During a session presented at the 2016 ASCO Annual Meeting exploring breast cancer survivorship, ONS member Debra L. Barton, RN, PhD, AOCN®, FAAN, a professor at the University of Michigan, discussed how effective management of symptoms can improve rates of adherence to therapy.

Consistent findings have demonstrated that by the end of year one, approximately one-quarter of women have discontinued treatment. Though it is difficult to determine predictors of nonadherence, Barton noted that very young and older women are more likely to be nonadherent, as well as those with hormone receptor negative or unknown tumors, those who pay more for drugs, those who experience more severe side effects, and those with comorbidities. 

Barton noted approaches to encouraging treatment adherence by educating patients about the benefits and risks, assessing priorities around toxicities, assessing decision-making preference and engaging the patient, and managing side effects proactively. She discussed some symptoms that breast cancer survivors face and how to manage them.

Hot flashes “may seem somewhat unimportant, but they can impact a person’s ability to work and to function,” Barton said. Serotonergic-based antidepressants can improve hot flashes, though they are associated with their own side effects. Psychoeducational interventions and hypnosis are also treatment options. Dietary supplements also can improve hot flashes and “spare your patients time and money,” Barton said.

Next, she discussed vaginal atrophy, which includes dryness, dyspareunia, and negative desire impacts. Lubricants and moisturizers serve as nonhormonal treatment, although estrogen is a hormonal therapy option as well. She said that testosterone and dehydroepiandrosterone are also being evaluated in clinical trials. 

Lastly, Barton discussed joint aches and pain, with nonsteroidal anti-inflammatory drugs commonly used for treatment. Vitamin D and acupuncture are other nonpharmacologic options for joint pain. 

“Evidence-based practices for improving adherence include educating patients upfront about how endocrine therapy may specifically benefit them, what the side effects are, and then discussing what side effects would be intolerable,” Barton concluded. “Choose an agent together that the woman feels will be most well tolerated for [him or her] and then be proactive about how to self-manage the potential side effects. Evaluate tolerability and switch agents if needed. Finally, if not already engaged in physical activity, discussing a plan to become active including preferred activities and needed resources would likely be beneficial on many fronts.”

For more information on managing more than 20 cancer-related symptoms and side effects, refer to the ONS Putting Evidence Into Practice Resources.

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