Navigating the Challenges of Adjuvant Hormone Therapy in Breast Cancer Survivors: Understanding Side-Effects, Treatment Adherence, and Quality of Life Implications

Breast cancer survivors face the dual challenges of combating the disease and managing the side effects associated with long-term Adjuvant Hormone Therapy.

FREMONT, CA: Breast cancer (BC) is a global health concern, ranking as the most prevalent cancer worldwide. Fortunately, therapy advancements have improved BC patients' survival rates. Age-standardized BC mortality in high-income countries has seen a significant drop of 40 percent between the 1980s and 2020, resulting in BC survivors constituting the largest group of cancer survivors. Among hormone receptor-positive BC patients, who make up 70 percent of total BC cases, Adjuvant Hormone Therapy (AHT) has become a cornerstone of treatment. AHT suppresses hormone production or interferes with hormone receptor signaling, offering promising outcomes in reducing the risk of BC recurrence and mortality.

While AHT proves effective in reducing the risk of BC recurrence by 40 percent and mortality by a third, it is not without its drawbacks. AHT can give rise to a wide range of side effects, although less severe compared to other treatments like chemotherapy. It is essential to note that AHT treatment periods are significantly longer, typically lasting from 5 to 10 years. Physical health-related side-effects associated with AHT include joint pain, musculoskeletal symptoms, carpal tunnel syndrome, cognitive difficulties such as poor concentration and memory loss, hot flushes and night sweats causing sleep disturbances, general fatigue, and concerns regarding body image due to weight gain.

The presence and severity of these AHT side effects have been identified as barriers to treatment persistence and adherence. Disturbingly, studies reveal that approximately 50 percent of women take less than 80 percent of the prescribed dosage, and up to 50 percent discontinue their treatment within the first five years. Poor adherence and early discontinuation of hormone therapy contribute to higher relapse and mortality rates. 

However, these side effects often receive inadequate attention during follow-up visits that primarily focus on the risk of recurrence. The exclusion of patient-reported outcomes (PROs) from care protocols further contributes to the underreporting and subsequent challenges in detecting and treating these problems.

The AHT side effects not only impact physical health but can also significantly affect BC survivors' quality of life (QoL) and well-being. These side effects have a "disabling" effect with severe emotional implications, such as social withdrawal and a decline in professional confidence. Additionally, psychosocial factors play a role in chronic pain, and these side effects may contribute to its persistence and exacerbation.

Despite the relevance of studying the impact of AHT on the QoL of BC survivors, data on this subject remains to be limited. Previous studies exploring this matter have limitations, including the absence of a control group comprising BC survivors without AHT, making it challenging to determine the contribution of AHT to persistent symptoms and the trajectory of recovery. Furthermore, many studies have focused on relatively short periods despite AHT being prescribed for more extended durations.

Given the profound impact of AHT side effects on BC survivors, it is evident that more studies are needed to clarify the various variables involved. One crucial variable to consider is the time elapsed since the end of primary treatment.

Understanding the impact of AHT on treatment persistence, adherence, and quality of life is crucial for healthcare providers in delivering comprehensive care and support to BC survivors. Further research focusing on the variables involved and addressing the limitations in existing studies will enable a deeper understanding of the experiences of BC survivors and aid in developing targeted interventions to enhance their well-being.