Taking prescribed medicine and completing the full course does not appear to be a problem experienced in South Africa only. A presentation by Yehui Zhu, a nursing sister specialising in breast cancer in Shanghai, revealed that even patients who are on hormonal therapy for breast cancer have a very poor adherence to taking them. The five year retrospective survey showed that only 60% of the patients who started taking hormone therapy were still taking it after five years.
Considering that 1.38 million were diagnosed with breast cancer in 2008 alone, and that about 75% of breast cancer are oestrogen positive, requiring hormone therapy – it is an alarming result. Particularly when hormone therapy is considered to be most effective form of treatment if taken over a period of five years.
The problem appears to be that patients are seeing bad press about the drugs they have been prescribed. They gather their information from non-professionals and web sites which are not necessarily accurate, rather than medical professionals. Patients base their decisions on this information and don’t take into account the efficacy of the hormone therapy.
Side effects also play a major role in determining whether a patient will intentionally discontinue with the medication and particularly in non-menopausal women. Tamoxifen, for example, can have unpleasant side effects. These include: hot flashes, headaches, joint pain and where there is no medical insurance, problems with the cost of the medicine.
Although the research was based on hormonal therapy prescription re-fills over a period of five years, Yehui Zhu says that filling a prescription does not necessarily mean the patient is actually taking the tablets so she feels that there is a need for more in-depth studies to determine the extent of non-adherence. Zhu also believe it is the responsibility of oncology staff to establish communication channels, educate the patients and assist with unpleasant side effects.
It has been proven that hormonal treatment is pivotal in reducing mortality in breast cancer patients who ar ER positive so it is essential.