Acceptance of adjuvant therapy and quality of life issues

The acceptance of adjuvant treatment for early breast cancer (EBC) is dependent on the information that women are given about: available options, likely therapeutic gains, side effect profiles, convenience of treatment as well as their prior knowledge, experience and expectations. Acceptability in terms of adherence to treatment is then dependent on the actual burden experienced and the impact this has on quality of life (QoL). Studies show that >40% women do not adhere to tamoxifen because of side effects affecting QoL. The burden of adjuvant therapy may be underestimated by clinicians; thus, when options are discussed, treatments may appear more favourable and acceptable than they really are. The aim of the newer aromatase inhibitors (AIs) is to enhance efficacy without the associated unacceptable side effects. Interim results from the QoL sub-protocols of three trials, ATAC, IES and MA-17, provide useful indications of acceptability and the impact that AIs have on QoL. Data from patient self-report questionnaires and preference studies are needed to inform treatment recommendations and to aid the development of ameliorative interventions needed to accompany the most efficacious therapies.