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Title: Tamoxifen Treatment Compliance Tailing Radiation and Chemotherapy for Breast Cancer: Presented at ASBS

"Tamoxifen Treatment Compliance Tailing Radiation and Chemotherapy for Breast Cancer: Presented at ASBS"

By Carole Bullock NEW YORK -- May 9, 2008 -- Women with breast cancer are risking a higher rate of local and distance recurrence by not following their tamoxifen regimens, reported investigators in a study that looked at the consequences of patient-driven noncompliance of adjuvant therapy, reported here at the American Society of Breast Surgeons (ASBS) 9th Annual Meeting. "Noncompliance with tamoxifen was observed in 37% of 788 patients who were recommended the drug treatment," Aye Moe Thu Ma, MD, Attending Surgeon, St. Luke's-Roosevelt Hospital, New York, New York, said in presentation on May 2. A prospective database that included the age, race, tumour size, pathology, differentiation, nodal involvement, and outcome of breast cancer patients who were recommended adjuvant radiation after breast conservation surgery, chemotherapy, or hormonal therapy with tamoxifen was used to compare outcomes of those who complied versus those who refused (were noncompliant). Results show that noncompliance with radiation, tamoxifen, or chemotherapy is "infrequent," but that the effects differ. Chemotherapy refusal was infrequent (7% of 421 patients) and did not adversely affect the local or distant disease-free outcome. Radiation therapy refusal was seen in 3% of 883 patients who had potentially curative lumpectomy, and was associated with higher 10-year rate of local and distant recurrence compared with irradiated patients (13% vs 6%, 30% vs 7%, respectively). Five-year local and distant disease-free survivals were lower for tamoxifen noncompliant patients compared with compliant patients (87% vs 96%, 76% vs 87%, respectively; [P < 0.001).

"We did not investigate the specific reasons for refusal, but we were able to identify several factors related to noncompliance," Dr. Ma noted in an interview.

Older women had a higher incidence of noncompliance with chemotherapy and radiation, but younger women tended to be noncompliant to tamoxifen more often than older women.

The rate of nonpersistence/noncompliance with therapies in this study is similar to what has been reported in previous studies, she said, which raises concern about how big this problem is for other oral hormonal therapies.

"We also need more research to identify barriers to compliance since hormonal therapy is the most effective treatment for [oestrogen]-positive patients," she said.

"Patients are not making good decisions about taking their tamoxifen treatments and this is sad, because it may be the only drug that works for them," she said in an interview.

Dr. Ma said the results are of concern, since the younger women appear less compliant and yet, their risk may be as high -- or higher than -- the risk of their older counterparts. Younger women may not feel as vulnerable to the negative outcomes of untreated breast cancer, she said.

Physicians need to know that their patients may not be taking their medication and should "always make inquiries about [compliance with cancer] treatments," added Dr. Ma.

[Presentation title: Noncompliance With Adjuvant Radiation, Chemotherapy or Hormonal Therapy in Breast Cancer Patients]

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