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Introduction: Adjuvant hormonal therapy in oestrogen receptor (ER) positive breast cancer patients improves survival. In
2006 the original tamoxifen preparation (Nolvadex) was discontinued and patients were since gradually switched to alternative
generic tamoxifen brands. The goal of this study is to evaluate factors affecting adjuvant tamoxifen related side effects and
compliance including altering tamoxifen products.
Methods: Consecutive patients treated for ER positive breast cancer (stage I-III) in the Royal Hampshire County Hospital
between January 1, 2007 and December 31, 2009 were included. 327 questionnaires were sent to eligible patients. Pearson’s χ2
test was used for data analysis.
Results: 59% of patients experienced side effects associated with tamoxifen treatment out of which 53% were severe. Switching
to generic tamoxifen was associated with more severe side effects (p=0.02). Non-prescribed supplements were taken by 42% of
symptomatic patients with no significant improvement (p=0.05). Interestingly, the concomitant use of SSRI had no effect on
side effects experienced by patients. A significant number of patients considered discontinuing tamoxifen because of the side
effects (p=0.001), yet this did not translate into tamoxifen discontinuation or non adherence (p=0.8 and 0.08 respectively).
Conclusions: Severe tamoxifen side effects are commonly experienced by breast cancer patients and are altered by change in
tamoxifen brand. Most patients will continue to take tamoxifen despite these side effects following clinicians’ advice to avoid
cancer relapse. Supplementation and antidepressants did not improve tamoxifen related side effects. Further studies are needed
to validate our preliminary findings.
Bashar Zeidan is a Clinical Lecturer in Surgery at the University of Southampton. He has a special interest in breast cancer research and oncoplastic breast surgery. He was awarded the first UK Academic Clinical Fellowship in Surgery in 2007. Following his fellowship he completed a higher degree focusing on breast cancer research and was granted a Doctorate of Philosophy Degree from the University of Southampton in 2013. He is an author of more than 15 papers and 2 book chapters in the field of surgery.