What Influences a Woman’s Decision to Stop Chemopreventive Therapy for Breast Cancer?
In an analysis from the Canadian Cancer Trials Group MAP.3 chemoprevention trial reported in the Journal of Clinical Oncology, Meggetto et al found that worsening of overall menopause-specific quality of life was associated with early discontinuation of study treatment in high-risk postmenopausal women, as were worsening in any quality-of-life domain, assignment to exemestane, history of smoking, and current employment.
Study Details
In the MAP.3 trial, 4,560 high-risk postmenopausal women were randomized between 2004 and 2010 to receive exemestane at 25 mg or placebo for 5 years. The current analysis included 4,501 participants, who completed the Menopause-Specific Quality-of-Life Questionnaire (MENQOL) at study entry and at 6 months.
Risk of Early Discontinuation
In total, 724 participants (17%) discontinued assigned treatment within the first year after randomization, including 19% of the exemestane group and 13% of the placebo group. Overall, between 19% and 35% of patients exhibited clinically meaningful worsening in the MENQOL vasomotor, sexual, physical, and psychosocial domains within 6 months of starting treatment. Worsening in each of these domains was significantly associated with early treatment discontinuation (relative risks [RRs] = 1.41–1.71). Worsening in overall menopause-specific quality of life was significantly associated with early treatment discontinuation (RR = 1.79, 95% confidence interval [CI] = 1.53–2.10) irrespective of assignment to exemestane or placebo (P = .53 for interaction).
On multivariate analysis, in addition to worsening in overall menopause-specific quality of life (RR = 1.76, 95% CI = 1.48–2.09), assignment to exemestane (RR = 1.59, 95% CI = 1.33–1.90), history of smoking (RR = 1.22, 95% CI = 1.02–1.45, for past; RR = 1.39, 95% CI = 1.00–1.91, for current), and current employment (RR = 1.22, 95% CI = 1.01–1.47) were also significantly associated with early discontinuation of treatment.
The investigators concluded: “Negative changes in menopause-specific [quality of life] influence a woman’s decision to stop chemoprevention therapy. Attention to such symptoms may improve [quality of life] and potentially improve chemoprevention adherence.”
The study was supported by the Canadian Cancer Society Research Institute.
Harriet Richardson, PhD, of Queen’s Cancer Research Institute, Kingston, Ontario, Canada, is the corresponding author of the Journal of Clinical Oncology article.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
