Considering not taking an anti-hormonal

Primary Care

Written by Irene Mace Hamrick MD, FAAFP, AGSF

This study asked 40 community-dwelling patients ≥65 years of age (average age, 75.7 years) from four Johns Hopkins centers about their communication preferences regarding testing for three cancers: breast, prostate, and colorectal. The Choosing Wisely campaign states: "Don't recommend cancer screening in adults with life expectancy of less than 10 years." Interviewers specifically mentioned that it may take up to 10 years before a cancer grows to the point of causing health problems, so that someone who will not live 10 years may not benefit and may be harmed from screening.

Although almost half, 19 (47.5%) had a life expectancy of ≤10 years and 8 participants (20%) had <4 years, statements about life expectancy were not well-understood. Participants were less receptive to what they perceived as harsh, negative statements about benefits and life expectancy. Almost universally they preferred statements like "this test will not help you to live longer" versus "you may not live long enough to benefit from this test." A seemingly subtle difference in phrasing, but important in the participants' minds is the difference between discussing a possibility of no benefit versus a statement of their probable mortality.

Most had a long-standing relationship (average, 3.7 years) with their primary care provider (PCP), reflected in high levels of trust (average score, 4.7 of 5). Patients were receptive to the idea of ceasing screening based on their having a long, trusted relationship with their provider. Stopping screening was greeted with relief by many, "My doctor is a good doctor and if he feels I can stop, it will be a relief not to be poked and prodded anymore."

I explain that breast and prostate cancer is slower growing with older age. I also explain normal aging changes, including thinner and less elastic colon increases perforation risk, and I demonstrate decreased elasticity by comparing the skin of the back of the patient's hands with that of my student's or resident's, (rarely mine, as my skin's lack of elasticity is approaching that of my patients'). Undergoing colonoscopy without sedation is not painful and decreases perforation risk because the patient can alert the endoscopist if it does become painful.

I have taken care of several patients who sustained a stroke from A-fib while pausing anticoagulation for prostate biopsy or surgery, when the cancer would not have affected their life expectancy. As PCPs, we need to inform our patients of the overall risks before we recommend screening or referral to surgeons.

As with all of us, I'm sure this information is more than confusing ! After surgery, chemo and radiation my MO started me on Arimidex. Since my entire body had been invaded by surgeons, chemo , Neulasta shots and then radiation I was always in severe pain. I started the medication, but couldn't be sure if the joint and muscle pain was from the meds or still SE from the procedures. I absolutely knew that the hot flashes, which were unbelievable, were from the medication. The MO finally put me on Welbutrin for the hot flashes which actually did help....they went away. The pain did not. I knew in my heart it was the medication. So instead of seeing her in 3 months, I waited. I recently went to see her, told her I had stopped taking it and why, so she switched me to Femara/Letrozole. I've only been on it for a week......the hot flashes have now resurfaced, with a vengeance !!!! But I'm not having the previous pain. I am more tired/weak but that could just be an adjustment period. My husband doesn't think I should be taking it, but I said I have to give it a bit of time before I just quit.....again!

Each of us brings something different from our own experiences. What you have to remember is that you're not alone in this battle......we all are trying are very best for....and what works for one person may not work the same for some else.

Be brave, question your doctor's , but trust your heart also.

Quality of life is tops imo. For that low of ER I wouldn't bother. But there are some folks who have minimal se on AIs. You could always try it and see if you are nervous about it but if it were me, I'd say no thanks and diet/exericse healthy lifestyle it.