You may have spotted headlines today claiming that women’s ‘failure’ to take the drug tamoxifen is costing ‘hundreds of lives every year’ in deaths from breast cancer.
The headlines come from research published in the British Journal of Cancer, funded by Breast Cancer Campaign . The researchers, based in Glasgow, looked at the medical records of 1263 breast cancer patients, to see how many completed their prescribed course of tamoxifen.
The authors found that nearly four out of 10 women on the study completed less than 80 per cent of their prescription. Among women whose cancer came back, such ‘low adherers’ tended to have their cancer come back sooner.
The authors, who also looked at a range of other data on the women, calculated that if all of them were to have completed their prescription it would save several hundred lives, and save the NHS around £30 million.
So, what should we make of this finding? Are we to ‘blame’ women – as the tone of some news reports implied – for costing the NHS money by their ‘failure’ to take the drug? Or is it, as so often the case, a bit more complicated than that?
As many readers will doubtless be aware, tamoxifen is a drug used in the prevention and treatment of breast cancer. It works by blocking the action of the hormone oestrogen, and is usually given to women after treatment for breast cancer, to try to prevent their cancer from coming back.
Research has shown that taking tamoxifen for five years after treatment can prevent breast cancer returning, and save lives.
But, like all drugs, it has side effects . Because it works by stopping oestrogen from having its normal effects, it can cause menopause-like symptoms. In some women these can be extremely debilitating, and some women choose to stop taking it.
We spoke to our head information nurse, Martin Ledwick, about what he thought of the findings, and what women should make of them.
“This study highlights the fact that a significant number of women don’t take their tamoxifen – either for as long as they should, or every day as prescribed. Worryingly, this can make it more likely that their cancers could come back, leading to more treatment and a worse outlook for them,” he told us.
This is an important issue, says Ledwick, and raises lots of questions about whether and how doctors and other healthcare professionals can help and support women to continue with their treatment, or to take it regularly.
However, there’s an important caveat. “The study doesn’t look at why women didn’t take their tamoxifen as prescribed, and doesn’t differentiate between women who stopped taking the drug completely, and those who seemed to take it inconsistently.”
“So to find out how best we can help women to stick to their treatment plan we would need to understand more about why they didn’t in the first place,” Ledwick says.
“Tamoxifen does have side effects, but women have different individual experience of their severity. Some women find these side effects very hard to bear and perhaps this is one of the reasons why they stop taking tamoxifen. If women choose to stop taking a drug because of its side effects, it is important that they have made an informed choice,” he says.
But some women in this study took their tamoxifen inconsistently rather than stopping all together.
“It could be that these women forgot from time to time rather than made an active decision not to take it. Tamoxifen is a drug that we expect women to take long term, so it wouldn’t be surprising that sometimes someone might forget to take it.”
There could be other psychological reasons too. “Taking a drug every day following treatment for breast cancer might be acting like a daily reminder of their cancer experience for some women, making them less inclined to want to continue taking it,” Ledwick says.
“It’s important that health professionals don’t make women feel they have failed if they find it hard to continue their treatment. We need to try and find ways of making treatments easier and more bearable,” says Ledwick.
Until we have answers to these outstanding questions it will be hard to develop specific ways to support women taking tamoxifen.
One thing the medical teams can do, says Ledwick, is to make sure women understand the importance of continuing hormone therapy, and explain the risks of not taking it against the benefits of taking it. Then if any woman chooses to discontinue treatment they will at least have made a fully informed choice.
And researchers need to continue working towards finding treatments that are easier to take and have more manageable side effects.
Media stories about cancer research can often lead to negative feelings, particularly of ‘blame’ , in patients and survivors. Today’s headlines may have been alarming for some – particularly women taking (or who have stopped taking) tamoxifen. If this affects you, you can call our nurse team on 0808 800 4040, or visit our Cancer Chat forum to talk to others in a similar situation.
McCowan C., Wang S., Thompson A.M., Makubate B. & Petrie D.J. (2013). The value of high adherence to tamoxifen in women with breast cancer: a community-based cohort study, British Journal of Cancer, 109 (5) 1172-1180. DOI: 10.1038/bjc.2013.464