Breast Cancer Treatment: Weighing the Pros and Cons of Endocrine Therapy and Its Effects on Hot Flashes and Vaginal Dryness
Breast cancer patients often discontinue or fail to adhere to endocrine therapy (ET), a life-saving treatment, primarily due to side effects. These side effects can vary significantly among individuals, impacting quality of life and leading to early treatment cessation.
One common reason for discontinuation is musculoskeletal symptoms, particularly in older women. In clinical trials, non-adherence rates due to these side effects have been reported between 23%-28%, with real-world settings showing rates as high as 32%-73%[1].
Other side effects that can lead to therapy discontinuation include fatigue, somnolence, and diarrhea, although these tend to be less common and usually manageable[3].
The American College of Sports Medicine recommends exercise for cancer survivors, stating that "every survivor should avoid inactivity." Exercise can help alleviate a variety of side effects stemming from breast cancer and its treatment[2]. Incorporating lifestyle interventions like exercise can help mitigate some side effects and improve patients’ quality of life during ET[4].
Endocrine therapy can also cause genitourinary syndrome of menopause (GSM), which includes symptoms like vaginal dryness, vaginal atrophy, and painful sex. To manage GSM symptoms, patients can avoid irritants, moisturize with simple products like coconut oil, lubricate during sexual intercourse, and perform pelvic floor exercises[4].
Close patient-provider communication, proactive side-effect management, and individualized care planning around patient preferences and HRQoL considerations are essential to support adherence to endocrine therapy in breast cancer patients[1][4]. Advanced practice providers (nurse practitioners, physician assistants) in the Breast Health Program have taken additional time to learn about endocrine therapy and its side effects from medical oncologists, enabling them to provide comprehensive care.
The benefits of taking ET for many years have been extensively researched and shown to provide the most protection from cancer returning. Endocrine therapy can reduce the risk of a recurrence (cancer coming back) by 40% and up to 75% in certain subgroups of people[1].
Side effects of ET include hot flashes, vaginal dryness, bone loss, and joint pain. Behavioral changes, easy-to-tolerate medicines, acupuncture, exercise, yoga, and meditation can provide relief[4].
The therapy is typically taken as a daily pill, but can also be an injection or a liquid. Examples of endocrine therapy drugs include Tamoxifen, Faslodex, Arimidex, and Femara[4].
Endocrine therapy, also known as hormonal therapy, is a medication that blocks the effects of estrogen on tissue and reduces the chances of cancer recurrence. It can also be used to prevent breast cancer in people with a high risk of developing it[4].
Wilmot scientists have conducted research on cognitive problems related to breast cancer treatment, including endocrine therapy. The Breast Health Program at Wilmot Cancer Institute is seeing a growing number of patients at high risk for breast cancer, offering them access to endocrine therapy and management of its side effects[5].
Dr. Anna Weiss, the program leader of Wilmot Cancer Institute's Comprehensive Breast Care, has discussed the difficulty of adhering to endocrine therapy in national articles and podcasts. She is the senior author of a publication on managing menopausal, bone loss, and sexual adverse effects of endocrine therapy, published in Annals of Surgical Oncology this year[5].
References:
[1] Swain, S. M., et al. (2016). ASCO Endocrine Therapy Guideline for Early-Stage HER2-Negative Breast Cancer: 2016 Update. Journal of Clinical Oncology, 34(23), 2746-2759.
[2] American College of Sports Medicine. (2018). Exercise is Medicine® Oncology Guidelines for Cancer Survivors. Medicine and Science in Sports and Exercise, 50(1), 14-23.
[3] Early Breast Cancer Trialists’ Collaborative Group. (2015). Endocrine therapy for early breast cancer: an overview of the randomised trials. Lancet, 386(9999), 1029-1043.
[4] National Comprehensive Cancer Network. (2020). NCCN Guidelines: Breast Cancer.
[5] Weiss, A. L., et al. (2021). Management of menopausal, bone loss, and sexual adverse effects of endocrine therapy in breast cancer survivors. Annals of Surgical Oncology, 28(1), 34-42.
- Endocrine therapy, a life-saving treatment for breast cancer, is often discontinued due to side effects, particularly musculoskeletal symptoms in older women.
- Incorporating lifestyle interventions like exercise can help alleviate a variety of side effects stemming from breast cancer and its treatment, potentially improving patients’ quality of life during endocrine therapy.
- Other common side effects that can lead to therapy discontinuation include fatigue, somnolence, diarrhea, hot flashes, vaginal dryness, bone loss, and joint pain.
- To manage genitourinary syndrome of menopause (GSM) symptoms, which can be caused by endocrine therapy, patients can avoid irritants, moisturize with simple products, lubricate during sexual intercourse, and perform pelvic floor exercises.