Menopause-Related QoL Changes Reduce Breast Cancer Chemoprevention Adherence

Worsening quality of life from menopause symptoms leads to breast cancer chemopreventive treatment discontinuation

medwireNews: A menopause-specific decrease in quality of life (QoL) reduces the likelihood of women completing 5 years of aromatase inhibitor chemoprevention for breast cancer, research indicates.

Of the 4501 postmenopausal women participating in the Mammary Prevention.3 trial, 19% of the patients randomly assigned to receive exemestane 25 mg/day and 13% of those given placebo discontinued treatment within the first year.

Comparing responses to the Menopause-Specific Quality of Life Questionnaire (MENQOL) at baseline and after 6 months of treatment showed that 24% of patients had an overall worsening of their score, say Harriet Richardson, from the Queen’s Cancer Research Institute in Kingston, Ontario, Canada, and co-workers.

A clinically meaningful worsening in the vasomotor, sexual, physical and psychosocial domains of the MENQOL score was experienced by 35%, 19%, 28% and 27% of the participants, respectively, they report in the Journal of Clinical Oncology

Overall worsening in any MENQOL domain significantly predicted chemoprevention discontinuation within 1 year, with worsening in the overall score giving a relative risk (RR) of 1.79.

But this relationship was not modified after considering whether the patients received exemestane or placebo, or when considering only patients who completed the MENQOL within a month of discontinuing treatment.

“Our findings highlight the recently recognized importance of symptoms in women receiving endocrine therapy being misattributed as resulting from being adherent to the medication”, the researchers say.

Similarly, when simultaneously considering all possible factors associated with early chemoprevention discontinuation, worsening in MENQOL score was the strongest factor (RR=1.76), with receipt of exemestane (RR=1.59), current or past smoking (RR=1.39 and 1.22, respectively) and current employment (RR=1.22) all significant but weaker predictors.

“[A]lthough the efficacy of chemoprevention agents has been established, the benefits of chemoprevention as a primary prevention strategy in clinical practice for women at high risk for breast cancer will largely depend on the uptake of and adherence to these agents”, the authors emphasize.

They therefore suggest: “Attention to such symptoms may improve QOL and potentially improve chemoprevention adherence.”

Reference

Meggetto O, Maunsell E, Chlebowski R, et al. Factors associated with early discontinuation of study treatment in the Mammary Prevention.3 breast cancer chemoprevention trial. J Clin Oncol; Advance online publication 9 January 2017. DOI: 10.1200/JCO.2016.68.8895

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