title: The impact of tamoxifen brand switch on side effects and patient compliance in hormone receptor positive breast cancer patients.
abstract: BACKGROUND
  In 2006 Nolvadex was discontinued and replaced by a variety of alternative generic tamoxifen brands for the adjuvant treatment of breast cancer. Anecdotally, patients are switching brands and taking alternative medications to reduce treatment related symptoms. Nevertheless, more severe side effects may equate to better relapse prevention. This study evaluates generic tamoxifen adherence and its correlation with side effects and brand switch.
  
  
  METHODS
  Consecutive disease free ER positive patients (stage I-III) were invited to respond to a questionnaire. 165 of 327 questionnaires were returned (50% response). Pearson's Chi Square test was used for data analysis.
  
  
  RESULTS
  63 patients (38%) reported a switch between generic tamoxifen. 59% of all patients experienced side effects associated with tamoxifen treatment of which 53% were severe. Patients experiencing differential symptoms dependent on tamoxifen brand reported more severe side effects (p = 0.02). Non-prescribed supplements were taken by 42% of all patients with no significant improvement in climacteric symptoms (p = 0.05). The concomitant use of SSRIs appeared to have no effect on symptoms. A significant number of patients considered discontinuing tamoxifen because of the side effects (p = 0.001), yet this did not translate into discontinuation or non-adherence (p = 0.8 and 0.08 respectively).
  
  
  CONCLUSIONS
  Severe tamoxifen side effects are commonly experienced by breast cancer patients and can be significantly altered by change in tamoxifen brand. Most patients will continue to take tamoxifen, despite side effects to avoid cancer relapse. Supplementation and antidepressants did not improve tamoxifen related side effects in our cohort.
authors.affiliation: Breast Unit, Hampshire Hospitals NHS Foundation Trust, Winchester, SO22 5DG, United Kingdom; Cancer Sciences Division, University of Southampton, Southampton, SO16 6YD, United Kingdom.
authors.forename: B
authors.initials: B
authors.lastname: Zeidan
authors.affiliation: Breast Unit, Hampshire Hospitals NHS Foundation Trust, Winchester, SO22 5DG, United Kingdom.
authors.forename: K
authors.initials: K
authors.lastname: Anderson
authors.affiliation: Breast Unit, Hampshire Hospitals NHS Foundation Trust, Winchester, SO22 5DG, United Kingdom.
authors.forename: L
authors.initials: L
authors.lastname: Peiris
authors.affiliation: Breast Unit, Hampshire Hospitals NHS Foundation Trust, Winchester, SO22 5DG, United Kingdom.
authors.forename: D
authors.initials: D
authors.lastname: Rainsbury
authors.affiliation: Breast Unit, Hampshire Hospitals NHS Foundation Trust, Winchester, SO22 5DG, United Kingdom. Electronic address: Siobhan.laws@hhft.nhs.uk.
authors.forename: S
authors.initials: S
authors.lastname: Laws
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018931:Antineoplastic Agents, Hormonal / Q000009:adverse effects*; D001943:Breast Neoplasms / Q000737:chemistry / Q000188:drug therapy* / Q000523:psychology; D016009:Chi-Square Distribution; D057915:Drug Substitution / Q000009:adverse effects* / Q000523:psychology; D064420:Drug-Related Side Effects and Adverse Reactions / Q000209:etiology / Q000523:psychology*; D016568:Drugs, Generic / Q000009:adverse effects*; D005260:Female; D006801:Humans; D055118:Medication Adherence; D008875:Middle Aged; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000032:analysis; D011795:Surveys and Questionnaires; D013629:Tamoxifen / Q000009:adverse effects*
chemical_list: D018931:Antineoplastic Agents, Hormonal; D016568:Drugs, Generic; D018719:Erb-b2 Receptor Tyrosine Kinases; D013629:Tamoxifen; C508053:ERBB2 protein, human
keywords: Brand; Breast Cancer; Compliance; Side effects; Tamoxifen