When indicated, adjuvant hormonal treatmenti.e. following breast cancer surgery, can help reduce the risk of the disease recurring. And all the dangers resulting from the resurgence of the tumor. However, women do not always follow this treatment with the right attention. The numbers say it.
On average, almost one in three women with breast cancer stops hormone therapy. And from the first to the fifth year after starting treatment, the adherence percentage decreases by 25.5%. With serious consequencesboth for the patient because non-adherence leads to an increased risk of relapse and death, and for the health service due to the higher costs for treatment and hospitalization caused by the return of the disease.
The data emerge from the systematic review published in the journal “The Breast”, in which 26 studies were analysed, in each of which on average more than 5,000 patients with breast cancer were examined. But it’s not enough. The results are also confirmed by a survey of 1000 women with breast cancer. In fact, 35% state that they do not consider themselves adherent to hormone therapy (18% are not completely adherent, 17% only sometimes). The reasons given are different. Fear of side effects, forgetfulness, ignorance of the real benefits of therapy or psychological aspects.
What hormone therapy does and what side effects it can cause
If taken correctly, adjuvant hormone therapy can reduce tumor recurrence by 40%. e di one third the mortality for breast cancer. “It consists of the administration of drugs that block the activity of estrogens, hormones normally produced by the body, but responsible for the onset and development of at least two thirds of breast tumors – reports Alessandra Fabi, member of the AIOM National Board. It can be implemented sequentially after chemotherapy or alone. Hormonal drugs are administered orally in tablets and, in some cases, intramuscularly.
Depending on the mechanism of action, they are divided into antiestrogens, aromatase inhibitors and LH-RH analogues. Aromatase inhibitors they are taken orally and are indicated in postmenopausal women. They are generally used after surgery, to prevent recurrences. In women with advanced breast cancer, therapy with aromatase inhibitors in combination with molecules called cyclin inhibitors is indicated. This association allows an enhancement of the effectiveness of hormonal therapy and the postponement of chemotherapy, with great advantages in terms of quality of life and fewer toxicities. In patients with early-stage breast cancer at high risk of recurrence, adjuvant therapy with cyclin inhibitors in combination with hormonal therapy is indicated.”
In short, in breast cancer, the risk of recurrence remains high even 20 years after diagnosis. This is why hormone therapy is proposed. “Nevertheless, from the systematic review published in ‘Breast’ it emerged that, after five years, both adherence and persistence to therapy reached average values of around 66%, progressively reducing from the first to the fifth year – comments Fabi.
In the study, the most attentive women were 50-65 year olds. The lower adherence of the younger ones it is determined by the fear of the side effects caused by drugs, especially regarding fertility and sexuality. The lower adherence in the elderly, however, is mainly linked to the simultaneous presence of other diseases, poor health literacy, decline in cognitive functions and lack of social support”.
When hormone therapy is needed
To improve the level of awareness of patients on taking hormonal treatments in the doses and times indicated by the oncologist, AIOM (Italian Association of Medical Oncology) and the AIOM Foundation promote a national information campaign on the topic.
The initiative was presented at the AIOM National Congress in Rome. In 2023, in Italy, 55,900 new cases of breast cancer were estimated, the most frequent in the entire population. Hormone therapy is indicated in hormone-sensitive forms, which constitute approximately 70% of the total.
“Adjuvant therapy, i.e. subsequent to surgery – states Saverio Cinieri, President of the AIOM Foundation – can be considered one of the greatest successes in oncology over the last thirty years. Nonetheless, it is estimated that one in three patients does not take adjuvant hormone therapy as prescribed by their doctor. This condition is associated with an increased risk of relapse and mortality and, more generally, healthcare interventions, representing damage to both patients and the system.
Greater adhesion means lower risk of hospitalizationfewer complications associated with the disease, greater safety and effectiveness of treatments, increased survival and reduction in treatment costs. It is important that patients are aware of the benefits of adjuvant therapy and are informed about all aspects of the therapy: duration, choice of treatment scheme and extent of side effects. Today there are treatments that are not only much more effective than in the past, but also capable of improving the quality of life.”
The importance of the doctor-patient relationship
According to the survey promoted by AIOM and the AIOM Foundation, 76% of patients report side effects to the oncologist. Although 88% believe they have received adequate information from the clinician, almost half (47%) are not aware that non-adherence can cause disease recurrence.
“Communication between oncologist and patient it is fundamental as a reinforcing action to improve the levels of treatment intake and to make people understand that endocrine therapy represents, in fact, a real ‘lifesaver’ – explains Massimo Di Maio, President-elect of AIOM. The drugs used can cause side effects such as hot flashes, tiredness, joint pain or nausea. It is important that the oncologist provides the patient with guidance, including on healthy lifestyles, to combat these disorders.
Among the reasons that lead to suspending endocrine therapy, there are not only side effects and lack of awareness of the benefits, but also forgetfulness. That is, patients do not remember to take the drug. In another meta-analysis, conducted by the University of Colorado and published in the ‘Journal of Clinical Oncology’, 33 studies involving a total of more than 375,000 women were analyzed on the topic of adherence to hormone therapy for breast cancer and on how to improve it.
Different ways of memorizing this fixed appointment have been tested, through letters, text messages, smartphone notifications, phone calls or ‘smart’ pillboxes, which have had a significant effect in improving treatment intake in the doses and times prescribed by the doctor”.
The indications contained in this article are exclusively for informational and informative purposes and are in no way intended to replace medical advice from specialized professional figures. It is therefore recommended to contact your doctor before putting into practice any indication reported and/or prescribing personalized therapies.
