Real-world data indicate lower adherence rates for breast cancer endocrine therapy when radiation therapy is omitted
Many patients with early-stage breast cancer do not consistently maintain the long-term hormone therapy prescribed after lumpectomy, a large U.S. insurance claims analysis indicates. The findings provide real-world context for treatment approaches that consider omitting radiation therapy, which typically rely on the expectation that patients will continue taking medication for at least five years.
A study analyzing real-world data indicates that patients with early-stage breast cancer who omit radiation therapy following lumpectomy are less likely to adhere to long-term hormone therapy. Researchers from Washington University School of Medicine in St. Louis presented their findings at the American Society for Radiation Oncology (ASTRO) Annual Meeting.
The analysis of insurance claims data from over 17,000 patients revealed that fewer than 30% of individuals maintained an adequate level of adherence to endocrine therapy for all five recommended years. Those who did not undergo radiation therapy were more prone to experience significant lapses in adherence compared to those who did receive radiation therapy. Additionally, younger patients were also associated with lower adherence rates.
Radiation therapy after lumpectomy is known to reduce the risk of breast cancer recurrence in the treated breast. However, for some patients with lower-risk disease, radiation therapy may be omitted after an individualized discussion, assuming they will continue endocrine therapy for several years. The study found that this approach is more challenging in routine practice, as maintaining endocrine therapy as prescribed—taking a daily medication for five years—is difficult for many patients.
Endocrine therapy, which blocks or lowers hormones fueling hormone receptor-positive breast cancer, can cause side effects such as hot flashes, fatigue, joint pain, and changes in memory and concentration. These side effects can make it challenging for patients to continue treatment over an extended period. The study highlights the importance of having realistic conversations with patients considering radiation therapy omission, addressing the implications of long-term treatment and quality of life.
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