Quality of Life Changes Linked to Aromatase Inhibitor Nonadherence in Breast Cancer

Chemoprevention for breast cancer is vastly underused, and those who are on regimens for prevention are generally nonadherent. Worsening menopausal symptoms among women taking exemestane can lead to early discontinuation, according to a randomized placebo controlled trial published in the Journal of Clinical Oncology.¹

Breast cancer is the most common malignancy in women worldwide, resulting in 14% of all cancer related deaths.  Exemestane, an aromatase inhibitor (AI), is approved by the U.S. Food and Drug Administration for chemoprevention among patients at high risk for developing breast cancer.

Because there is limited evidence showing reasons for early discontinuation of exemestane, researchers evaluated whether negative changes in menopause specific quality of life (QOL) influences a woman’s decision to stop treatment.

Participants completed the Menopause Specific Quality of Life Questionnaire (MENQOL) at entry and at 6 months.  MENQOL is a 29 item questionnaire divided into 4 domains: vasomotor, sexual, physical, and psychosocial. Patients were asked to rank the presence of a symptom and quantify their discomfort using a 7- point scale.

A statistically significant (P < .001) number of women stopped their treatment of exemestane due to the development of worsening menopausal symptoms. Patients in the exemestane group were 59% more likely to discontinue the drug within the first year compared to patients in the placebo group.

Between 19% and 35% of all participants experienced a clinically meaningful worsening of vasomotor, sexual, physical, and psychosocial domains of the MENQOL within 6 months of treatment initiation. A worsening in overall menopause-specific QOL was also associated with discontinuation of assigned treatment within the first year (RR, 1.79; 95% CI, 1.53-2.10).

Researchers observed consistent discontinuation of both exemestane and placebo if adverse menopausal symptoms occurred.

Patients were likely to not adhere to chemoprevention medication if they felt a decline in their QOL. Attention to these symptoms, regardless of whether they are caused by exemestane, could improve QOL and therefore medication adherence.

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 10. doi: 10.1200/JCO.2016.68.8895 [Epub ahead of print]