Guide to Managing Hormone Therapy: For Breast Cancer Patients

MD Anderson Cancer Center
Date: March 2012

Christi Bowe, advanced practice nurse:
Hormone therapy has significant, proven benefit.  It can be beneficial in preventing a breast cancer from ever developing, it can reduce the risk of recurrence, or it can be used to slow the growth of an existing tumor. 
Narrator:
If you're watching this program, tests probably confirmed that hormones like estrogen or progesterone are needed for your cancer to grow and now your doctor may be recommending hormone therapy as the next phase in your treatment to slow or prevent cancer from coming back. 
In this program, a nurse practitioner, a pharmacist and several patients will offer advice about how to best develop a plan for taking your hormone therapy medication, as well as how to best manage any possible side effects you may encounter. 

Hormone Therapy: What Is It?
So what exactly is hormone therapy?  The term can sound confusing. 

Christi Bowe, advanced practice nurse:
I think that the term hormone therapy can be confusing because people confuse it with HRT therapy that's given to women after menopause to alleviate symptoms. 

Bonnie Boster, clinical pharmacy specialist:
Hormone therapy is not hormone replacement therapy although it sounds very similar.  Hormone therapy can also be looked at as anti-hormone therapy or some people call it endocrine therapy but really the goal is to lessen or deprive the body of estrogen. 

Narrator:
Estrogen is a female hormone produced naturally in the body.  It can be made in small amounts even when a woman is in menopause.  When estrogen attaches to a receptor in a breast cancer cell, it sends a signal to the cell to grow and multiply. 
Hormone therapy medicines can block this signal either by reducing the amount of estrogen in the body or by preventing the cells from using estrogen.  This stops cancer from growing or returning. 

Hormone therapy is usually prescribed as a pill taken orally once a day.  Your doctor will decide the specific type of hormone therapy medicine, timing and length of hormone therapy that's right for you. 

Christi Bowe, advanced practice nurse:
Endocrine therapy is a preferable treatment because it is easy to take.  It's one pill taken every single day. 

Cyndi, patient undergoing hormone therapy:
You know it would be like if I found out I had high blood pressure.  I'd have to take a pill for that or if I had high cholesterol, there's pills for that.  This is just my little pill that I take that is, you know, helping me to keep my cancer from returning. 

Lu Juan, patient undergoing hormone therapy:
I guess I felt like after the radiation everything should have been over and then here I go taking pills for 5 years and it probably put a couple of questions in my mind, in the back of my mind, like okay, I'm still going through cancer, do I still have that and, you know, those feelings soon subsided when I realized this was just helping me to stay away from having cancer again.  So.

Janet, patient undergoing hormone therapy:
As the doctor explained it to me, he said it's like insurance.  We think we got or the surgeon told me we think we got all the cancer out, we don't think you have cancer now, but this is insurance so that in the first five years we hope the cancer won't reoccur.  So, I said I'm for that.  Count me in. 

Hormone Therapy: Taking Your Medicine

Christi Bowe, advanced practice nurse:
It is very important that they take the medicine every day.  The studies done on these endocrine therapies show a significant benefit in most women who take these therapies.  So it's very important that the medication is taken in the way that it was studied and it was studied every single day. 

Narrator:
Once you begin taking your hormone therapy medicine, it is important to develop a routine for taking it.  That includes taking your hormone therapy at the same time each day. 

Bonnie Boster, clinical pharmacy specialist:
There are some people with today's technology that will use a little alarm whether it's on their watch or their phone to remind them.  There are some people that may use little calendars to mark, you know, kind of like a to-do list.  A pillbox reminder is very helpful. 

Cyndi, patient undergoing hormone therapy:
In the evening when I wash my face, brush my teeth and I have my little pillbox sitting right there by my sink and I take, you know, my little group of pills that I have to take and every Sunday I fill it back up.

Narrator:
Many women find keeping the pill box in the same place also helps. 

Janet, patient undergoing hormone therapy:
I'm getting older.  So, when I go home, I have to put my keys in the same place, the pills reminder has to be in the same place or I may not find it. 

Hormone Therapy: Managing Side Effects
While on a hormone therapy medication, you could begin feeling a side effect. 

Christi Bowe, advanced practice nurse:
The most common side effect that women experience are hot flashes, also called hot flushes or by some women burning infernos. 

Cyndi, patient undergoing hormone therapy:
It's the big joke, oh, I'm on a tropical vacation for one. 

Christi Bowe, advanced practice nurse:
Basically it's a reaction where you have an intense, intense internal heat that arises somewhere in the chest and goes through the head and causes sweating and causes a lot of discomfort in addition to sometimes embarrassment. 

Bonnie Boster, clinical pharmacy specialist:
The extent of hot flashes varies from person to person greatly. 

Lu Juan, patient undergoing hormone therapy:
I was waiting for them; they just never showed up so I said that's okay.

Cyndi, patient undergoing hormone therapy:
I start counting them.  I'm having seven hot flashes a day.  It's just, I can't do this.  I called my nurse practitioner and I explained to her I said these hot flashes are just, they're embarrassing. 

Narrator:
If you are experiencing hot flashes, talk with your health care provider and note the time of day and severity of the hot flashes in a journal. 

Christi Bowe, advanced practice nurse:
A journal is an excellent source to keep track.  You think you remember but over time you tend to forget exactly.  When I ask patients how many hot flashes, for example, are you having?  They'll give me a lot of times just answers like all day or all night.  For me to recommend the best treatment for them it's more helpful to know how many are you having during the day, how long are they lasting, are they keeping you up at night?  How many times do you wake up at night? 

Narrator:
This information can help your healthcare provider determine what type of treatment option is best for you.  Be leery of over-the-counter remedies for hot flashes. 

Bonnie Boster, clinical pharmacy specialist:
You don't want to just use something that you can buy without a prescription that says for women's health mainly because a lot of those products that they are helping with hot flashes they have hidden estrogen in them.

Narrator:
Other side effects you may experience could include fatigue, joint aches and stiffness, leg cramps, mood swings, anxiety and depression, nausea, loss of appetite or weight gain.  You may also experience vaginal dryness and a decreased sex drive.  You could also be at an increased risk of osteoporosis or bone deterioration.  The side effects vary between medications. 

You can find detailed information about side effects in your guide.  The important thing to remember is that the majority of side effects can be managed and if you have side effects, discuss them with your health care provider. 

Christi Bowe, advanced practice nurse:
There are many, many ways that we can treat some of the common side effects from these medications and it's very important to tell your health care provider; don't just suffer in silence. 

Joint Aches, Stiffness

Yolande, patient undergoing hormone therapy:
I have nagging joint and just, you know, on the fingers. 

Bonnie Boster, clinical pharmacy specialist:
The way we describe it to patients is all of a sudden you feel will you have arthritis and you didn't have it before and this is more common with our aromatase inhibitors. 

Narrator:
If you have any joint aches or stiffness, exercise, even a little may help. 

Janet, patient undergoing hormone therapy:
Of course my son came to visit and said, mom, your weight routine is under 2 minutes.  I said well that's 2 minutes more than 0.  So I'm doing well and it seems to be helping me so.

Narrator:
You can also try walking, stretching, swimming or even a dance class. 

Yolande, patient undergoing hormone therapy:
I took Zumba.  The music is good, the exercise is good.  So I enjoy it.  The other problem is gone.  I told doctor I can, you know, free now.  [laughter]

Vaginal Dryness

Bonnie Boster, clinical pharmacy specialist:
Vaginal dryness can range anywhere from some type of local irritation feeling.  It can progress to itching and it can progress to pain and bleeding. 

Narrator:
If you are experiencing vaginal dryness, it's important to talk with your healthcare provider.  They can recommend products to help. 

Mood Swings

Bonnie Boster, clinical pharmacy specialist:
We are manipulating hormone levels and so sometimes a question I get asked is about mood swings and recognizing the fact that, yes, it can happen.  A lot of it in terms of like what do I do?  How should I act on it?  You know, part of it is knowing what's normal for the individual and then for the individual and then part of it is also being able to say, look, I think I need some help here or where are my resources. 

Narrator:
If you're feeling anxiety or depression, being positive and having people around you who care can help you feel better. 

Mood Swings

Christi Bowe, advanced practice nurse:
As far as managing a patient's side effects, knowledge is power and there are several support groups that patients can turn to.  I feel like that helps just identify what you're going through with someone else is very empowering and can help. 

Janet, patient undergoing hormone therapy:
We have a listserv and so people get to ask questions, you know, what are you on?  Has anybody had a problem with X or I'm going to do this now or, hey, I just went for my six months and I'm good, you know, or this happened and so it's a very, very supportive group of people. 

Hormone Therapy: Challenges You May Face

Narrator:
Along your journey, you may face some additional challenges. 

Christi Bowe, advanced practice nurse:
I think one of the challenges is just feeling better and not wanting to or not remembering to take the medication anymore.

Bonnie Boster, clinical pharmacy specialist:
Well, the first year you're a lot more motivated and the second or third, you know, you start dwindling.

Christi Bowe, advanced practice nurse:
Some women think that they can't tolerate the symptoms so they stop taking the medication or I've had patients tell me that they take the medications every other day or every two days and that's really not recommended.  So, the most important thing is to talk to your health care provider before you stop taking the medication or alter the way that you take it. 

Narrator:
Throughout your treatment, you will see your health care provider regularly to discuss how you are tolerating your hormone treatment and how the treatment may be affecting your body. 

Bonnie Boster, clinical pharmacy specialist:
By you taking the pill once a day or having your therapy on a regular basis whatever that may be that's enabling you to live the life that you want. 

Janet, patient undergoing hormone therapy:
You have to keep your perspective here so you have some side effects, but you don't have breast cancer.  So, what would you like?  Do you want a possible recurrence of breast cancer or taking the pill? 

Cyndi, patient undergoing hormone therapy:
Those five years, it's a blink of an eye and if it keeps me here longer, I'm sorry, to see my children, to see my husband, see my kids graduate from high school, college, medical school, to see my grandchildren, I'll take it.