Our expert answers 3 Questions
I have been thinking a lot about how to increase the likelihood that a patient with breast cancer will continue taking anti-hormone therapy for the recommended 5-10 years, without compromising her quality of life. We know that symptoms cause a lot of patients to stop taking the medication, but that isn’t the whole story. How much do their beliefs about medications and about breast cancer play a role? And how much is because they can’t tell how much the medication is helping, whereas they certainly know what side effects they are experiencing? Until we know the answers to these questions, it will be difficult to know how best to support our patients and enable them to better endure the therapy.
I have had the pleasure of collaborating with investigators around the country on projects related to symptom management and medication adherence in patients with cancer. In my role as the Co-Chair of the Symptom Management and Quality of Life Committee for the SWOG Cancer Research Network, I have had the opportunity to think about ways to improve the quality of life of cancer survivors. These connections have also enabled me to start to explore ways to incorporate these interventions into routine medical care. However, it is clear that there is no one-size-fits-all approach that will increase medication compliance in cancer survivors. Across Michigan Medicine, there are experts in communication, decision-management, public health, and behavioral economics who all have unique insights into the issue of medication adherence. By leveraging these resources and expertise, we will hopefully be able to make headway against this vexing problem and tailor interventions for individual patients.
Multiple studies have demonstrated that poor adherence and persistence with endocrine therapy is associated with increased risk of breast cancer recurrence. However, endocrine therapy clearly causes toxicity that worsens quality of life. This trade-off between potential benefit and experienced toxicity can be difficult to navigate, especially for those patients who are experiencing more side effects. It is therefore important to use insights from throughout medicine, public health, economics, and psychology to address this issue and reduce breast cancer mortality.