The impact of tamoxifen brand switch on side effects and patient compliance in hormone receptor positive breast cancer patients

- Generic tamoxifen brand switch can cause severe menopausal side effects.
- Supplementation and antidepressants do not improve tamoxifen related side effects.
- Patients with worsening side effects do consider but don't actually stop treatment.
- Evaluating the cause and remedy for variable tamoxifen brand side effects is key.

BackgroundIn 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.MethodsConsecutive 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.Results63 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).ConclusionSevere 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.