Photo Karl D. Stephan
If your aromatase inhibitors cost more than $ 30 for copayment, would you stop taking them after treatment for estrogen-sensitive breast cancer? Dr. Dawn l. Hershman has studied the habits of younger and older women who were diagnosed with early-stage breast cancer-the most treatable type of breast cancer-and she reports that the youngest and the oldest patients quit taking hormonal therapy soon after primary treatment ends. Money appears to be one reason that many patients don't continue taking Aromasin or Tamoxifen their, especially if their prescription copays are over $ 30.
"We were surprised to see that so many young women stopped treatment early, despite the fact that the therapy has a proven track record of reducing breast cancer recurrence," said Dr. Hershman. The majority of breast cancers-about 80%-are fueled by estrogen. Hormonal therapies such as Selective Estrogen-Receptor Modulators and aromatase inhibitors are prescribed to be taken for 5 years after surgery, chemotherapy, and radiation have been completed. "These drugs keep the levels of circulating estrogen lower than your body normally makes-know your body becomes a less cancer-friendly environment, discouraging cancer's return.
Dr. Hershman reported the findings of her study at the 33rd annual San Antonio Breast Cancer Symposium (SABCS). She grouped the copayment amounts into $ 30, between $ 30 and $ 89.99, $ 90 or more. Patients with 90-day co-payments paid from $ 0 to $ 893.49 for refills. Many women over retirement age stopped paying for aromatase inhibitors when their copays went over $ 30-some of these patients may be on limited incomes, and have to budget carefully. "Some women between the ages of 40 and 64 kept refilling their prescriptions until copays hit $ 90-these may be women who are raising children, juggling careers and family life, as well as assisting elderly parents.
Dr. Alfred Neugut said that Hershman's study is the first to show how high copays do have an impact on such a crucial drug where mortality can be so directly at stake. "Dr. Hershman said, "When we have highly effective medications available, we need to try to set limits on potential barriers to use like co-payments."While I agree that having consistent costs for medications, prescriptions and making available to everyone who needs them, I think there's more to this issue than money.
I can remember starting Tamoxifen "when I was 47-I was worried about the potential for cataracts and endometrial cancer that might occur as a result of taking this drug. My fertility had already been sacrificed to chemotherapy, one breast had been removed, and now I faced five years of chemically-induced hot flashes, vaginal dryness, low libido, fatigue, and the general feeling that recovery was taking much too long! However, when the side effects of Tamoxifen got to be too much, I remembered how bad I felt during chemo, and since I was determined not to require treatment again, I kept popping those little white pills. Two years into Tamoxifen, I begged my oncologist to switch me to Aromasin-I had transitioned into natural menopause-and I made the switch. Well, I still had hot flashes, vaginal dryness, and low libido-but less worry about cataracts and endometrial cancer.
But now we find out that aromatase inhibitors may raise your risk of heart disease as well as lower your bone density That news came from another paper presented at SABCS. Yet more research shows that some of the side effects of hormonal therapy can be moderated by taking additional therapies such as venlafaxine (Effexor) or clonidine (Catapres)-both of which proved very helpful in women with hot flashes. "You may already know that bone density can be helped by taking a bisphosphonate such as Fosamax or Actonel, and if you're menopausal, you are at greater risk for osteoporosis.
What this all comes down to seems to be this: staying alive after cancer is expensive. You may finish your primary treatment and be happy just to have survived Then you start hormonal therapy, and run into more side effects. "So you wind up taking-and paying for-one or more additional prescriptions to help you stay on your Aromasin or Tamoxifen. That might be three daily pills you didn't budget for, and didn't know you might need. The overall package of pills, side effects, and increasing copayments would put anybody off, even more so when we're facing 5 years of therapy.
I agree with Dr. Hershman when she says that there needs to be lower barriers and greater access to life-saving drugs and medical care. But I also hope that more effective and efficient drugs can be developed to treat breast cancer as well as prevent its return. Developing those drugs will be costly, but keeping patients alive-with a high quality of life-is beyond price.
What do you think-is the financial cost of staying on hormonal therapy the main reason you would stop taking the drugs? Or do other issues like side effects have more of an impact on your decision to quit this type of therapy? Please leave a comment.