Q & A: Taking Meds as Prescribed

CURE, Fall 2010, Volume 9, Issue 3

Adherence to oral hormone therapy for breast cancer patients is important, but non-compliance, and its consequences, are just now being recognized.

Q: Is it OK if I skip doses of my oral hormone therapy?

A: For decades, doctors have known that patients simply don’t take their pills the way they are supposed to. However, in cancer treatment—because many of the medicines are given intravenously in a clinical setting—that has not been viewed as a large problem.

Oncologists have assumed that cancer patients, unlike those with other diseases, would take their oral medicines willingly, just the way they are instructed, because cancer can be so scary.

For many women with breast cancer, taking pills at home is very much a part of their treatment programs, especially to prevent the cancer from recurring. For many of those women, taking medicine by mouth for five years can be the difference—literally—between life and death.

So imagine how surprised oncologists have been to find out through several studies that many women in fact do not take their breast cancer adjuvant treatment as prescribed. A study recently published in the Journal of Clinical Oncology further underscores the problem we call “compliance” with taking medicines as prescribed.

The researchers examined medical records from nearly 8,800 women who were prescribed oral medicine to prevent the return of their breast cancer and were followed over four and a half years. They found that about one-third of the women stopped taking their medicine completely before the end of their expected treatment program. For the women who continued their medication, about one-fourth didn’t take them as instructed. And it didn’t matter whether the drug was tamoxifen or one of the aromatase inhibitors.

The net result? Only about half of the women in this study took their treatment for the complete course (usually five years) or followed their doctor’s instructions as to how to take their medicine.

Compliance is a serious issue, especially because many more cancer drugs are now given orally instead of intravenously. And predictions are that many new drugs on the horizon are going to be taken at home by mouth.

We all need to pay attention to the implications of this and other similar studies. We can’t assume that a cancer diagnosis is going to make patients more inclined to take their medicine, especially when we consider the costs and side effects of cancer treatment. Careful counseling, monitoring, and follow-up all need to be part of our efforts if we are going to continue to get the benefits that modern cancer treatment has to offer.