Treatment for Menopausal Symptoms in Breast Cancer Patients: Is Hormone Therapy a Viable Option?
Breast cancer survivors often face challenges in adhering to endocrine therapy (ET), a crucial part of treatment for estrogen-sensitive cancers. Non-adherence to ET is primarily due to medication side effects, psychological distress, socioeconomic factors, and patient beliefs about medication.
The most frequently reported reasons for non-adherence include musculoskeletal symptoms, fatigue, and other treatment-related adverse effects that impact quality of life, especially within the first 90 days of treatment. Psychological factors such as depression, anxiety, and cognitive impairment, often linked to ET-induced estrogen depletion, also contribute to poor adherence.
Socioeconomic and racial disparities further impede adherence. Black breast cancer survivors, for instance, often face challenges like distrust in healthcare providers and high out-of-pocket costs.
Strategies to manage side effects and improve compliance include early identification and management of side effects, multidimensional, interdisciplinary care, psychological interventions, tailored nutritional and physical rehabilitation plans, and addressing socioeconomic barriers.
Dr. Anna Weiss, the leader of Wilmot Cancer Institute's Comprehensive Breast Care program, has been at the forefront of discussing the challenges of adhering to ET. She is the senior author of a publication on managing menopausal, bone loss, and sexual adverse effects of ET, published in Annals of Surgical Oncology this year.
The Wilmot Cancer Institute's integrative oncology center offers care for symptoms related to ET, including hot flashes and genitourinary syndrome of menopause (GSM). The therapy, typically taken for 5 years, can also be prescribed for 10 years for patients at a slightly higher risk of cancer returning.
For brain fogginess, being physically active can help, according to research conducted by Wilmot scientists and the American College of Sports Medicine. Side effects of ET can include hot flashes, vaginal dryness, bone loss, and joint pain.
Endocrine therapy, also known as hormonal therapy, is a medication that blocks the effects of estrogen on tissue and reduces the chances of cancer recurrence. It can reduce the risk of a recurrence by 40% and up to 75% in certain subgroups of people.
To manage GSM symptoms, patients can avoid irritants, moisturize with simple products like coconut oil, lubricate during sex, and consult with their gynecologist about pelvic floor exercises. The American College of Sports Medicine recommends that every cancer survivor avoid inactivity and consult with healthcare providers about an exercise plan.
Despite its life-saving benefits, more than 30% of patients stop taking ET early, and many don't take it as prescribed. The discontinuation rate of ET is around 30%, which is high considering its life-saving benefits.
The Breast Health Program at Wilmot Cancer Institute is seeing a growing number of patients at high risk for breast cancer, and advanced practice providers have taken additional training to manage ET and its side effects. Endocrine therapy can also prevent breast cancer in individuals with a high risk of developing the disease.
In conclusion, an integrated approach, combining symptom management, psychological support, and socioeconomic considerations, is essential to improve adherence to ET and ultimately, breast cancer outcomes.
- The discontinuation rate of endocrine therapy, a crucial part of treatment for estrogen-sensitive cancers like breast cancer, is around 30%, which is high considering its life-saving benefits.
- Strategies to manage side effects and improve compliance for endocrine therapy include addressing socioeconomic barriers, early identification and management of side effects, and the use of psychological interventions.
- In the management of menopausal, bone loss, and sexual adverse effects of endocrine therapy, patients can take measures such as engaging in physical activity for brain fogginess, avoiding irritants, moisturizing with simple products, and consulting with their gynecologist about pelvic floor exercises.
