Patients who complete their endocrine treatment show better long term outcomes

Recent research carried out in the Waikato region has found that breast cancer patients who discontinue their endocrine therapy are more likely to have their breast cancer return or die from it than those who complete their treatment.

Study author, Dr Sanjeewa Seneviratane found adherence in the Waikato region  was approximately 60% after 5 years and there were significant differences between Māori and European populations. By the fifth and final year of therapy, 60.2% of European women were still taking their medicine compared with 54.2% of Māori.

Waikato professor and surgeon Ian Campbell who supervised the research re-iterated the importance of patients continuing to take their treatment. “We recommend endocrine treatments because they reduce recurrence and improve cure rates for many women with breast cancer.”

Two of the more common treatments prescribed are Tamoxifen and Aromatase Inhibitors such as Letrozole, Anastrozole or Exemestane. Dr Campbell said both types of treatments significantly reduce patients’ chances of recurrence and death. “Tamoxifen reduces recurrence and death from hormone responsive breast cancer by about one third. Aromatase inhibitors reduce risk of recurrence by almost 50%.”

Dr Campbell said the results of the adherence study showed patients who did not take their medicines had a 1.77 times greater chance of dying and more than doubled the risk of their breast cancer returning. “When women consider the impact of the side effects on their quality of life, these results need to be put into the equation and women need to consider what their own risk of recurrence is and what impact a recurrence of cancer would have on their quality of life.”

There are many reasons why some patients choose to stop taking their medicines including side effects, financial reasons and transport difficulties for those who live in rural areas. In an effort to support and encourage patients to continue with their therapy, an endocrine telephone clinic was set up in 2010 at Waikato Hospital. Two Breast Cancer Nurse Specialists (CNS) phoned patients at 6 weeks and again at 6 months after they started treatment. In one year, this practice produced a significant improvement in compliance.

Breast Cancer Nurse Specialist, Rachael Collier said each of the two telephone calls lasted on average 30-45 minutes and a lot of issues were talked about. “I think sometimes its easier to talk about your issues over the telephone than face to face as there is a certain degree of anonymity.” As well as discussing side effects, general health and life style issues were discussed and the calls generated a lot of referrals to other support services such as lymphodema and counselling clinics. 

With only two nurses telephoning more than 200 patients each year, the practice was time-consuming and has since been cut back. Ms Collier says a letter is now sent to patients 6 weeks into their treatment and a telephone call is made six months later. But she believes that giving the patients information up front and telling them who they can contact if they have any problems means patients are more likely to respond.

For those experiencing side effects from the medication or any other related issues, Ms Collier recommends patients contact their breast cancer nurse or their GP.

BCAC Chair, Libby Burgess hopes the success of the endocrine telephone clinic will encourage other DHBs to replicate this type of intervention in clinics around the country. “Given that endocrine therapy can be just as important as chemotherapy or radiation treatment in beating breast cancer, it’s a real concern that only 60 percent of patients are completing five years of treatment.  I would urge women experiencing unpleasant side effects to visit their oncologist to discuss ways of reducing these. It really is worth sticking with the programme to ensure the best possible outcome.  The success of the Waikato telephone clinic shows that DHBs can play a big part here by investing in follow-up by breast care nurses.”

23 April, 2015

Article Type: