According to the American Cancer Society, more than 200,000 new cases of breast cancer are diagnosed each year in the United States. About 80% of these breast cancers are estrogen-receptor positive, meaning the tumors have estrogen receptors on their surface, and are likely to respond to hormonal therapy, also called endocrine therapy or “anti-estrogen” medications.
These medications are taken orally and are used to treat breast cancer by reducing the risk of disease recurrence. These medications are often recommended to be taken for 5-10 years, and sometimes for life or for definitive treatment in patients who cannot tolerate other forms of treatment. They do have side effects, most of which are manageable, and are typically well tolerated by patients. However, some patients cannot tolerate the side effects and ultimately stop taking the medication, thereby forfeiting the risk-reduction benefit they offer. According to some research studies, the attrition rate is self-reported to be about 20-50%.
It is important that doctors understand why women make the decision to stop the medication they have been prescribed, so they can understand the issue, provide resources and support the patient through this part of their treatment.
Some of the reasons described, contributing to attrition are that patients do not feel comfortable talking to their doctor about side effects, such as weight gain, sexual dysfunction and mood changes. Furthermore, these medications are often the last treatment for their cancer, in that it is started after surgery chemotherapy and/or radiation, when the threat of death from their breast cancer is less obvious. Visits with their doctors at this point are often every six months and women may feel they are left to manage symptoms or side effects on their own, often just stopping the medication all together.
In conclusion, endocrine therapy plays an important role in reducing the risk of breast cancer recurrence and improves survival from breast cancer. Healthcare providers and patients must work together to discuss their concerns and communicate effectively so that patients do not feel like their only option is to stop the medication.