tamoxifen and anger

[AliciaB]

I have been on tamoxifen now for almost three weeks. Changes I have noticed

anger
pimples
no interest in sex
lack of patience
Extra facial hair like a beard

Can anyone tell me if this is “normal"?

[lasarles]

I started tamoxifen on 9/24. I have also noticed more facial hair. Also, hot flashes and night sweats. Yipee, 1 month down, 59 to go.

[Jackie07]

Ann Oncol. (http://www.ncbi.nlm.nih.gov/pubmed/22467902) 2012 Oct;23(10):2566-72. Epub 2012 Mar 30.
Correlation of treatment-emergent adverse events and clinical response to endocrine therapy in early breast cancer: a retrospective analysis of the German cohort of TEAM.
Hadji P (http://www.ncbi.nlm.nih.gov/pubmed?term=Hadji%20P%5BAuthor%5D&cauthor=true&cauthor_uid=22467902), Kieback DG (http://www.ncbi.nlm.nih.gov/pubmed?term=Kieback%20DG%5BAuthor%5D&cauthor=true&cauthor_uid=22467902), Tams J (http://www.ncbi.nlm.nih.gov/pubmed?term=Tams%20J%5BAuthor%5D&cauthor=true&cauthor_uid=22467902), Hasenburg A (http://www.ncbi.nlm.nih.gov/pubmed?term=Hasenburg%20A%5BAuthor%5D&cauthor=true&cauthor_uid=22467902), Ziller M (http://www.ncbi.nlm.nih.gov/pubmed?term=Ziller%20M%5BAuthor%5D&cauthor=true&cauthor_uid=22467902).
Source
Departments of Gynaecological Endocrinology, Reproductive Medicine and Osteoporosis, University Hospital of Giessen and Marburg, Marburg.
Abstract
Background Previous studies have suggested a correlation between the occurrence of vasomotor or joint symptoms during tamoxifen or aromatase inhibitor treatment and improved clinical response. Patients and methods A retrospective analysis of the German cohort of the Tamoxifen Exemestane Adjuvant Multinational (TEAM) trial was carried out to assess disease-free survival (DFS) and overall survival (OS) in patients with and without arthralgia/myalgia and/or menopausal symptoms during adjuvant endocrine treatment. Results A total of 1502 patients were included; 739 patients received tamoxifen followed by exemestane and 763 received exemestane. Patients reporting arthralgia/myalgia and patients reporting menopausal symptoms during endocrine treatment had significantly longer OS and DFS than those not reporting these events. The effect on OS was irrespective of treatment. DFS was significantly improved in exemestane-treated patients reporting arthralgia/myalgia or those reporting menopausal symptoms versus those not reporting these events. This effect on DFS was not observed in patients receiving sequential treatment. A combined analysis of patients reporting either menopausal symptoms or arthralgia/myalgia showed that OS and DFS were significantly improved in patients reporting one of these symptoms versus those not reporting either symptom. Conclusion The occurrence of arthralgia/myalgia or menopausal symptoms during endocrine treatment is associated with significantly improved OS.


Anticancer Res. (http://www.ncbi.nlm.nih.gov/pubmed/22993340) 2012 Sep;32(9):3933-8.
Compliance, Analgesic Use and Side-effect Protection within a German Cohort of the TEAM Trial.
Bossart M (http://www.ncbi.nlm.nih.gov/pubmed?term=Bossart%20M%5BAuthor%5D&cauthor=true&cauthor_uid=22993340), Becker M (http://www.ncbi.nlm.nih.gov/pubmed?term=Becker%20M%5BAuthor%5D&cauthor=true&cauthor_uid=22993340), Hadji P (http://www.ncbi.nlm.nih.gov/pubmed?term=Hadji%20P%5BAuthor%5D&cauthor=true&cauthor_uid=22993340), Kieback DG (http://www.ncbi.nlm.nih.gov/pubmed?term=Kieback%20DG%5BAuthor%5D&cauthor=true&cauthor_uid=22993340), Hasenburg A (http://www.ncbi.nlm.nih.gov/pubmed?term=Hasenburg%20A%5BAuthor%5D&cauthor=true&cauthor_uid=22993340).
Source
University Hospital Freiburg, 79106 Freiburg, Germany. annette.hasenburg@uniklinik-freiburg.de.
Abstract
BACKGROUND:
Compliance is an essential aspect for the success of any medical intervention. Adverse events (AEs) contribute significantly to non-compliance with endocrine treatment. The Tamoxifen Exemestane Adjuvant Multinational (TEAM) trial compared five years of adjuvant exemestane therapy with the sequence of tamoxifen followed by exemestane.
PATIENTS AND METHODS:
A retrospective analysis of the German cohort of TEAM was conducted to determine the effects of prior tamoxifen on the tolerability profile of exemestane in both treatment arms.
RESULTS:
Fracture incidence was significantly higher during the first 30 months of exemestane versus the 30 months of exemestane following tamoxifen for 2-3 years; however, the incidence of AEs was not significantly different. With regard to compliance, the use of analgesics did not influence overall or disease-free survival (DFS) nor the incidence of distant recurrence in both treatment groups.
CONCLUSION:
Tamoxifen has a boneprotective effect when applied before exemestane treatment. Intake of analgesics (or pain medication) does not influence compliance or treatment outcome.

[snolan]

I have gotten more facial hair on chin, decreased sexual drive started during chemo and hasn't ended, but none of the others.

[Kellennea]

Decreased sexual drive which started during chemo, Oily skin (facial), weight gain, slight mood swings (I say slight, my Husband probably would say major), leg cramping at night, thick uterus lining - which ended in a complete hysterectmy.

[Jackie07]

Well, I did not show the abstracts to my new oncologist - a tall, hansome young doctor with a hard-to-pronounce Indian name. (The oncologist I'd had for 9 years had moved back to his hometown to practice in July.) But he prescribed me Exemestane anyway! My blood work looked fine. He will schedule a bone density scan in 2-4 weeks and I'm going to make sure taking a Centrum Silver for Women that has high amount of Vitamin D... I'm also going to take my 30-minute daily walk more seriously...

Let's form an Exmestane club and exchange our experience...

ps. One thing Dr. Surapaneni had mentioned was that Tamoxifen carries a higher risk of mini strokes. Because of my brain tumor history and cognitive problems, he felt Exemestane will be a better choice for me. He will monitor my bones more closely as osteoporosis is a known side effect of AIs.

[Pray]

Hi Jackie,

Do you know if all the AI's carry the risk of osteo. for just the first two years. Or are they all different. I just switched to Aromasin. (Tamox. 6mon. arimedex 1 yr. previous). Does it start over every time you start a new one? I don't see my onc. for 3 or 4 weeks. Thanks for any advice you have.

Your friend,

Nancy

[Jackie07]

Here's what's listed in the Aromasin (Exemestane)website:

http://www.aromasin.com/content/index.aspx

[Jackie07]

Climacteric. (http://www.ncbi.nlm.nih.gov/pubmed/22612608#) 2012 Jun;15(3):229-34.
Hormone therapy and the risk of stroke: perspectives 10 years after the Women's Health Initiative trials.

Henderson VW (http://www.ncbi.nlm.nih.gov/pubmed?term=Henderson%20VW%5BAuthor%5D&cauthor=true&cauthor_uid=22612608), Lobo RA (http://www.ncbi.nlm.nih.gov/pubmed?term=Lobo%20RA%5BAuthor%5D&cauthor=true&cauthor_uid=22612608).
Source

Department of Health Research & Policy (Epidemiology), Stanford University, Stanford, California 94305-5405, USA.

Abstract

Principal findings on stroke from the Women's Health Initiative (WHI) clinical trials of hormone therapy indicate that estrogen, alone or with a progestogen, increases a woman's risk of stroke. These results were not unexpected, and research during the past decade has tended to support these findings. Consistent evidence from clinical trials and observational research indicates that standard-dose hormone therapy increases stroke risk for postmenopausal women by about one-third; increased risk may be limited to ischemic stroke. Risk is not modified by age of hormone initiation or use, or by temporal proximity to menopause, and risk is similar for estrogen plus progestogen and for unopposed estrogen. Limited evidence implies that lower doses of transdermal estradiol (≤50 μg/day) may not alter stroke risk. For women less than 60 years of age, the absolute risk of stroke from standard-dose hormone therapy is rare, about two additional strokes per 10 000 person-years of use; the absolute risk is considerably greater for older women. Other hormonally active compounds - including raloxifene, tamoxifen, and tibolone - can also affect stroke risk.

[Pray]

Thank you so much Jackie! I do appreciate your time and effort.

[Jackie07]

Here's the 'requested' abstract (I'm very scatter-brained and easily side-tracted...):

Clin Cases Miner Bone Metab. (http://www.ncbi.nlm.nih.gov/pubmed/23087717#) 2012 May;9(2):89-91. Epub 2012 Sep 30.
Osteoporosis and aromatase inhibitors: experience and future prospects.

Bosco D (http://www.ncbi.nlm.nih.gov/pubmed?term=Bosco%20D%5BAuthor%5D&cauthor=true&cauthor_uid=23087717).
Source

UOSD of Endocrinology, AO San Giovanni Addolorata, Rome, Italy.

Abstract

INTRODUCTION:

The aim of this study is to improve the assistance given to patients under treatment with aromatase inhibitors in order to prevent secondary osteoporosis through the planning of an awareness programme for the oncologist and offering a facilitated treatment path.
MATERIALS AND METHODS:

Thirty-nine postmenopausal women treated with aromatase inhibitors for breast cancer were selected. For each subject, the age at the beginning of the therapy, the type of aromatase inhibitors and the age at the performance of the bone densitometry was registered. In addition, the use of osteoporosis medication and supplementation of calcium and vitamin D were evaluated. Participants were required to answer a questionnaire consisting of closed questions relating to booking procedures of the bone densitometry and about their own knowledge of osteoporosis related to the use of aromatase inhibitors.
CONCLUSIONS:

Although there is evidence of negative impact of the aromatase inhibitors on bone, our data still show a poor application of the recommendations in order to prevent osteoporosis related to the administration of these drugs. Our suggestion is a more active implementation of the guidelines, also by means of a greater collaboration between the oncologist and the specialist in osteoporosis, and the offer of a diagnostic and therapeutic pathway.

PMID:23087717[PubMed] PMCID:PMC3476523Free PMC Article (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3476523/)


Images from this publication.See all images (5) (http://www.ncbi.nlm.nih.gov/pmc?term=23087717[PMID]&report=imagesdocsum) Free text (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3476523/)
http://www.ncbi.nlm.nih.gov/pmc/articles/instance/3476523/bin/ccmbm-89-91f1.gif (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3476523/figure/f1-ccmbm-89-91/)Figure 1
Questionnaire relating to booking procedures of the bone mineral densitometry and about the women’s knowledge of osteoporosis related to the use of aromatase inhibitors.

Osteoporosis and aromatase inhibitors: experience and future prospects (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3476523/)
Clin Cases Miner Bone Metab. 2012 May-Aug;9(2):89-91.



http://www.ncbi.nlm.nih.gov/pmc/articles/instance/3476523/bin/ccmbm-89-91f2.gif (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3476523/figure/f2-ccmbm-89-91/)Figure 2
Numbers of subjects who performed the bone mineral densitometry depending on when aromatase inhibitors were initiated.

Osteoporosis and aromatase inhibitors: experience and future prospects (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3476523/)
Clin Cases Miner Bone Metab. 2012 May-Aug;9(2):89-91.



http://www.ncbi.nlm.nih.gov/pmc/articles/instance/3476523/bin/ccmbm-89-91f3.gif (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3476523/figure/f3-ccmbm-89-91/)Figure 3
Results of bone mineral densitometry in the subgroups of patients divided by the timing of the performance of the radiological exam.

Osteoporosis and aromatase inhibitors: experience and future prospects (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3476523/)
Clin Cases Miner Bone Metab. 2012 May-Aug;9(2):89-91.



http://www.ncbi.nlm.nih.gov/pmc/articles/instance/3476523/bin/ccmbm-89-91f4.gif (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3476523/figure/f4-ccmbm-89-91/)Figure 4
Subjects who recommended the bone mineral densitometry.

Osteoporosis and aromatase inhibitors: experience and future prospects (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3476523/)
Clin Cases Miner Bone Metab. 2012 May-Aug;9(2):89-91.



http://www.ncbi.nlm.nih.gov/pmc/articles/instance/3476523/bin/ccmbm-89-91f5.gif (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3476523/figure/f5-ccmbm-89-91/)

[Jackie07]

You might want to ask your oncologist for a full-text copy of the following article:


J Clin Oncol. (http://www.ncbi.nlm.nih.gov/pubmed/23008309#) 2012 Oct 20;30(30):3665-74. doi: 10.1200/JCO.2012.42.2097. Epub 2012 Sep 24.
Bone health in adult cancer survivorship.

Lustberg MB (http://www.ncbi.nlm.nih.gov/pubmed?term=Lustberg%20MB%5BAuthor%5D&cauthor=true&cauthor_uid=23008309), Reinbolt RE (http://www.ncbi.nlm.nih.gov/pubmed?term=Reinbolt%20RE%5BAuthor%5D&cauthor=true&cauthor_uid=23008309), Shapiro CL (http://www.ncbi.nlm.nih.gov/pubmed?term=Shapiro%20CL%5BAuthor%5D&cauthor=true&cauthor_uid=23008309).
Source

Starling-Loving Hall, Rm B405, 320 West 10th Ave, Columbus, OH 43210-1240; charles.shapiro@osumc.edu.

Abstract

Optimizing health outcomes, including prevention of osteoporotic fractures, is essential for promoting the well-being of the growing number of cancer survivors. Medical providers who participate in the care of cancer survivors should be aware that various cancer treatments may cause bone loss, which can increase the risk of subsequent of osteoporosis. Healthy bone remodeling is a balanced and dynamic equation between new bone formation and bone resorption. Aging, natural menopause, and cancer treatments such as surgical oophorectomy, gonadotropin-releasing hormone agonists, chemotherapy-induced ovarian failure, androgen deprivation therapy, and aromatase inhibitors can all promote bone loss. The WHO Fracture Assessment Tool can be used as a clinical aid to assess an individual's osteoporotic fracture risk, with or without bone mineral density measurements obtained from dual-energy x-ray absorptiometry. Preventative strategies include adequate calcium and vitamin D supplementation and modifying risk factors such as alcohol intake, tobacco use, and lack of exercise. Bisphosphonate therapy and rank-ligand monoclonal antibody therapy are the most commonly used agents for management of bone loss resulting from cancer treatment. This review will summarize the mechanisms by which cancer treatments cause bone loss as well provide screening and treatment recommendations for the management of bone loss.

[MJo]

Are you getting steroids with the tamixifen. Roid Rage is real!

[Jen]

I have all these symptoms you have mentioned and I'm not even on Tamoxifen. Sounds like menopause. When I get Jazzy str8tened out I am going to go to dr and get some estrogen supplements. I know my family Hx with breast cancer but I am gonna go estrogen anyway. I'll roll the dice and accept the consequences.