Interventions, Lower Cost Improve Adherence to Endocrine Therapy

Interventions can increase breast cancer survivors’ adherence to adjuvant endocrine therapy by nearly 1.5 times, researchers have found.

A systematic review of 33 studies including a total of 375,951 participants, and a meta-analysis of 25 studies utilizing information from 367,873 patients, found that interventions made therapy adherence 1.412 times more likely, according to results published Aug. 2 in the Journal of Clinical Oncology.

“Interventions can work,” co-author Joanna Arch — Yvonne Kristy Endowed Chair of the Renée Crown Wellness Institute and professor in the department of psychology and neuroscience at the University of Colorado Boulder and member of the Cancer Prevention and Control program at the University of Colorado Cancer Center — told CURE®.

“If we make an effort to help women who are taking anti-hormonal therapy (e.g., adjuvant endocrine therapy) ... and to support them in adhering to that medication, that can make a difference,” Arch said.

Endocrine therapies are medications that stop hormones such as estrogen and progesterone from attaching to breast cancer cells’ receptors and are often used after surgery to reduce the risk of breast cancer recurrence, according to the American Cancer Society.

The medications, Arch explained, “save lives.”

“When women adhere to these medications every day for 5 to 10 years as prescribed, they cut their rates of breast cancer recurrence basically in half, it's by 40% to 50%,” she said. “It is incredibly effective, (it is) generally as or more effective as chemotherapy. And if you recur with breast cancer, many times recurrence will be metastatic and incurable and eventually deadly. So it's a big deal to prevent breast cancer recurrence.”

Challenges to Adherence

As crucial as adjuvant endocrine therapy is for breast cancer survivors, there are several challenges regarding treatment adherence, with side effects being chief among them, as Arch explained.

“Taking these medications, if you're not already in menopause, immediately floods many women with menopausal symptoms like hot flashes, joint pain and weight gain,” she said. “These can be very challenging side effects that can make women feel older and more tired than they already feel (as they are) coming off of cancer treatment. And then, for women who have already gone through menopause, it can exacerbate symptoms and make them worse.”

Other challenges including remembering to take the medication every day for five to 10 years, and the cost of the medication itself.

“Cancer has a very high degree of what we call financial toxicity, putting people into a large amount of debt to afford treatment,” Arch said. “So many women, by the time they're treated with endocrine therapy, they've already finished breast cancer treatment and are already in a lot of debt from it, and now they have to afford a medication every month.”

Arch and her colleagues found “the most consistent winner” in supporting breast cancer survivors to be lower medication costs via oral parity laws. “Basically, these laws make endocrine therapy cheaper, and more likely to be better covered by insurance,” she said.

Forty-three states and the District of Columbia have passed oral parity laws since 2008 to ensure that cost-sharing is equal for patients for either oral or intravenous medications, with similar legislation having recently been passed by the Michigan House of Representatives, according to the American Cancer Society Cancer Action Network.

Psychosocial and reminder interventions also showed promise for increasing treatment adherence, Arch and her colleagues found.

“However, now what?” Arch asked. “Because many women still have, even in states with these laws, relatively low adherence rates. And so now, we need psychological strategies and reminder strategies and perhaps other kinds of strategies that we haven't yet developed to support women to achieve higher rates of adherence, while still living full, high-quality lives, because we don't want adherence to come at the cost of quality of life.”

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