Exercise, or Reducing AI's Side Effects

All of us 'lucky' people with hormone positive breast cancer, get the 'benefit' of being able to take hormone therapy or aromatase inhibitors (AIs) such as Femara, Aromasin, etc. These lovely little pills potentially reduce your risk of breast cancer recurrence (that most dreaded of all possibilities).

However these aforementioned lovely little pills cause nice side effects such as bone loss and joint pain. I have friends who had to discontinue AIs because of these side effects. They can be THAT bad.

So a new research study (because we always need more research) has come up with a cure for these issues: Exercise. Parts of me says this is just another reason they want us to exercise. But in this case apparently it really helped women in dealing with the side effects.

Guess what the suggested exercise is: 150 minutes a week of aerobic and resistance exercise. That is the same amount that is suggested for every one for every issue.

I do more than that each week. I do about 180 minutes of cardio and then another 120 minutes of resistance exercise. I have joint pain and osteopenia (the precursor to osteoporosis). I think I would be in horrible shape if I didn't exercise.

I guess this study results in the same message we get all the time: exercise.

A cheap little pill

I have often blogged about the high prices of medications because I think some of them are just astronomical and are partly priced based on what their manufacturers think is something along the line of the value to patients. If a pill costs $100,000 and will make you get a break from your ailment, would you be willing to pay it (with help from your insurance company)?

But to see for example of how price impacts patient's compliance with the doctor's advice, look at this study. Basically it found that household net worth had a large impact on women continuing their post breast cancer hormonal therapy - aromatase inhibitors.

Its a relatively cheap little pill. I was on tamoxifen and now on letrozole (femara) which costs me a few dollars (less than $5) for a 90 day supply now that a generic is available. It has shown to greatly reduce recurrence rates for breast cancer. Previous studies suggested a five year course after treatment ends but now new studies show that ten years or longer are even better. Thus, I will be on it for a few more years, at least.

Some parts of me are amazed that a cheap little pill could be helping prevent a cancer recurrence. Other parts of me think of it as just a cheap little pill and maybe I could stop it so I had one less pill to take each day. My oncologist doesn't want me to be off it for more than a couple days at any time. If there is a gap in my supply because I forgot a refill, she will be happy to do what she can to make sure I have a supply.

So back to the study. Apparently 10% of women stop taking their aromatase inhibitors each year and 24% never start them or stop them overall. Even though they can reduce your risk of recurrence by 50%. So there is  a potentially big impact for those who take them. The study showed that lower net worth households (this is all assets - house, stocks, cars, etc - less debt (mortgage, loans, credit cards) have a higher rate of discontinuing their hormonal therapy. It was not influenced by income or race as usually reviewed.

If patients have enough issues in complying with their doctor's advice for an inexpensive little pill that has high impact, what about the affordability of these higher priced medications?

Femara

Now I have switched to Femara from Tamoxifen. Tamoxifen is the gold standard for hormone therapy for Estrogen/Progesterone positive breast cancer. It has been around for thirty years or so. Basically, here's my non medical school brain attempts to give a coherent explanation, if your breast cancer is hormone positive, feeding off the hormones, they can suppress the hormones with Tamoxifen for an additional five or more years of treatment. Particularly true for women who were premenopausal.

However then there was additional research and aromatase inhibitors were discovered. Currently there are several on the market, Femara, Arimidex, and Aromasin. Research was done and found that women who took Tamoxifen for 2-3 years and then switched to an AI, did just as well or better, than those who stayed on Tamoxifen. This was particularly true for post menopausal women, most of whom skip Tamoxifen these days and go directly to an AI after treatment. Anyway to beat the odds of recurrence works for me.

So yesterday I went to pick up my prescription and blinked several times at the price of the co-pay - $120 for a 30 day supply. I said a small 'eek' and bit the bullet and bought it. I then called my insurance company and found I can get it online for $65 for a 3 month supply. I am switching to the online for this. I don't usually like ordering online because of the delay in getting them and basically I just don't really like it. But I will like it in this case because I am cheap.

Then I started thinking about the name. Obviously its something made up. What were they thinking? It doesn't sound like a food product - I'll have the spaghetti alla femara please. It doesn't sound like a plant - I planted some femara in the sun last year and they bloomed all summer. It doesn't sound like a geographical area - I spent several days in the Femara region last summer, it was quite nice and relaxing. It sounds like a feminine hygiene product - the femara is stocked in pink boxes right next to the tampons in aisle 7, halfway down on the left.. Actually its not pink, they are little tan pills that come in a big bottle that is also tan and all color coordinated. How special, and over designed, just like all the thought process that was put into coming up with the name.

Next I was stupid and went online to WebMD and started reading the reviews of it. Never do this. Everyone who has a problem with it posts and tells how miserable they were. If I look up all my medications, everyone hates them all. Just skip this step, you'll be happier.

So I've done my research, thought about it and figured out what I need to know. I took the first pill this morning about an hour ago and I didn't have any initial reactions.

Today is Mother's Day - Happy Mother's Day Mum! We went out to dinner last night. Today I am supposed to get some gardening done as well as fold laundry and clean the kitchen. How exciting.