Managing Patients on Endocrine Therapy: Focus on Quality-of-Life Issues

PURPOSE

To review the health-related quality of life (QOL) of women treated with adjuvant hormonal therapy.

EXPERIMENTAL DESIGN

To review the limited QOL data from randomized trials of tamoxifen versus placebo and ovarian ablation versus none. To discuss QOL results from randomized trials of aromatase inhibitors compared with tamoxifen or placebo for adjuvant therapy of postmenopausal women with estrogen receptor-positive and/or progesterone receptor-positive breast cancer.

RESULTS

QOL is generally good in up to 3 years of follow-up with either tamoxifen or aromatase inhibitors. Vasomotor and sexual complaints remain problematic, however, in only a small proportion of women. There are fewer data regarding the QOL effects of ovarian ablation, which may nonetheless be more substantial.

CONCLUSION

Tamoxifen and aromatase inhibitors cause specific vasomotor or gynecologic symptoms, which may affect sexual function. However, clinical benefits of these agents are generally achieved without major detrimental effect on overall QOL.

Aromatase inhibitors in the adjuvant treatment of postmenopausal women with early stage breast cancer

This article summarizes the current data regarding the use of the aromatase inhibitors as adjuvant hormonal therapy for postmenopausal women with early stage breast cancer. The article focuses on the five major trials examining the use of these drugs and their toxicity in the adjuvant setting. The data currently available suggest that the aromatase inhibitors are efficacious, either as upfront therapy or after a course of tamoxifen. Ongoing trials will compare these approaches and guide the use of these agents in the years to come.