Breast Cancer Now Forum

And let's not forget that the UK is losing the EU agency for regulating pharmaceuticals; it's going (or may well have gone by now) to Amsterdam.   The NHS is reliant on skilled migrants as nurses and clinicians at all levels of expertise, and on international collaboration in research, together with financial assistance. This will all be severely affected. It is difficult to see how the NHS will survive.   As you say, it's not happening yet. ... View more

Aromatase Inhibitors (AIs) block the production of Aromatase in our fat cells which consequently blocks the production of oestrogen in our fat cells so, if we are post-menopausal, we stop producing oestrogen altogether.   Tamoxifen operates differently. There are two main oestrogen receptors, ER𝜶 and ERβ expressed throughout the brain. In general, ERβ is expressed at high levels in the hippocampus and temporal cortex, whilst ER𝜶 is expressed at higher levels in the amygdala and hypothalamus.   Multiple studies indicate that AIs and Tamoxifen can cross the blood-brain barrier. All AIs inhibit both ER𝜶 and ERβ whilst Tamoxifen has a mild stimulatory effect on ER𝜶 and completely blocks ERβ activity.    My own experiences Letrozole caused an allergic rash. Anastrozole caused the following side effects after 9 1/2 weeks: Severe joint and muscle pain well above normal, particularly left shoulder, upper arm (axillary node clearance) and left wrist (fractured May 2017). Increased pain in right wrist (arthritic). Both knees painful and stiff (already osteoarthritic but not normally painful). Increased fatigue (above earlier level of chronic fatigue). Extreme sleepiness. Mood changes, including severe depression and extreme irritability similar to PMT and menopause. Symptoms similar to earlier experience of hormonal disturbance, including problems with HRT and coming off it. No interest in anything or in doing anything. Slower cognition; like thinking through pea soup. Difficulty finding words. Poorer short term memory than usual. Felt as though someone inside my head tinkering with it. Slight metallic taste in mouth; at times, lack of taste altogether. Nausea. Loss of interest in food; slight increase in weight despite small quantities of healthy foods. The following information has come from research papers obtained from: NICE, the BMJ and the Lancet.   Exemestane is likely to prompt the same adverse effects as Anastrozole. The Electronic Medicines Compendium states for Exemestane: ‘Most adverse reactions can be attributed to the normal pharmacological consequences of oestrogen deprivation.'  My Consultant Oncologist has confirmed that the actions of all three Aromatase Inhibitors is much the same pharmacologically and that they all have the effect of removing all oestrogen from the body.   However, oestrogen is important throughout the body for its functioning, including in the brain for effective operation of neurotransmitters.   From a research paper (source: NICE) published 2014, several studies report the negative effects of Tamoxifen on cognitive function, patients in this group being significantly impaired on tasks involving memory, information processing and decision-making. The findings suggest that Tamoxifen plays an antagonistic role in the areas of the brain where oestrogen receptors are present, including the prefrontal cortex (higher level functioning), the hippocampus (factual and episodic memory) and the amygdala (controlling fight or flight and emotions). Other papers support this. The information on Tamoxifen in the electronic medicines compendium suggests that adverse effects are closely related to the drug's effects on the two oestrogen receptors.    Other papers maintain that Tamoxifen and its active metabolites inhibit dopamine transporter function independently of the oestrogen receptors. Dopamine controls movement, cognition, mood and reward. The dopamine transporter modulates dopamine levels in the brain. Tamoxifen, as a dopamine antagonist, has the effect of lowering dopamine levels in the brain.   Dopamine levels can be significant in forms of depression, as well as the neurotransmitters serotonin and noradrenaline.   Some women are much more sensitive to oestrogen deprivation than others. I have decided not to continue with Endocrine Therapy on account of the conflict between the common side effects and aspects of my medical history. My BCN and GP are very sympathetic and supportive about this. My Consultant Oncologist is very sympathetic also, but unfortunately my review last week was dealt with by a very junior registrar (I would imagine about 25 or 26 and very under-experienced) who kept repeating that as I am strongly oestrogen +ve I need Endocrine Therapy to prevent cancer returning. It transpired he hadn't read any of my medical notes. Neither was he able to discuss the pharmacological implications of the different drugs. It was also clear he had no understanding of the pharmacology of antidepressants or the differences between different ones.   I wrote to my Consultant and so did my GP (who described my session with the Registrar as dysfunctional). My Consultant has invited me to make an appointment to see him personally to discuss issues further, so that should be within the next couple of weeks.    I mention my own experiences because it seems the medical profession is still bent on treating cancer as though longevity is of prime importance and quality of life is secondary or not significant at all. The statistical information they quote (NHS Predict) is based on this view and takes no account of lifestyle, circumstances, diet or anything beyond age and pathology of tumour. It seems that young practioners especially are programmed to force treatments on to us which themselves can cause serious health problems.   No doubt some women benefit greatly from Endocrine Therapy and I am not attempting to put any of you off persevering with it, if that is what you feel is right for you.   I would say be prepared to question your Oncologist and BCN over the side effects and longer term effects of the drugs, and stress your own needs and requirements in your day-to-day life. Don't let anyone bully you into taking something you find intolerable. Medical opinions are gradually changing anyway.   Good luck.   ... View more

You mention you keep trying to take bisphosphonates 'from time to time'. Have you had a chat with your Oncologist and/or your Breast Care Nurse about this? The tablets are only effective if taken as prescribed. If you are having unacceptable side effects, there is the option of Zoledronic Acid infusions every sixth months which seem to be better tolerateld by many people.   Re knowing whether Anastrozole is working or not, the purpose of taking it is to block the production of Aromatase in our fat cells which itself is involved in the production of Oestrogen. The effect is to block the production of Oestrogen. It takes a few weeks for Oestrogen to leave your system altogether (you could check this with your Onc or your BCN) but that is the effect.   Some women are much more sensitive to the effects of Oestrogen depletion than others, so whether or not you have side effects is not an indicator of the effectiveness of the Anastrozole.   If you have a word with your Onc or your BCN you could put your mind at rest. ... View more

Yes, I ended up with severe depression and feeling absolutely appalling after 9 1/2 weeks of Anastrozole. I was advised to come off it. It took about 5 weeks or so to return to where I had been  before. My Breast Care Nurse and a nurse I spoke to from Macmillan both said that most women who have a history of depression find they have to come off (and stay off) endocrine therapies (and that includes Tamoxifen, although its pharmacology is different).   Obviously it is your own decision as to what you can cope with and what you can't. Individuals vary, but the general aim of all Endocrine therapies (including Tamoxifen) is to starve the body of oestrogen by one process or another. A woman who is very sensitive to hormonal fluctuations is particularly likely to have problems. Oestrogen plays an important part in the brain in the management of neuroreceptors.   My own decision is to refuse further Endocrine therapy of any sort, having tried Letrozole (allergic rash) and Anastrozole (adverse reactions associated with oestrogen depletion). I have several reasons for not trying Tamoxifen, one being that I have to take a drug (as a form of antidepressant) that is a dopamine agonist, which increases the level of dopamine in the brain. Tamoxifen is a dopamine antagonist and interferes with dopamine transporters in the brain. My own GP and my BCN have both said it would be very undesirable to take the two at the same time as they would be in opposition to each other.    I do hope you find a solution suitable for you. You might need to keep off Anastrozole for longer than two weeks. I would have another word with your BCN. ... View more

Oh dear, Pinklily, this does sound nasty.   Have you had a chat with your GP? He or she could perhaps recommend a chiropodist, and probably one who could make home visits. It sounds as though you need professional advice.   My own GP has such information and put me onto a really good chiropodist who charges £30.00 for a visit (that's inclusive) and is very helpful. Getting such help through the NHS is, I think, a bit difficult nowadays, but you could make enquiries.   Hope you can get it sorted soon. ... View more

If your sentinel node(s) was negative, that suggests the cancer has not spread from your breast into your lymphatic system. As the surgeon has not done an axillary node clearance, that would support that view.   Your oncologist would not recommend delaying further treatments if he/she thought there was a risk of cancer cells spreading in that time. It sounds, from your description, that chemo and/or radiotherapy would be preventative measures anyway, along the lines of the icing on the cake. It's not as though they were considered vital treatments.   You should have been assigned to a Breast Care Nurse, so why not have a chat with her? Also, raise your concerns with your Oncologist. You could phone his/her secretary and ask to speak over the phone if you can't have a face to face appointment.   Hope you hear soon.         ... View more

It isn't just the things people say, either. It's what they expect of us too. Perhaps I can let off some steam.   A friend of mine who lives about 80 miles away was, when I was diagnosed with breast cancer last March, a bit dismissive. He thought that the older you are (I'm 69) the less likely you are to die from it and the less serious it is. I've provided him with suitable statistics indicating the opposite and have received a dignified apology!   The poor man was diagnosed with cancer of the bone marrow last June, which is under control but obviously very worrying. He's 77, lives on his own but has four adult sons, two of whom live within reasonable travelling distance for a day visit and a third able to travel to stay. For a long time he was very unwilling to express to them how depressed and worried he was because 'they have their own family and their own lives and worries and I don't want to bother them' etc. etc.. I kept telling him he should let them decide what they could and couldn't do for him, and simply be honest with them about his health and his depression.   We talk by phone every week. Over this winter he has been in the pit of despair. Each time I have used all the counselling skills I've ever learnt to haul him out of it, successfully, only for him to be back in it the following week. He did eventually have frank discussions with his sons and spent Christmas with two in turn, after a great deal of further telephone counselling from me.   I don't have any family and live on my own. Friends have been as helpful as they can be over the last 10 months, but they do have family commitments so I have to manage on my own most of the time and take myself to most hospital appointments.   Somewhere about New Year I started screaming at myself, silently. My friend has been in hospital for the last 2 weeks having fainted at home. He has contacted his sons and two are in dicsussion with the hospital doctors, so he is getting proper supervision. He had not even thought to tell the doctors he recently had shingles until I prompted him.   He still likes to talk over the phone and couldn't understand yesterday why I said I couldn't speak for very long. I've suggested that as he is due to be discharged later this week, he now emails me once he's home. I've also suggested that he thinks up something interesting for us to discuss, e.g.  stately home or some aspect of history, and emails me the Internet link so we can go on a telephone virtual tour.   We have helped each other along for years (support has been in both directions) but for several months it's been exhaustingly one-way and I've now begun to feel suffocated. Because I sound alert and constructive over the phone my friend takes that to indicate I'm well and happy. Actually, I'd like to scream but that would plunge him back into his escape pit of 'I"m a nuisance to every one else and this is my fault,' which comes out too easily.   I expect there are many of you out there who have to carry others along whilst needing support yourselves. How do you deal with it?   Best wishes to all  ... View more

Flora29, could you contact the RSPCA re your FIL's poorly cat? If the animal is only mildly ill, they could perhaps treat it and then find it a home when it has recovered. It would be a great shame to put puss down because your family can no longer keep it. Did your FIL ever take it to a local vet for vaccinations, etc.? If he did, perhaps they could help. My own vet has a policy of never putting down a healthy animal. A fundamentally healthy one which needs treatment is, when recovered from their treatment, sent to a cat shelter or found a home by them. Or, the PDSA might be able to treat puss without charging you anything.   Sorry, can't help with your FIL! ... View more

Thank you Cybele, that's very helpful.   What you say supports my experience of Anastrozole, which is of course a sister drug to Letrozole. I was on the latter for only about 3 weeks as I developed a rash which my clinical oncologist identified as being caused by the drug. I was then on Anastrozole for 9 1/2 weeks, by which time I had symptoms including extreme irritability (over nothing), extreme fatigue, muscle and joint pain, extreme depression, complete loss of motivation, nausea and loss of appetite. I was advised to stop taking it and although offered Exemestane, I declined as the medical literature indicates that the adverse effects of Exemestane, very similar to those of Letrozole and Anastrozole, are attributable to oestrogen depletion. After all, the AIs are designed to render our bodies free of oestrogen.   The irritability was extremely horrible. I would wake feeling really bad tempered, and would keep looking for something to be bad tempered about. It meant exerting extra cognitive control the whole time and it just wasn't feasible.   Tamoxifen, although operating by a different mechanism to the AIs, does not appear to be at all preferable. I've posted details about the pharmacology of Tamoxifen in other threads. (It blocks oestrogen receptor beta which can have a resounding effect on many of our functons, including cognition. It mildly increases oestrogen receptor alpha, but that can prompt uterine bleading and other nasties.)   Individuals differ, but it looks as though some of us might be particularly sensitive to reduction in oestrogen, so as these drugs are designed to wipe it out altogether by one method or another, we are between a rock and a hard place. ... View more

Seasons greetings to all of you; hoping 2019 will be kinder to everyone and an improvement on 2018.   There is an old Yorkshire custom that every mince pie you eat between 1 Dec and 6 Jan, made by a different pair of hands (or a different commercial firm), gives you a wish and a happy month for the coming year. So if you manage 12 different ones in that time, you should be well set for a better 2019!   May your wishes come true.                                                             ... View more

Oh dear, that IS a bad start to the festive season. I think you were extremely restrained, Maggie. I might have responded, 'Is that a question, or are you telling me something?' followed by the feline effortless look of being unimpressed.   Have a restful and relaxing Christmas, despite faux pas from people who need to think a little harder. ... View more

Tolerating Tamoxifen   All the Endocrine therapies, including Tamoxifen, are designed to deplete our bodies of oestrogen by one mechanism or another.   Oestrogen depletion in itself can have damaging effects on our bodies, including our cognitive abilities, so it's a matter of deciding where our priorities lie. Are we so afraid of cancer that we subject ourselves to a miserable life with debilitating health issues, or do we take the risk of a cancer recurrence in order to have quality of life whilst we have it?   There are two main oestrogen receptors, ER𝜶 and ERβ, which are expressed throughout the brain. In general, ERβ is expressed at high levels in the hippocampus and temporal cortex, whilst ER𝜶 is expressed at higher levels in the amygdala and hypothalamus. Multiple studies have indicated that AIs and Tamoxifen can cross the blood-brain barrier and enter the brain. All AIs inhibit both ER𝜶 and ERβ whilst Tamoxifen has a mild stimulatory effect on ER𝜶 and completely blocks ERβ activity.    The information on Tamoxifen in the Electronic Medicines Compendium suggests that adverse effects are closely related to the drug's effects on the two oestrogen receptors.    Quoting from a research paper (downloaded from NICE) published in 2014, several studies have reported the negative effects of Tamoxifen on cognitive function. Results indicated that patients in the Tamoxifen group were significantly impaired and performed significantly worse on various tasks involving memory and information processing. The study demonstrates that breast cancer patients taking Tamoxifen have several decision-making impairments. The findings may support the idea that Tamoxifen resulting in cognitive changes plays an antagonistic role in the areas of the brain where oestrogen receptors are present, including the prefrontal cortex (responsible for higher level functioning), the hippocampus (responsible for factual and episodic memory) and the amygdala (controlling fight or flight and emotions). There are quite a few other papers making very similar observations.    For other side effects, see the Electronic Medicines Compendium and enter Tamoxifen. Amongst the undesirable effects listed are the following:   Common: Uterine firbroids Common: Anaemia Very common: Fluid retension Very common: Depression Common: cataracts Very common: hot flushes Common: thromboembolic events Very common: nausea Common: Vomiting, diarrhoea and constipation Common: changes lin liver enzyme levels Very common: skin rash Common: Alopecia Common: Leg cramp, myalgia Very common: Vaginal discharge, vaginal bleeding Very common: fatigue Common: Bone and tumour pain   It is very much a personal issue as to how any one patients reacts to the drug; coming off it and returning to a normal state will vary very much between individuals and will depend, in part, on how long your body takes to restore its normal oestrogen levels. ... View more

Dear Kathyx   Your situation is similar to that of many of us; you are not alone. Quality of life is so important, especially at our age (I'm 69).   A specialised nurse I spoke to over the phone at Breast Cancer Care was extremely sympathetic to the issues and said that most women with a history of depression find they have to come off Endocrine therapies. When I mentioned this to my Consultant Oncologist, he said that is absolutely true.   I too have a history of depression. Mine is atypical and appears to be associated, at least in part, to dopamine levels. I am prescribed, in the long term, a drug that is a dopamine agonist. Tamoxifen is a dopamine antagonist, and affects dopamine transporters in the brain. My GP has agreed it would be unwise to take it.   The general advice given to me by my very understanding BCN and echoed on the BCC and Cancer Research UK sites is to keep weight down, keep to a healthy diet, avoid alcohol and not to smoke.  Beyond that, there is no scientific evidence that omitting certain foods is likely to give any protection against a recurrence of cancer. It's a matter of eating sensibly and enjoying what we eat.   All the very best for your own experiences. ... View more

This is a post I put in another thread on this forum recently.   My information comes from scientific papers obtained by searching NICE, the BMJ and the Lancet sites.   As the Aromatase Inhibitors effectively block production of oestrogen altogether, we have to face the consequences of oestrogen depletion as long as we are taking them. The Electronic Medicines Compendium states for Exemestane: ‘Most adverse reactions can be attributed to the normal pharmacological consequences of oestrogen deprivation.' Letrozole and Anastrozole have much the same action. All the Aromatase Inhibitors are notorious for causing cognitive problems, as well as severe joint and muscle pain and, in some patients, severe depression.     Oestrogen depletion in itself can have damaging effects on our bodies, including our cognitive abilities, so it's a matter of deciding where our priorities lie. Are we so afraid of cancer that we subject ourselves to a miserable life with debilitating health issues, or do we take the risk of a cancer recurrence in order to have quality of life whilst we have it?   There are two main oestrogen receptors, ER𝜶 and ERβ, which are expressed throughout the brain. In general, ERβ is expressed at high levels in the hippocampus and temporal cortex, whilst ER𝜶 is expressed at higher levels in the amygdala and hypothalamus. Multiple studies have indicated that AIs and Tamoxifen can cross the blood-brain barrier and enter the brain. All AIs inhibit both ER𝜶 and ERβ whilst Tamoxifen has a mild stimulatory effect on ER𝜶 and completely blocks ERβ activity.    The information on Tamoxifen in the Electronic Medicines Compendium suggests that adverse effects are closely related to the drug's effects on the two oestrogen receptors.    Quoting from a research paper (downloaded from NICE) published in 2014, several studies have reported the negative effects of Tamoxifen on cognitive function. Results indicated that patients in the Tamoxifen group were significantly impaired and performed significantly worse on various tasks involving memory and information processing. The study demonstrates that breast cancer patients taking Tamoxifen have several decision-making impairments. The findings may support the idea that Tamoxifen resulting in cognitive changes plays an antagonistic role in the areas of the brain where oestrogen receptors are present, including the prefrontal cortex (responsible for higher level functioning), the hippocampus (responsible for factual and episodic memory) and the amygdala (controlling fight or flight and emotions). There are quite a few other papers making very similar observations.    NHS Predict Version 2.1 is generally used by oncologists to give us some idea of our likely lifespan with or without endocrine therapy. Unfortunately, it only takes into account the pathology of our cancer, our age and how our tumour was detected. It doesn't allow for lifestyle, co-morbidity, or give any guide as to what might kill us eventuallly, or how far our lives might be reduced by the treatments themselves.   I discussed all this recently with a friend of mine who is a very experienced doctor who has worked in public health for many years at a senior level. These were her observations.    Cancer treatment efficacy is always measured in terms of 5 or 10 year survival (as a proxy for cure) whereas for many other interventions we look at QALYs (quality adjusted life years) which takes quality of life into account.  We have conditioned people to aim for cancer elimination almost at any cost as it is assumed that living with it is too fearful.  In reality it is no different to any other chronic condition that people may live with.  I think this has come about because the big advances in cancer treatment have been with childhood cancers where aiming for cure is entirely reasonable and parents are often accepting of short term distress for their child if they have a good chance of achieving a normal healthy life post treatment.  Priorities and decisions are very different at the other end of life.   So, it is very much down to a matter of personal choice. Do we do as the oncologist tells us and suffer debilitating health issues in order to just stay alive, or do we treat quality of life as a priority?   I had to come off Anastrozole on 24 Sep this year after taking it for 91/2 weeks; my symptoms had built up gradually and included severe depresson, extreme joint and bone pain, nausea, weight gain but reduced interest in food, reduced cognitive abilities (like thinking through pea soup), fatigue, extreme irritiation of the sort where you feel extremely angry about nothing, complete lack of motivation to do anything.  My BCN and my GP agreed I should stop taking the drug, these symptoms being largely those associated with oestrogen deprivation.   Subsequently I've seen my Consultant Oncologist who has suggested Tamoxifen. I explained to him the information I have found (outlined above) and asked him if he felt this was accurate. He replied that he din't know and would have to look it up. I've also spoken to a clinician in the Breast Unit of my hospital who has had 20 years experience of working with breast cancer patients. Whilst being a lovely sympathetic person, she couldn't tall me anything either, remarking that I would know more pharmacology than any of the doctors treating me.   After 11 weeks without Anastrozole, I have returned to where I was before taking it. It isn't just a matter of 'getting the drug out of your system' as it appears to be the effects of oestrogen depletion that cause the most problems, so it's a matter of giving your body time to start producing oestrogen in your fat cells again, and for the oestrogen levels to return to normal all over your body, including in your brain. No-one has been able to tell me how long that can take. Presumably, it will be different for different women. ... View more

you need a reconstruction as your husband would not want to see you like that ??   Tili, that's shocking.   I'd have been inclined to answer something like: 'My husband is a very kind, considerate and sensitive person who believes my body belongs to me; that's why I married him.'         ... View more

'You can stop the treatment anytime you want, you don't really want to have a poorer quality of life do you'.   I do understand why this distesses you, Pinklily, but I can also see what your friend probably meant by it. Chemo doesn't necessarily prevent breast cancer coming back again, and it can have long term effects of its own, so whether to accept it or not is a very difficult choice to make. You do have the option to stop it, and doing so doesn't automatically mean cancer will come back.   A great deal depends on age, also. A young person in their 30s or 40s has a stronger chance of keeping cancer at bay for much longer than someone in their 70s or 80s. (We are told that there is no certain cure for breast cancer and it can always come back after even 20 years.) At the older end of life, quality of life is so important and some of us feel that's more significant than longevity.   Whatever you do, believe in yourself. ... View more

Hello MysteryMouse   It sounds as though you are in a very difficult place at them moment; I do empathize.   Have you discussed your concerns in detail with your GP and with your Oncologist?   Different antidepressants work in different ways, and different individuals respond very differently to the same drug, so it would be very difficult for any of us to give advice on their impact on health, or on what to expect when ceasing to take them. You need to discuss this with your GP and you could also ask a pharmacist at the chemists from which you collect your prescription.    The Aromatase Inhibitors are well known for causing depression in patients, so perhaps this is something to discuss with your medical oncologist who first prescribed Anastrozole.   As for stigma, depression is something which the bravest and most stable of people can suffer from, so do not feel bad in any way by admitting to it. It takes strength to acknowledge having mental health issues, strength to seek help, and strength to find a solution.    Good luck. ... View more

Here is another interesting study about the general effects of Endocrine therapies and women's responses.   A hard pill to swallow: a qualitative study of women’s experiences of adjuvant endocrine therapy for breast cancer   Alison Harrow,1 Ruth Dryden,2 Colin McCowan,3 Andrew Radley,4 Mark Parsons,5 Alastair M Thompson,6 Mary Wells7 To cite: Harrow A, Dryden R, McCowan C, et al. A hard pill to swallow: a qualitative study of women’s experiences of adjuvant endocrine therapy for breast cancer. BMJ Open 2014;4:e005285. doi:10.1136/ bmjopen-2014-005285   ABSTRACT Objective: To explore women’s experiences of taking adjuvant endocrine therapy as a treatment for breast cancer and how their beliefs about the purpose of the medication, side effects experienced and interactions with health professionals might influence adherence.   Design: Qualitative study using semistructured, one-to- one interviews.   Setting: 2 hospitals from a single health board in Scotland. Participants: 30 women who had been prescribed tamoxifen or aromatase inhibitors (anastrozole or letrozole) and had been taking this medication for 1–5 years.   Results: Women clearly wished to take their adjuvant endocrine therapy medication as prescribed, believing that it offered them protection against breast cancer recurrence. However, some women missed tablets and did not recognise that this could reduce the efficacy of the treatment. Women did not perceive that healthcare professionals were routinely or systematically monitoring their adherence. Side effects were common and impacted greatly on the women’s quality of life but did not always cause women to stop taking their medication, or to seek advice about reducing the side effects they experienced. Few were offered the opportunity to discuss the impact of side effects or the potential options available.   Conclusions: Although most women in this study took adjuvant endocrine therapy as prescribed, many endured a range of side effects, often without seeking help. Advice, support and monitoring for adherence are not routinely offered in conventional follow-up settings. Women deserve more opportunity to discuss the pros, cons and impact of long-term adjuvant endocrine therapy. New service models are needed to support adherence, enhance quality of life and ultimately improve survival. These should ideally be community based, in order to promote self-management in the longer term.   My own comments: Whilst, of course, every patient is an individual, there is a growing body of evidence that Endocrine therapies, both AIs and Tamoxifen, have very serious side effects for not all, but for most women taking them. A woman's own medical history is likely to be very significant but, apparently, this is not generally taken into account. As many studies indicate, more research is required and greater opportunities needed, for women to discuss the implications to them personally of long-term use of AIs and Tamoxifen.   For women who do manage to tolerate them, the adverse effects are generally cumulative and can take several years to become significant.   My Consultant Medical Oncologist informed me that most women with a history of depression find they have to come off all the Endocrine therapies and remain off them.        ... View more

Some of you might be interested to read the abstract of this paper.   The Impact of Endocrine Therapy on Cognitive Functions of Beast Cancer Patients: A Systematic Review   Author(s) Bakoyiannis I; Tsigka EA; Perrea D; Pergialiotis V Source Clinical drug investigation; Feb 2016; vol. 36 (no. 2); p. 109-118 Place of Publication New Zealand   Abstract BACKGROUND AND OBJECTIVE: The purpose of the present review was to study the impact of endocrine therapy (ET) on the cognitive outcomes of breast cancer patients.MATERIALS AND METHODS: We systematically searched the literature using the MEDLINE (1966-2015), Scopus (2004-2015), ClinicalTrials.gov (2008-2015) and Cochrane Central Register (CENTRAL) databases, as well as the references of the electronically retrieved articles.   RESULTS: Twelve studies were included in the present systematic review, which assessed the cognitive function of 2756 patients. Among these patients, 2381 received ET, whereas the remaining 375 served as controls (placebo or no therapy). The majority of patients were postmenopausal, and the minimum follow-up period was 3 months and the maximum 2 years. Treatment with ET seems to be accompanied by altered cognitive abilities, including verbal memory, verbal fluency, motor speed, attention and working memory. Tamoxifen seems to be related to decreased cognitive performances compared with treatment with an aromatase inhibitor.   CONCLUSIONS: ET among breast cancer patients seems to negatively alter the cognitive outcomes of breast cancer patients. However, the methodological heterogeneity of the included studies, as well as the relatively small follow-up period, render imperative the conduct of further studies in the field.     My own comment: We have to bear in mind that pharmaceutical companies do not fund research into the adverse effects of their drugs, only the benefits. Adverse effects are picked up on along the way. ... View more