Tolerance and consecutive patients adherence to hormonal treatment for early breast cancer.
Authors: Meunier A , Bachelot T , Pleynet E , Faure C , Dussart S 
Published: December 2010

Abstract
Abstract #1140
Body: For the past few years, Aromatase Inhibitors (AI) have been the standard hormonal treatment for menopausal women with breast cancer. Although the side effects described are as low as with Tamoxifen, tolerance is poor, and some patients wish to suspend treatment. A prospective observatory of patients under AI was initiated in our institution to assess patients' perception of side effects.&#x2028; Method: This monocentric prospective study was proposed to patients receiving AI treatment. After a medical visit, patients answered a specific questionnaire about their tolerance and including questions about their adherence to treatment: if necessary, reasons for stopping (either deliberate or not) were specified. The questionnaire was completed after the end of the medical visit and without the presence of the doctor. Medical evaluation of tolerance and cancer evolution was also collected. Statistical analyses were performed to test the correlation between patients' and physicians' perception according to side effects, patients' tolerance or desire to stop AI (Fischer test).&#x2028; Results: Of 450 post-menopausal patients included between Dec 2005 and Dec 2007, 300 were eligible for the adherence study. Median age was 59 years (range, 40-82) and cancer stages were: stage I: 40.5%, stage II: 46.8%, and stage III: 12.7%. Non menopausal women (2.3%) received gonadotropin-releasing hormone analogs. The three AI were Anastrozol (71.3% of cases), Letrozole (17.3%) and Exemestane (11.3%), Tamoxifen was initially prescribed to 30.8% of patients. Median follow-up was 23.1 months (range, 2.1-58.8) and the median number of questionnaires per woman was 1.46 (range, 1-5).&#x2028; Different side effects were reported; all declared symptoms were taken into account: insomnia (98.7%), arthralgia (85.3%), fatigue (72%), memory troubles (59.7%), concentration difficulties (55.3%), hot flushes (63.3%), decreased libido (56.7%), ocular troubles (50%), fracture (5%).&#x2028; Medical reports and patient responses were compared. Significant differences were seen in many items: arthralgia (85.3% vs. 49.3%, p&lt;0.001), fatigue (72% vs 17%, p=0.007), fracture (5% vs. 1%, p=0.04).&#x2028; Treatment adherence was high: at first medical visit (&gt; 3 months after the beginning of treatment) 81.4% of patients reported taking their treatment everyday (82.3% at second visit). But 6.1% decided to discontinue treatment (8.8% at the second visit). The main reasons were: bad tolerance (41.2%), recall of illness (17.6%) and lack of treatment information (17.6%).&#x2028; Discussion and Conclusions: Our results give evidence of the difficulty for the physicians to accurately determine patient's tolerance to a given treatment and consequently its observance. Adherence results appear better than in several previously published studies.&#x2028; This study was supported by grants from Astra Zeneca, Pfizer and Novartis.
Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 1140.