Think positive. That is the take-away from a study of the relationship between patient expectations and medication side effects experienced by women with breast cancer. Researchers in Germany and the United States sought to understand the significance of patients’ expectations of the side effects they might experience from their treatment, in particular the nonspecific toxic effects of chemotherapy such as nausea, pain, and fatigue. Do these expectations play a role in what patients actually experience? Do expectations affect patients’ quality of life and how long they remain in treatment?

Recent studies indicate that adverse side effects can result from factors unrelated to the pharmacologic agent, but rather from other factors. such as the person’s expectation of experiencing negative side effects. For example, patients with heightened expectations of negative side effects may actually experience these effects even if they were given a placebo, referred to as the nocebo effect.1

For this 2-year prospective clinical cohort study, the investigators enrolled 111 women who had undergone surgery for hormone receptor (HR)-positive breast cancer. Participation was initiated when the patients were about to start adjuvant endocrine treatment with tamoxifen, exemestane, or another aromatase inhibitor. They were given a booklet detailing the mechanism of action, benefits, and the 18 most common and serious side effects of the aromatase inhibitors.


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Following a script to avoid influencing the patient’s expectations of negative effects, a trained clinician discussed the information provided with each woman after she had read the booklet. At that point, 9 women reported not expecting to experience any negative effects from their treatment, 70 reported anticipating mild side effects, and 32 women reported expecting their side effects to be moderate to severe.