Acceptance of adjuvant therapy and quality of life issues

Authorship

Acceptance of adjuvant therapy and quality of life issues by Lesley Fallowfield

2005

Affiliations of authors

Cancer Research UK Psychosocial Oncology Group, Brighton & Sussex Medical School, University of Sussex.

Key outtakes

  • “Studies show that 40% women do not adhere to tamoxifen because of side effects affecting Quality of Life (QoL).”
  • “Most novel therapies appear, initially at least, to have much better profiles than the standard treatment that has been in use for much longer.”
  • “In one such study, 72 pre-menopausal women who had taken part in a clinical trial of adjuvant goserelin and/or tamoxifen… Symptoms such as weight gain, hot flushes, fatigue and night sweats were commonly reported.”
  • “Another study compared the symptoms reported on QoL questionnaires by 581 women who had been taking 2–3 years of tamoxifen… Hot flushes, weight gain, night sweats, loss of libido and sleeping difficulties were frequently reported by the women as severe…”
  • “In the pre-menopausal women, the effects of a premature menopause and fertility loss following adjuvant chemotherapy exerts a profoundly deleterious impact on QoL.”
  • “Adjuvant endocrine therapy Until recently, tamoxifen was the gold standard in adjuvant endocrine treatment,but despite the efficacy of the drug, the serious side effects such as thromboembolic problems, stroke and endometrial cancer limit its use.”
  • “Tamoxifen also has many nonlife threatening side effects, which also affect QoL.”
  • “Although the drugs appear to be reasonably well-tolerated in the trial settings in which they have been tested, there are significant, non-life threatening problems that women must endure.”
  • “The worst symptoms of endocrine therapy are the vasomotor problems with hot flushes, night sweats and cold sweats being apparent…”
  • “Joint pains with particularly troubling arthralgia are something to watch and if in the future the fracture rate increases then this will have a detrimental effect upon QoL.”

Paper

The full paper can be found here: Click here

Risk-Benefit Profiles of Women Using Tamoxifen for Chemoprevention

Authorship

Risk-Benefit Profiles of Women Using Tamoxifen for Chemoprevention by Hazel B. Nichols, Lisa A. DeRoo, Daniel R. Scharf, Dale P. Sandler

2015

Affiliations of authors

Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC (HBN); Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway (LAD); Westat, Durham, NC (DS); Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, NC (DPS).

Study scope/scale

The Sister Study, a cohort of 50,884 US and Puerto Rican women age 35 to 74 years enrolled from 2003 to 2009.

Key outtakes

  • “Tamoxifen has been US Food and Drug Administration–approved for primary prevention of breast cancer since 1998 but has not been widely adopted, in part because of increased risk of serious side effects.”
  • “…20% of women who used tamoxifen had insufficient evidence that the benefits of tamoxifen outweigh the risk of serious side effects.”
  • “After 4.5 years, 46% of women had discontinued tamoxifen.”
  • “While the majority of women who used tamoxifen for primary prevention of breast cancer were likely to benefit, substantial discontinuation of tamoxifen before five years and use by women at risk of serious side effects may attenuate benefits for breast cancer prevention.”
  • “An estimated 15% of US women age 35 to 79 years are eligible for breast cancer chemoprevention; however, less than 5% may have favorable risk-benefit profiles.”
  • “National estimates indicate that less than 1% of eligible women use tamoxifen for prevention.”
  • “…substantial nonadherence to the recommended five-year course of tamoxifen has been reported in prevention trials.”
  • “…risk of serious side effects (endometrial cancer, stroke, pulmonary embolism, deep vein thrombosis, and cataract)…”
  • “At 4.5 years, 46% of tamoxifen users had discontinued use.”
  • “Tamoxifen users were 49% more likely (95% CI = 1.05 to 2.11) to report cataract…”
  • “Recent trials of aromatase inhibitors (23,24) show important benefits for breast cancer prevention; however, their use is limited to postmenopausal women. Until alternative therapies for premenopausal women become available, tamoxifen will continue to have an important role in breast cancer primary prevention.”
  • “…review of studies examining decision making surrounding tamoxifen use concluded that higher perceived breast cancer risk increased willingness to consider tamoxifen for prevention, but few other characteristics have been identified.”

Paper

The full paper can be found here: Click here