Women with breast cancer are more likely to discontinue chemoprevention therapy if menopause-specific symptoms negatively impact their quality of life (QOL), according to a study published in the Journal of Clinical Oncology (February 2017;35[6]:629-635).
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Clinical trials have shown aromatase inhibitors to be effective chemoprevention agents for primary prevention in women at high risk for breast cancer. However, many women who begin chemoprevention are not fully adherent, which reduces the effectiveness of the inhibitor treatment. Factors associated with aromatase-inhibitor non-adherence in the prevention setting are yet to be determined.
Harriet Richardson, BSc, MSc, PhD, Queen’s Cancer Research Institute (Canada), and colleagues investigated potential associations between menopause-specific QOL, baseline participant characteristics, and early treatment discontinuation within the Mammary Prevention.3 breast cancer prevention trial. In the trial, 4501 individuals were randomized to receive the aromatase inhibitor exemestane or a placebo. Participants were given the Menopause-Specific Quality of Life Questionnaire (MENQOL) at baseline and after 6 months. Multivariable log-binomial regression was used to assess the associations of baseline participant characteristics and menopause-specific quality of life (QOL) with treatment discontinuation at 1 year.
Results of the analysis showed that 724 (17%) discontinued treatment within the first year of random assignment of treatment (19% of the exemestane group, 13% of placebo group). As much as 35% of women experienced a clinically meaningful worsening in the vasomotor, sexual, physical, and psychosocial areas of the MENQOL within 6 months of initial treatment. Worsening in any MENQOL area, especially in overall menopause-specific QOL, was associated with early treatment discontinuation in both the exemestane and placebo groups (relative risk, 1.79; 95% CI, 1.53-2.10 for overall worsening).
Smoking history, current employment, and assignment to the exemestane group were also strongly associated with discontinuation of treatment.
Researchers concluded that negative changes in menopause-specific QOL have a significant impact in chemoprevention therapy non-adherence for women with breast cancer. To improve adherence to chemoprevention, researchers suggest monitoring and addressing such symptoms to increase QOL.
