Hot flushes deter cancer patients

Tamoxifen is linked to hot flushes

The hot flushes associated with hormone treatment cause some breast cancer patients to take a break from their therapy, research shows.

A University of Sussex study of 208 breast cancer patients found 13.1% deliberately omitted taking tablets at times.

The study, in Annals of Oncology, found nearly two-thirds would opt for a daily tablet over a monthly injection.

But if an injection carried less risk of hot flushes, most would switch.

I would give a Nobel prize to the doctor who could eliminate hot flushes Professor Lesley Fallowfield

In fact, just 27% said they would stick with the pills under those circumstances.

And nearly three-quarters said they would prefer a monthly double injection if it would control their cancer better than daily tablets.

This was despite the fact that 37.5% said they were anxious about the thought of injections, and 13.5% said they had had a phobia about needles at some time.

Distressing symptoms

Lead researcher Professor Lesley Fallowfield said: "These findings provide two potentially important messages.

"The first is that the distress caused by the side-effect of the hot flushes that all endocrine treatments produce is seriously under-played.

"The second is that, although the assumption of many health professionals that patients generally dislike injections is correct, most patients are willing to sacrifice preference for efficacy."

Professor Fallowfield said patients' concerns or preferences about treatment were rarely explored.

She said the impact of the hot flushes associated with breast cancer treatment was often under-estimated by the medical profession.

"Post-menopausal women are embarking on treatment that brings back hot flushes and night sweats when they thought they had finished with them.

"For pre-menopausal women the sudden onset of menopausal hot flushes and night sweats is a devastating assault on their well-being."

Efficacy effect

"A third of women are still getting hot flushes after two years - so that's why we are seeing these 'little drug holidays'.

"It is serious because we don't know how many tablets have to be missed before efficacy is affected.

"Hormone treatments are playing a major role in reducing recurrence of breast cancer and, ultimately, deaths, so it is essential for women to adhere fully to their treatment programme."

She said doctors should be more pro-active in getting patients to tell them how much of a problem hot flushes were, so they could watch out for the patients more likely not to adhere to treatment and offer them extra help.

"Personally, I would give a Nobel prize to the doctor who could eliminate hot flushes. It really is important."

Emma Taggart, of the charity Breakthrough Breast Cancer, said: "With the advent of more treatments for breast cancer we hope that some of the issues around side-effects will be addressed.

"In the meantime, women need advice so they can make informed decisions about their treatment options and how to manage potential side-effects.

"Anyone with concerns about their treatment should share this with their consultant."

Liz Carroll, of the charity Breast Cancer Care, said it was no surprise that some women stopped taking their medication because of hot flushes.

"Women and men tell us that hot flushes as a result of their treatment can be very unpleasant.

"As the study points out, more attention must be paid to finding ways to reduce these side-effects."