Exploring Hormonal Disturbances: Is Hormone Treatment a Consideration for Managing Breast Cancer Symptoms Like Hot Flashes and Vaginal Dryness?
Endocrine therapy (ET), also known as hormonal therapy, plays a crucial role in the treatment and prevention of breast cancer, particularly for those with hormone-receptor positive tumours. However, adherence to this therapy remains a significant issue, with around 30% of patients stopping the treatment prematurely.
One of the primary reasons for non-adherence is the side effects associated with ET. Musculoskeletal symptoms, such as joint pain, are common, particularly in older women, leading to premature discontinuation. Financial challenges, including high costs, lack of insurance, and instability in income or access to needs, also contribute to non-adherence, especially during times of crisis like the COVID-19 pandemic.
Symptom distress and worsening side effects during therapy, patient factors such as preferences, comorbidities, and psychosocial issues, also influence a patient's willingness to continue therapy. Models to predict non-adherence based on demographics perform poorly, indicating multifactorial and personal reasons.
Effective management of side effects and adherence support tailored to individual patient needs are crucial. Counselling and adherence support tailored to individual barriers have been tested, such as nurse-led medication reconciliation, pharmacist counseling, and training on adherence tools. Addressing financial hardship through supportive interventions may indirectly improve adherence and side-effect management by reducing associated stressors.
Completing the recommended duration of therapy is essential to reduce the risk of breast cancer recurrence. While specific durations and comparative survival data are not detailed, clinical guidelines generally recommend at least 5 years of therapy, emphasizing the importance of completing prescribed treatment duration to improve survival outcomes.
For those at high risk for breast cancer, ET can be taken as a preventive measure. However, it's associated with side effects such as hot flashes, vaginal dryness, bone loss, and joint pain. Managing these symptoms is crucial for ensuring treatment adherence. For managing genitourinary syndrome of menopause (GSM), avoid irritants, moisturize with simple, bland substances like coconut oil, always lubricate during sex, and consider pelvic floor exercises. Hot flashes can be managed through behavioural changes, easy-to-tolerate medicines, acupuncture, exercise, yoga, and meditation.
Despite the challenges, the benefits of ET outweigh the risks. It is effective in reducing breast cancer recurrence and improving survival for hormone receptor-positive breast cancer. The Wilmot Cancer Institute's Comprehensive Breast Care program, led by Anna Weiss, M.D., is at the forefront of managing endocrine therapy and its side effects, with a growing number of individuals at high risk for breast cancer seeking care. Weiss, the senior author of a publication on managing menopausal, bone loss, and sexual adverse effects of ET, underscores the importance of addressing these challenges to ensure treatment completion and improve survival outcomes.
In conclusion, adherence to endocrine therapy is crucial for breast cancer patients, and managing side effects and providing tailored adherence support are key to ensuring treatment completion. The benefits of ET in reducing breast cancer recurrence and improving survival far outweigh the risks, making it a vital tool in the fight against breast cancer.
- For women experiencing menopause as a side effect of endocrine therapy, managing symptoms such as hot flashes, vaginal dryness, and bone loss is crucial for ensuring treatment adherence.
- Financial challenges are contributors to non-adherence to endocrine therapy, especially during times of crisis like the COVID-19 pandemic, and addressing these issues may indirectly improve adherence and side-effect management.
- Effective management of genitourinary syndrome of menopause (GSM) may improve adherence to endocrine therapy, with strategies including avoidance of irritants, the use of simple, bland substances like coconut oil for moisturizing, lubrication during sex, and pelvic floor exercises.
