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  • br Discontinuation of oral BPs br of patients

    2022-05-07


    3.4. Discontinuation of oral BPs
    22% of patients reported they had considered stopping their oral bisphosphonates but only 16% of responders (n = 47) had stopped. Of those that had stopped, 10% converted onto IV zoledronic K 252a but the remaining 6% did not continue with adjuvant bisphosphonates either due to advice from the General Practitioner, Oncology team or patient choice. In the 47 patients who had to stop oral BPs, the majority of those ceased the medication in the first 6 months of use (see Fig. 4).
    4. Discussion
    Adjuvant BPs have now become standard of care to reduce breast cancer mortality in post-menopausal early breast cancer patients in Europe and America, supported by published guidelines on drug choice, duration and patient selection [13,14]. Clinicians have the option to prescribe intravenous or oral BPs for 3–5 years duration after con-sideration of side effect profile and according to local commissioning agreements.
    Patient satisfaction and compliance with BPs is important to opti-mise the benefit of a 17% relative reduction in breast cancer mortality as demonstrated in the recent meta-analysis of adjuvant BP clinical trials [12]. In the present study we investigated patient reported tol-erability with daily ibandronate in women with early breast cancer. Patient satisfaction overall was good and less than 10% of patients were extremely bothered by side effects. This data reflects better tolerability than patient data from the metastatic setting where 24% of patients expressed dissatisfaction with the constraints, especially the time re-quired to be upright after taking the tablet [20].This may be due to differences between the patient cohorts with the patients in our study receiving curative breast cancer treatment compared to the metastatic setting where polypharmacy is more likely to occur, patients may be symptomatic of their metastatic disease and a duration for compliance with the tablets is not defined, all of which can impact on resilience to comply with daily oral medication that requires such a stringent ad-ministration process. In addition, the potential to prevent metastatic disease and improve survival may be a stronger driver to comply with medication in the adjuvant setting than the prevention of skeletal re-lated events in the metastatic setting.
    In the adjuvant setting, there is currently no patient reported data on compliance and tolerability of oral BPs administered as a daily dose to reduce breast cancer mortality in a ‘real world’ setting. In the context of a randomised controlled trial of adjuvant clodronate, adherence to treatment at 3 years was 56% [10]. In the present study, rates of dis-continuation from medication were low (16%) in the 295 patients who responded. This is lower than discontinuation rates seen in the meta-static studies of daily oral BP with clodronate (1600 mg/day) where rates of discontinuation were ∼35% due to GI side effects [21,22], but similar to metastatic studies with daily ibandronate (5–50 mg/day) with a 10% discontinuation rate [23]. Compliance with weekly oral BPs in the metastatic breast cancer setting has also been evaluated and showed poor persistence with 45.6% of patients stopping after 1 year of therapy [24]. Previous studies have suggested oncologists tend to overestimate patient compliance with oral bisphosphonates and a third of surveyed oncologists anticipated that adherence would be >70% in
    How often you have to take the medication 55
    How often you have to take the medication >55
    How easy cork cambium is to take medication 55
    How easy it is to take medication >55
    How easy it is to remember to take medication 55
    How easy it is to remember to take medication >55
    How well oral BPs fit into medication schedule 55
    How well oral BPs fit into medication schedule >55
    Amount of time required to take oral BPs including staying upright 55
    Amount of time required to take oral BPs including staying upright >55
    Overall satisfaction with medication 55
    Overall satisfaction with medication >55
    How satisfied to continue taking medication 55
    How satisfied to continue taking medication >55
    dissatisfie d
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    Diss 
    fi e d dissatisfied
    s
    ti
    Somewhat
    sa tisfied
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    dissatifie d
    or Somewhat
    satisfied 
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    Fig. 2. Patient reported satisfaction stratified according to age. (1 represents “very dissatisfied”, 7 “very satisfied”). Bars represent mean + 95%CI. *P-value < 0.05 (paired t-test).
    the metastatic setting [25]. This has the potential to negatively impact on clinical outcomes and there is recognition amongst clinicians that strategies to improve compliance are needed [26].