Older Women and Hormone Treatment: More Pain Than Gain?

Reviewed by
iStock

Question:

Carl from Lilliwaup

My wife, age 78, has had a double mastectomy. The cancer hadn’t spread to her lymph nodes. Her doctor is recommending hormone therapy, namely letrozole (Femara), which has many side effects — including bone loss. We feel this could really interfere with her quality of life; she already has osteoarthritis, and a broken arm from a fall. Our children feel differently, but we have a difficult relationship with them, and they won’t be involved with her care. I’m 83 years old, and we both feel that quality of life is more important than dealing with these side effects. Is letrozole worth it medically?

Answer:

Letrozole, one of the class of drugs called aromatase inhibitors (AIs), definitely has a medical benefit for selected breast cancer survivors. If a woman’s cancer is hormone dependent, then taking a five-year (or up to 10-year) course of letrozole will increase her survival rate.

The downside? Side effects, chiefly bone loss and joint and muscle pain. Other potential side effects include hot flashes, insomnia, vaginal dryness, and weight gain. Some women (an estimated 20 percent) find these side effects so bothersome that they quit taking the drugs.

The “good” news is, only about a third of women taking an AI experience frequent or severe pain. Another third experience mild off-and-on pain, usually when getting up in the morning. And the remainder are mainly pain-free. The question is, which group would your wife fall into?

I understand embracing the very best quality of life as you grow older. Your future is shrinking; you want to enjoy every moment. And your children, whether or not they’ll be involved with you and your care, aren’t the ones who should decide whether or not your wife takes letrozole. So how do you make this difficult decision?

Here’s my advice: Ask your wife’s doctor what the absolute benefit of taking letrozole is. (Be sure to specify the absolute benefit, not relative benefit; absolute benefit is more specific.) Will your wife’s five-year survival rate go from 75 percent without letrozole, to 97 percent with it? Then it’s probably worth considering.

However, since she’s had a double mastectomy and the cancer hadn’t spread outside her breast, her projected survival rate is probably already quite high. Would taking her survival rate from, say, 92 percent to 97 percent be worth the possibility of side effects?

Once you understand the degree of benefit your wife would probably get from letrozole, it’s easier to decide whether she might risk taking the drug. If you’re both on the fence about it, why not give letrozole a try? She can always simply stop taking it if the side effects are too bothersome. And if she remains free of side effects, then she’s gained letrozole’s medical benefit: an increased chance of survival.

You should know: The answer above provides general health information that is not intended to replace medical advice or treatment recommendations from a qualified healthcare professional.

See more helpful articles:

Aromatase Inhibitor FAQS

Breast Cancer In Women Over 70: Strategies For Deciding On Treatment

Skip Your Annual Mammogram? For Older Women, It’s an Option

Understanding Hormone Therapy Drugs

Hormone Drugs and Bone Loss: Beware Hidden Damage