Suffering in Silence
By Alicka C. Pistek
“I was a victim.” Tracy a 41-year old, 5-year survivor of early stage breast cancer on her experience taking tamoxifen.
Tamoxifen, the most widely used adjuvant endocrine therapy, is a selective estrogen-receptor modulator (SERM). It works by decreasing the growth of breast cancer cells. Tamoxifen has been used to treat estrogen receptor positive, early stage breast cancer for over thirty years, and the World Health Organization even considers it a key component in treating the disease. Studies show that patients who take it for at least five years have a notable 40% reduction in breast cancer recurrence rates, and reduction in mortality rate by 30%. Recent research has revealed that taking tamoxifen for 10 years reduced breast cancer recurrence by an extra 25%, compared to 5 years of tamoxifen.
But are women really benefiting?
“I have refused to continue taking tamoxifen. While I would never suggest this to anyone else, it was the right course of action for me. I am no longer in daily pain and feel more and more like myself every day.” Sarah, breast cancer survivor
According to studies and reviews of empirical literature, adherence rates to tamoxifen are between 77% to 88% during the first year and drop to an astounding low of 27% to 49% by years four and five. Among women determined to be high-risk for breast cancer, a recent study indicated that 6 out of 7 refused treatment with tamoxifen, citing possible life threatening side effects such as uterine cancer, liver cancer and blood clots. Common side effects such as depression, hot flashes, nausea, fatigue, headaches, pain, and mood swings are given as the main reason for stopping among women who are prescribed tamoxifen to reduce their risk of recurrence. Serious side effects include a small, increased risk of uterine cancer, stroke, vision problems and pulmonary embolism. In addition, studies show that even with 5-years use of tamoxifen, one-third of these patients still relapse within 15 years. These endocrine-resistant patients may represent up to one-quarter of all breast cancer patients, presenting a huge clinical challenge.
The reality of endocrine-resistance and rates of noncompliance are pronounced. While the clinical benefits of tamoxifen are clear for the majority of those prescribed this treatment, full compliance is necessary for patients to benefit. Long-term side effects and their impact on quality of life for patients are rarely acknowledged and effectively managed and contribute to patients refusing or discontinuing treatment.
The Laurus Project is listening.
The Laurus Project is addressing this issue head on by supporting integrative therapy programs and funding research to expedite new treatment options that have few side effects and that present a discernible path to preventing the onset and recurrence of the disease.
We strongly urge the medical community to acknowledge the quality of life issues that impact breast cancer survivors and to take an active role in open communication to discuss integrative strategies for long-term adherence with patients to optimize the benefits of this treatment.