Previously we highlighted that lifestyle factors apparently do not influence genetic risks for breast cancer. A recent study was conducted on approximately 8,800 women with early stage breast cancer. Experts from Columbia University Medical Center revealed that only 49 percent of women completed their full regimen of hormone therapy according to the prescribed schedule.
They identified that young women were more inclined to discontinue treatment. They conducted this study to identify refusal of treatment and also form interventions to lower it. Specifically for hormone-sensitive breast cancer five years of oral hormone therapy is usually prescribed to lower risk of cancer. Previous analyses shared that only 40-60 percent of women complete their recommended course of therapy.
“We were surprised to see that so many young women stopped treatment early, despite the fact that the therapy has a proven track record of reducing breast cancer recurrence. Perhaps we need to do a better job of making patients aware that to get the full benefit of treatment; they need to take their medications on time and for the full duration,” elucidates Dawn Hershman, MD, associate professor of medicine and epidemiology at Columbia University Medical Center, who led the study.
Scientists evaluated pharmacy records of 8,769 women detected with stage I, II or III hormone sensitive breast cancer between 1996 and 2007. This was mainly done to identify hormonal therapy prescriptions and refill dates. Within a span of one year each women filled atleast one prescription for hormonal therapy within a year of detection. They also revealed 43 percent women used tamoxifen, 26 percent used aromatase inhibitors and 30 percent used both.
The highest risk of discontinuing therapy early was among women below the age of 40 years. After 4.5 years, 32 percent women were observed to halt the therapy and of those who did not stop only 72 percent completed it on time. Women more likely to stop the treatment were below 40 years and older than 75 years. They had lumpectomy as opposed to mastectomy and also included those with other medical illnesses. There were less chances of not filling the prescriptions due to longer refill intervals.
Dr. Hershman shares, “Physicians are often unaware of patient compliance, and this is becoming an increasingly important issue in cancer. It’s very disturbing that patients under 40 had the highest discontinuation and non-adherence rates, because those patients have the longest life expectancy. If we can better understand the issues surrounding compliance with hormonal therapy, this might help us understand why patients don’t adhere to other treatments that are moving out of the clinic and into the home, such as oral chemotherapy, as often as we would like.”
Experts further say that there are many possibilities why women abstain from treating. They observed this by noting 13 percent of the women delayed getting their first prescription refilled. Abstinence may be due to side effects of the therapy namely joint pain, hot flashes or fatigue, a lack of understanding of the benefit of the therapy, and high costs of medications and insurance co-payments.
These findings were published online June 28, 2010 in the Journal of Clinical Oncology.