Patient Expectations Linked to Clinical Outcome from Endocrine Treatment

Negative patient expectations are associated with an increased risk of adverse events in patients with breast cancer undergoing endocrine therapy.
Negative patient expectations are associated with an increased risk of adverse events in patients with breast cancer undergoing endocrine therapy.

Negative patient expectations are associated with an increased risk of treatment-related adverse events, nocebo side effects, and nonadherence to treatment in patients with breast cancer undergoing endocrine therapy, a study published in the journal Annals of Oncology has shown.1

For the 2-year prospective clinical cohort study, investigators enrolled 111 postoperative patients with hormone receptor-positive breast cancer receiving routine primary care and scheduled to begin adjuvant endocrine therapy.

Participants completed structured patient-reported assessments of side effects, side effect expectations, quality of life, and adherence during the first week postsurgery and after 3 and 24 months of endocrine therapy.

Results showed that after 2 years of endocrine therapy, patients reported high rates of adverse events, including arthralgia (71.3%), weight gain (53.4%), and hot flashes (46.5%), as well as breathing problems (28.1%) and dizziness (25.6%) that were not directly attributable to endocrine treatment.

After controlling for relevant medical and psychological variables, researchers found that patient expectations prior to initiating endocrine therapy significantly predicted long-term adverse events and quality of life.

Specifically, patients with high negative expectations at baseline had an 83% (relative risk [RR], 1.833; 95% CI, 1.032-3.256) higher risk of experiencing adverse events after 2 years of endocrine treatment compared with those who had low negative expectations.

The study also revealed a significant association between baseline expectations and adherence to treatment after 2 years of treatment.

"Optimizing individual expectations might be a promising strategy to improve side-effect burden, quality of life, and adherence during longer-term drug intake," the authors conclude.

Reference

1. Nestoriuc Y, von Banckenburg P, Schuricht F, et al. Is it best to expect the worst? Influence of patients' side-effect expectations on endocrine treatment outcome in a 2-year prospective clinical cohort study. Ann Oncol. 2016 Aug 22. doi: 10.1093/annonc/mdw266. [Epub ahead of print]
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