Menopause-specific QoL Changes Associated With Chemoprevention Nonadherence

Aromatase inhibitors are established interventions for breast cancer chemoprevention, but nonadherence remains a challenge.
Aromatase inhibitors are established interventions for breast cancer chemoprevention, but nonadherence remains a challenge.

Among women at high risk for developing breast cancer, negative changes in menopause-specific quality of life impact a patient's decision to discontinue chemoprevention therapy with exemestane, a study published in the Journal of Clinical Oncology has shown.1

Aromatase inhibitors are established interventions for the chemoprevention of breast cancer; however, nonadherence remains a significant challenge in this setting. Therefore, researchers sought to investigate the association between worsening menopause-specific quality of life and early treatment discontinuation within the Mammary Prevention.3 (MAP.3) breast cancer prevention trial (ClinicalTrials.gov Identifier: NCT00083174).

For this secondary analysis, 4501 participants of the randomized, placebo-controlled MAP.3 trial, which is evaluating the efficacy of exemestane in preventing breast cancer in postmenopausal women, completed the Menopause-Specific Quality of Life Questionnaire (MENQOL) at entry and at 6 months.

Of the evaluable patients, 17% overall discontinued assigned treatment within the first year after randomization, including 19% of the exemestane group and 13% of the placebo group.

Researchers found that between 19% and 35% of women experienced a clinically meaningful worsening in the vasomotor, sexual, physical, and psychosocial domains of the MENQOL within 6 months of initiating treatment.

Irrespective of whether patients received exemestane or placebo, investigators found that experiencing a worsening in any MENQOL domain or overall menopause-specific quality of life was associated with 79% higher risk of early treatment discontinuation (relative risk, 1.79; 95% CI, 1.53-2.10).

The study further demonstrated that receipt of exemestane, a history of smoking, and current employment were significantly associated with early discontinuation.

These findings ultimately suggest that addressing these symptoms may improve quality of life and potentially improve adherence to breast cancer chemoprevention interventions.

Reference

1. Meggetto O, Maunsell E, Chlebowski R, Goss P, Tu D, Richardson H. Factors associated with early discontinuation of study treatment in the Mammary Prevention.3 breast cancer chemoprevention trial. J Clin Oncol. 2017 Jan 9. doi: 10.1200/JCO.2016.68.8895. [Epub ahead of print]

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