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Expectations may influence drug side-effects

Wednesday August 24th, 2016

A new study appears to show links between patient expectations and the severity of their side-effects from breast cancer treatment.

It was carried out by Professor Yvonne Nestoriuc and colleagues the University Medical Centre, Hamburg, Germany.

The team state in The Annals of Oncology yesterday (23 August) that: "Drug-related side-effects are a major public health concern. They frequently cause unfavourable health and treatment outcomes, including pre-mature drug termination."

The team adds: "Current research suggests that adverse side-effects are in part caused by non-pharmacological factors such as negative expectations."

They carried out a study of 111 post-operative patients with hormone-receptor-positive breast cancer. After two years of endocrine treatment with tamoxifen or aromatase inhibitors such as exemestane, patients reported high rates of side-effects including joint pain, weight gain, hot flushes, and symptoms not directly attributable to the medication such as breathing problems and dizziness.

They report: "Pre-treatment expectations significantly predicted patient-reported long-term side-effects and quality of life. Relative risk of side-effects after two years of endocrine treatment was higher in patients with high negative expectations at baseline than in those with low negative expectations."

Expectations about side-effects were also linked with adherence to treatment at 24 months. Patients with low expectations of side-effects before treatment had an 87% adherence rate, compared with 69% for those with high expectations of side-effects.

Professor Nestoriuc says: "Our results show that expectations constitute a clinically relevant factor that influences the long-term outcome of hormone therapy. Expectations can be modified so as to decrease the burden of long-term side-effects and optimise adherence to preventive anti-cancer treatments in breast cancer survivors."

She adds that controlled studies are needed in order to analyse "potential causal relationships".

Nestoriuc, Y. et al. Is it best to expect the worst? Influence of patients' side-effect expectations on endocrine treatment outcome in a two-year prospective clinical cohort study. The Annals of Oncology 23 August 2016; doi:10.1093/annonc/mdw266

Tags: Cancer | Europe | Mental Health | Pharmaceuticals | Women's Health & Gynaecology

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