The side effects of taking endocrine drugs are too great, can I suspend the drugs slowly?
My condition is relatively mild, can I stop taking endocrine drugs for a period of time?
The above questions must be emphasized to you again today, do not stop the drug without authorization, don't believe us to look at 2 cases.
Case 1:
In 2011, Guo Zhitao, director of the Breast Department of the Second Hospital of Traditional Chinese Medicine of Guangdong Province, performed breast-conserving surgery for 42-year-old Ms. Zhang, after which she only took 2 months and stopped secreting drugs, and in 2015, it was found that breast cancer recurred locally and metastasized to the lungs, bones and lymphatic and other places.
Case 2:
Tang Jia was diagnosed with breast cancer before 2014, when her condition was very mild, and after the operation, due to the strong adverse reaction (diarrhea) of tamoxifen, she stopped taking the drug on her own, and liver metastases were detected in 2017. For details, click "My breast cancer recurrence and metastasis is really a "made" ......".
After reading the above cases, Mutual Aid Jun also felt very sad, but I can also understand that the current endocrine drugs are generally taken for 5-10 years, and according to the real reactions of friends, taking drugs does have different side effects, but as mentioned in Figure 1, the side effects are nothing compared with recurrence.
So in today's article, Mutual Aid Jun wants to help you solve two problems:
1. Do I eat for 5 years or 10 years?
2. How to deal with the side effects of endocrine drugs?
01 5 years or 10 years, experts tell you
In our monthly "Chat with Manman", Professor Li Man and Professor Sun Siwen from the Second Affiliated Hospital of Dalian Medical University have answered this question.
Professor Sun Siwen
In fact, for postoperative patients with hormone receptor positivity, the drug selection and medication cycle involved in endocrine therapy are very important, and there are many individualized differences that need to be analyzed on a case-by-case basis.
To be sure, there is a growing body of data suggesting that extended endocrine therapy cycles significantly reduce the risk of recurrence in breast cancer patients at medium to high risk of recurrence.
In general, 5 years is the most basic endocrine therapy cycle, that is, 5 years is regarded as the shortest effective treatment period from the basic standard course of endocrine therapy.
■ For breast cancer patients with a large number of axillary lymph node metastases and breast cancer patients with other high risk factors for recurrence, then we recommend that the endocrine therapy cycle be extended from 5 years to 7-8 years, or even 10 years;
■ Conversely, if there is no axillary lymph node metastasis and no other high-risk factors for recurrence, 5 years of endocrine therapy is sufficient.
Professor Li Man:
In the final analysis, the key to determining the length of endocrine therapy is the risk of recurrence in breast cancer patients.
For example, when a patient's tumour is very large (5 cm or more in diameter), or when the patient is young and has lymph node metastases, or when the patient's histologically graded pathology is grade 3......
These conditions indicate a relatively high risk of recurrence and a relatively poor prognosis, for whom a 5-year endocrine regimen is clearly not sufficient.
Whether it is extended to 8 years or 10 years depends on the number of lymph node metastases and other factors.
02 Side effects are handled skillfully, and discontinuation of the drug is not the first choice
1. Doctor's guidance on medication
Don't be overly afraid of side effects, the family of endocrine drugs for breast cancer is very large (see the figure below), and the doctor will choose the most suitable drug for you according to your condition, physical condition and other factors.
2. Analyze the specific situation on a case-by-case basis
If there are side effects in the process of taking the medicine, there will be mild and severe, some mild side effects will be relieved by the body after time, and the more serious ones need to be intervened by the doctor, such as drug treatment, or consider whether to change the drug, the doctor will stop the drug as a last resort, after all, many authoritative studies have found that endocrine drugs can reduce the recurrence and metastasis rate of breast cancer.
3. Give timely feedback and communicate with doctors
Remind everyone to communicate more with the doctor during the treatment process, give timely feedback, and the doctor will help you with relief!
03 Common endocrine therapy side effects for breast cancer are:
1. Thickening of the endometrium
Patients taking tamoxifen or toremifene are prone to endometrial thickening and require regular gynecological examinations. If the intima is significantly thickened, greater than 10 mm, or even 15 mm, or there are obvious symptoms such as bleeding, it is necessary to see a doctor in time, and if necessary, curettage treatment should be performed. Patients with severe thickening may be considered for switching to endocrine drugs, such as aromatase inhibitors.
Professor Li Man of the Second Affiliated Hospital of Dalian Medical University once answered a question from a friend in the live broadcast
I have been taking toremipene for 8 months, the aminotransferases are a little high, and the blood sugar is also a little high.
In fact, breast cancer patients who take Toramiphene or tamoxifen may have elevated aminotransferases and other gynaecological symptoms, so such patients are usually advised to have regular liver function tests and specific color ultrasound tests. This can not only detect the adverse reactions of drugs early, but also facilitate effective monitoring of drug efficacy.
It should be noted that such patients may also experience elevated aminotransferases when taking tamoxifen, but it is unlikely to affect the blood sugar level, so the patient should consider whether he has received chemotherapy before (conventional chemotherapy can affect the function of pancreatic islets and cause blood sugar to rise).
Based on this, we recommend that this patient to:
Try switching from toremiphene to tamoxifen first, and if the elevated aminotransferases persist, try switching to an aromatase inhibitor.
It should be noted that aromatase inhibitors are mainly targeted at postmenopausal or premenopausal high-risk groups, and the combination of castration therapy (OFS), that is, the use of belly needles, can form a more effective endocrine treatment regimen.
2. Osteopenia
Patients taking letrozole, anastrozole, or exemestane are prone to bone density loss, which can lead to osteoporosis and even fractures.
When taking the above drugs, it should be combined with calcium supplements such as calcium tablets and vitamin D, and usually exercise more and spend more time in the sun. Bone mineral density should be measured every six months or one year, and if bone loss is severe, bisphosphonates or denosumab may be considered.
3. Bone and joint pain
Bone and joint pain all over the body, morning stiffness, etc., there is no good way, more exercise, calcium supplementation, more sun, perseverance will definitely change, severe cases need to seek medical treatment.
Extended reading:
"What to do if you have stiffness in the morning?8 magic weapons to solve the problem of endocrine side effects of breast cancer!"
"In this way, calcium supplementation can multiply the effect! it is a pity for breast cancer patients who don't know......"
4. Dyslipidemia
Endocrine therapy often has abnormal blood lipids, which can increase the risk of cardiovascular disease in the long run. Patients need to have their lipids checked every 3 to 6 months.
Eat a healthy diet that limits saturated fatty acids, trans-unsaturated fatty acids, cholesterol, alcohol and sugars, and does more than moderate-intensity aerobic exercise. In patients with severe dyslipidemia, change of endocrine drugs or lipid-lowering therapy with statins may be considered.
Extended reading:
"Cancer cells are so hateful! Abnormal indicators can increase the risk of breast cancer recurrence and metastasis!"
5. Menopausal syndrome
As estrogen levels decline, patients may have symptoms such as hot flashes, depression, forgetfulness, fatigue, and fatigue, which are not easy to deal with.
Extended reading:
"Eating Endocrine Drugs, Hot Flashes, Night Sweats, Upset, This Food, Breast Cancer Patients May Try It!"
6. Insomnia
Insomnia is one of the most serious side effects, and sleep deprivation can be very devastating to people, both physically and psychologically. It is recommended that patients first adjust their lifestyle, such as exercising more, soaking their feet at night, drinking milk, looking less at their mobile phones, etc., and if necessary, they should be treated with melatonin or sleeping pills, or seek treatment from a sleep department.
Write at the end
Although 10 years of endocrine therapy is relatively long, sisters, please come on, scientific and technological progress, medical development, maybe in the near future we will have better drugs or treatment options, shorten the treatment time, and improve the quality of life.
Warm reminder: The purpose of this article is to convey disease knowledge, and it is not used as a recommendation for diagnosis and treatment plans and medical basis.
Cover image source: photo.com
Editor in charge: Mijian Mutual Aid Jun