Shared Medical Decision on Endocrine Drugs in women with breast cancer

Dear Edito

In our routine outpatient clinic for breast cancer endocrine therapy, the majority of patients come with prescription requests of SERMs or AIs for their 5 to10 years of endocrine therapy. Some patients will complain of drug side effects, and the finger joints stiffness in the morning is the most common side effect. There is currently no effective way to handle the finger joint stiffness, which is usually not severe. Hence the time pressured doctor will just prescribe, without conversation with the patients about other medicines and comorbidities in the busy clinical settings. The prescription will be signed without adequate scrutiny.

Some patients will consult on the cessation of endocrine drugs. If the doctors advise the patients to discontinue endocrine drugs, most patients will show worry about breast cancer recurrence and/or metastasis without taking pills. Hence time-consuming shared medical decision (SMD) is warranted, which is not actionable in our busy outpatient clinical for breast cancer endocrine therapy. Without adequate SMD, the patients are inclined to continue taking their endocrine drugs. The problem in breast cancer endocrine therapy needs to be fully considered.