Adherence to endocrine therapy with tamoxifen and satisfaction with follow-up of women with breast cancer by a gynecologist: A survey study

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Abstract

Background. Side effects of endocrine therapy with tamoxifen (TAM) reduce the quality of life of patients with breast cancer (BC) and adversely affect treatment compliance. Against the background of treatment of BC with TAM, the risk of developing endometrial hyperplasia (EH) increases. At the moment, algorithms for monitoring patients receiving TAM by an obstetrician-gynecologist have not been developed and approved. There are also divergent opinions of experts regarding the diagnosis and management of patients in the detection of EH. This article presents the results of the final stage of the study in 2017–2022 – a survey study. The purpose of this study was to assess adherence to endocrine therapy and satisfaction with observation by a gynecologist of women with BC after 5 years of observation and their relationship with the identified early associated polymorphisms of the CYP2D6, CYP3A5, CYP2C9 and ABCB1 genes.

Materials and methods. 54 patients with BC, out of 120 who had previously passed the first pharmacogenetic stage of the study, were interviewed with specially designed questionnaire. Due to the small sample size, delta percentages (∆%) were used in each comparison group with a difference threshold of 5%. To assess associations with the studied genetic polymorphisms, previously obtained significant associations of adverse drug reactions with pharmacogenetics in the same patients were used.

Results. The prevalence of all adverse drug reactions (ADRs), with the exception of EH, was higher in the group of patients who canceled TAM. Over 5 years of follow-up, 57.4% of patients were regularly observed by an obstetrician-gynecologist, 42.59% of patients visited a gynecologist less than once a year. Of all the respondents, 53.7% of patients are satisfied with the regularity and quality of dispensary observation by an oncologist, 33.33% of patients are satisfied with the regularity and quality of dispensary observation by an obstetrician-gynecologist. All studied ADRs (EH, hot flashes, asthenia, bone pain and dyspepsia) associated with various genetic polymorphisms, prevailed in the group of patients who stopped taking TAM due to drug intolerance (∆%: 25.72, 6.97, 4.81, 6.97 and 24.52 respectively) compared with the TAM-group.

Conclusion. The results obtained confirm the role of the studied genetic polymorphisms in the development of ADRs of TAM, but only systemic (hot flashes, asthenia, bone pain and dyspepsia). With regard to endometrial hyperplasia, no significant differences were obtained, which requires more extensive studies.

About the authors

Ekaterina O. Golubenko

Russian Medical Academy of Continuous Professional Education

Author for correspondence.
Email: kate.golubenko@yandex.ru
ORCID iD: 0000-0002-6968-862X

obstetrician-gynecologist, Russian Medical Academy of Continuous Professional Education

Russian Federation, Moscow

Marina I. Savelyeva

Yaroslavl State Medical University

Email: marinasavelyeva@mail.ru
ORCID iD: 0000-0002-2373-2250
SPIN-code: 2434-6458

D. Sci. (Med.), Yaroslavl State Medical University

Russian Federation, Yaroslavl

Vera V. Korennaya

Russian Medical Academy of Continuous Professional Education

Email: drkorennaya@mail.ru
ORCID iD: 0000-0003-1104-4415

Cand. Sci. (Med.), Russian Medical Academy of Continuous Professional Education

Russian Federation, Moscow

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Supplementary files

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2. Fig. 1. Evaluation of disease outcomes of patients with breast cancer (BC) receiving endocrine therapy after 5 years of follow-up, %.

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3. Fig. 2. Frequency of visits to an obstetrician-gynecologist of patients with breast cancer receiving endocrine therapy during 5 years of follow-up, %.

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4. Fig. 3. Summarized results of the survey study, number/%.

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5. Fig. 4. Evaluation of satisfaction with medical follow-up by an obstetrician-gynecologist and an oncologist in patients with breast cancer receiving endocrine therapy, %.

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6. Fig. 5. Relationship between genotypes and complaints in a subgroup of patients who continued receiving ТАМ (n=32).

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7. Fig. 6. Relationship between genotypes and complaints in a subgroup of patients who discontinued ТАМ due to switching to an aromatase inhibitor (n=9).

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8. Fig. 7. Relationship between genotypes and complaints in a subgroup of patients who discontinued ТАМ due to poor tolerability (n=13).

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9. Fig. 8. Comparison of the frequency of TAM-related ADRs with the presence of genetic polymorphisms in 3 groups of patients: continuing to receive ТАМ, switched to aromatase inhibitor, and discontinued ТАМ due to intolerance, %.

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