS, et al. Treatment Adherence and Its Impact on Disease-Free Survival in the Breast International Group 1-98 Trial of Tamoxifen and Letrozole, Alone and in Sequence. J Clin Oncol, 2016 May 23.
Colleoni M, Giobbie-Hurder A, Regan MM, et al. Analyses Adjusting for Selective Crossover Show Improved Overall Survival With Adjuvant Letrozole Compared With Tamoxifen in the BIG 1-98 Study. J Clin Oncol, 2011 Mar 20;29(9):1117-24.
Male breast cancer accounts for about 1% of all breast cancer cases in the United States, therefore it can be a shocking diagnosis. During my career as a nurse practitioner in the field of breast oncology, I have been involved in the care of only five male breast cancer cases over the last 25 years.
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