Navigating Vasomotor Symptoms From Endocrine Therapy in Breast Cancer Treatment
A panelist notes that although chemotherapy’s adverse effects are intense but short-lived, endocrine therapy for hormone receptor–positive breast cancer involves persistent symptoms over several years, making symptom management essential for patient adherence and quality of life.
Many patients diagnosed with breast cancer are understandably anxious about undergoing chemotherapy, primarily due to its well-known adverse effects. However, it is important to communicate that chemotherapy is typically a short-term treatment, often lasting around 6 months. While the intensity and type of chemotherapy can vary, the limited duration means that its adverse effects, although sometimes severe, are temporary. In contrast, endocrine therapy, which is commonly prescribed for hormone receptor–positive breast cancer, has a longer treatment span, often lasting several years, that can significantly impact a patient’s quality of life over time.
The adverse effects of endocrine therapy, although generally less aggressive than those of chemotherapy, are persistent and affect most patients to some degree. For example, tamoxifen commonly causes vasomotor symptoms such as hot flashes. These symptoms are especially pronounced in younger, premenopausal women who undergo induced menopause through LHRH analogues, which can lead to intense and frequent hot flashes. Aromatase inhibitors also cause vasomotor symptoms but add arthralgia and myalgia to the list, contributing to discomfort and reduced quality of life. Although many patients experience these adverse effects most acutely at the beginning of treatment, the body often adjusts over time, allowing patients to better tolerate them.
Despite this adaptation, a subset of patients—estimated at around 5% to 10%—experience adverse effects so severe that continuing the prescribed therapy becomes impossible, necessitating a change in treatment strategy. The vasomotor symptoms, especially hot flashes, often disrupt sleep, leading to insomnia and sleep disturbances. These issues can contribute to chronic fatigue, further diminishing patients’ overall well-being. The extended duration of endocrine therapy and its adverse effects highlight the importance of supportive care and symptom management to help patients maintain adherence and preserve their quality of life throughout treatment.
