Tamoxifen adherence in South Africa

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Published: 8 Dec 2015
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Dr Sarah Rayne - Helen Joseph Breast Care Clinic, Johannesburg, South Africa

Dr Rayne talks to ecancertv at AORTIC 2015 about tamoxifen adherence in South Africa.

She says that, alarmingly, two thirds of women said they had considered stopping taking their tamoxifen when surveyed.

Women cited both side effects and transport issues among others, she says.

She argues that the benefits of the drug - namely protection against relapse - need to be properly communicated to patients to encourage them to maintain the tamoxifen regimen. 

 

In our government clinic in South Africa we see about 350 new breast cancers and we know that about 70-80% of them will be hormone receptor positive. Now, a while back we asked our patients what the biggest problems they had in managing their survivorship and one of the big ones was coming to the hospital every month to get their medications. This spurred us on to ask the question of have you ever considered stopping your Tamoxifen? We found that, surprisingly, alarmingly, two-thirds of women had considered that or had stopped it. Now the reasons why they had stopped it fall into two different categories: one section of patients found that the side effects were such that they didn’t want to continue it and the other set of patients had transport issues or other work and life related issues. That has to be addressed but what we found interesting is that if women were convinced of the benefits of Tamoxifen they were less likely to stop and that reinforces in us that we can’t just prescribe Tamoxifen and expect women to take it, we need to educate them so that they understand why they’re taking it and they buy into the idea of taking it lifelong. Because essentially the more studies that come out, we’ve moved from five years to ten years, and in order to make sure that women are going to take this medication for ten years, which requires a real input from them of taking time off work to come to the hospital every month, we have to make sure they know why they should do that. The reason is because the recurrence rate is hugely decreased if they do.