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Physicians Urged to Listen to Tamoxifen Users' Concerns

Physicians Urged to Listen to Tamoxifen Users' Concerns

An expert panel of 10 international cancer researchers and practicing oncologists met in Boston to discuss the past, present, and future uses of antiestrogens in the treatment of breast cancer. The first four articles in this series, based on the symposium presentations, appeared in Oncology News International in Oct 1996 , Nov 1996, Dec 1996 , and Jan 1997 . The symposium was sponsored by Zeneca Pharmaceuticals.

BOSTON--Breast cancer patients taking tamoxifen (Nolvadex) as adjuvant therapy may speak more freely of their concerns about the drug when their physician is female, Bonnie S. Reichman, MD, said in her presentation at the symposium. "All of my knowledge is gathered from experience with patients as a female physician who, I think, is tuned in to a lot of what goes on in my patient's lives."

Dr. Reichman, of Cornell University Medical College and New York Hospital, believes strongly in educating patients about the risks and benefits of tamoxifen, and in listening to the complaints of women on the drug and trying to treat any tamoxifen-related symptoms.

In addition to talking with patients, Dr. Reichman provides an educational handout and refers women to support groups. "When patients are well informed, then tend to take the drug, and if they are aware of the possible side effects, they know what to expect, know their side effects are real, and they do better."

One common side effect women complain of is weight gain, which physicians don't always take seriously. "Women who have just been through relatively deforming surgery, whether conservation or mastectomy and whether reconstructed or not, can be particularly sensitive about their body image," she said.

She offered patient quotes reflecting physician insensitivity on this issue: "I'm sick and tired of my doctor acting as if weight loss were easy." "I've gained 20 lb and my doc says just eat less."

Effects on Quality of Life

Women on tamoxifen often report severe menopausal symptoms, and yet, she pointed out, the NSABP B14 trial found no difference in quality of life between patients taking tamoxifen and controls. "I think this indicates there was a problem with the assessment tools they used, because it doesn't make sense in terms of our own clinical experience."

For hot flashes, she suggested using a divided tamoxifen dosing schedule or taking it at different times of the day. Over-the-counter remedies that may provide relief include vitamin B6 and selenium; prescription drugs include Bellergal, clonidine, and progestational agents.

"There is a 'hot' line on the Internet for women having hot flashes," she said. Some women add soy products to the diet several times a week or use a variety of Chinese herbs and so-called natural remedies such as primrose oil. "We don't know why or if they really help, but they are very popular."

Finally, uterine cancer and osteo-porosis are major concerns of these women. "We are now afraid not to investigate these patients more closely," she said, "but beyond annual Pap smear and pelvic exam with evaluation of bleeding, there doesn't seem to be any greater indication for testing in these women."

She noted that previously, physicians at her center had been doing pelvic ultrasounds, "but this resulted in a lot of biopsies for benign findings and a lot of angst among patients."

Dr. Reichman said that she has been ordering more bone density scans of late and has been shocked to find how many women have osteoporosis who do not appear to be at high risk. She emphasized that oncologists should find out if their postmenopausal patients are taking adequate calcium supplementation with vitamin D and exercising regularly.

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