***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Therapy-related adverse side effects are a main reason for non-persistence to adjuvant endocrine breast cancer therapy . This study reports frequency of drug-related adverse side effects that were so severe that a modification of the therapy was necessary . We evaluated how many patients discontinued adjuvant endocrine therapy because of these side effects ( non-persistence ) . Last , we analyzed how often a drug switch was undertaken for this reason and how often this measure led to the patient successfully continuing their endocrine therapy . Data concerning all postmenopausal breast cancer patients ( ≤80 years ) , who initiated endocrine adjuvant therapy between 1998 and 2008 in a Swiss breast center ( n = 400 ) , were analyzed . Out of these 400 women , 37 ( 9.3 % ) were defined as being non-persistent to the therapy ; out of these , 24 ( 64.9 % ) because of therapy-related side effects . About 78 patients ( 19.5 % ) suffered from severe therapy-related side effects that made a modification of therapy necessary . Out of these 78 cases , 14 patients ( 17.9 % ) stopped the therapy without attempting a drug switch ( non-persistence ) . In 64 patients ( 82.1 % ; 16 % of all women who started endocrine therapy ) , a drug switch was undertaken . Out of these 64 cases , in 52 cases ( 81.3 % ) endocrine therapy was completed after therapy modification . Patients who reported one major adverse effect were more likely to continue the endocrine therapy after a drug switch ( P = 0.048 ) compared with those who suffered from at least two different side effects . In 10 of the 64 cases ( 15.6 % ) , modification of the therapy was not successful and the patients stopped the treatment prematurely ( non-persistence ) because of ongoing side effects . In cases when therapy-related side effects occur , a drug switch is a promising step to further improve persistence and , by doing so , the outcome of breast cancer patients In a r and omized controlled design , this study tested the efficacy of a theoretically based uncertainty management intervention delivered to older long-term breast cancer survivors . The sample included 509 recurrence-free women ( 360 Caucasian , 149 African-American women ) with a mean age of 64 years ( S.D.=8.9 years ) who were 5 - 9 years post-treated for breast cancer . Women were r and omly assigned to either the intervention or usual care control condition . The intervention was delivered during four weekly telephone sessions , in which study nurses guided cancer survivors in the use of audiotaped cognitive-behavioral strategies to manage uncertainty about recurrence , and a self-help manual design ed to help women underst and and manage long-term treatment side effects and other symptoms . Treatment outcome data on uncertainty management were gathered at pre-intervention and 10-months afterward . Repeated measures MANOVA evaluating treatment group , ethnic group , and treatment by ethnic interaction effects indicated that training in uncertainty management result ed in improvements in cognitive reframing , cancer knowledge , patient-health care provider communication , and a variety of coping skills . Results are discussed in terms of the importance of theory-based interventions for cancer survivors that target triggers of uncertainty about recurrence and in terms of ethnic differences in response to the intervention Purpose Aromatase inhibitors ( AIs ) are increasingly used as adjuvant treatment of postmenopausal women with hormone receptor-positive breast cancer .  AIs are commonly associated with musculoskeletal symptoms . The primary objective of this study was to describe the musculoskeletal symptoms that developed in the first 100 subjects enrolled who had at least 6 months follow-up . Methods Women with early stage hormone receptor-positive breast cancer were recruited into a multicenter r and omized clinical trial to study the pharmacogenomics of two AIs , exemestane , and letrozole . Patients completed the  Health Assessment Question naire ( HAQ ) and Visual Analog Scale ( VAS ) at baseline , 1 , 3 , 6 , and 12 months to assess changes in function and pain , respectively . Patients were referred for evaluation by a rheumatologist if their HAQ and /or VAS scores exceeded a predefined threshold . Results Forty-four of 97 eligible patients ( 45.4 % ) met criteria for rheumatologic referral . Three patients were ineligible because of elevated baseline HAQ ( 2 ) and failure to initiate AI therapy ( 1 ) . No baseline characteristics were significantly associated with referral . Median time to onset of symptoms was 1.6 months ( range 0.4–10 months ) . Clinical and laboratory evaluation of patients evaluated by rheumatology suggested that the majority developed either non-inflammatory musculoskeletal symptoms or inflammation localized to tenosynovial structures . Thirteen patients discontinued AI therapy because of musculoskeletal toxicity after a median 6.1 months ( range 2.2–13 months ) . Conclusions Musculoskeletal side effects were common in AI-treated patients , result ing in therapy discontinuation in more than 10 % of patients . There are no identifiable pre-therapy indicators of risk , and the etiology remains elusive BACKGROUND During the last decade , survival rates for breast cancer have increased as a result of earlier detection and increased use of adjuvant therapy . Limited data exist on the psychosocial aspects of the transitional period between the end of primary treatment and survivorship . We investigated the baseline psychosocial status of women enrolled in a r and omized trial testing two psychosocial interventions for women at the end of primary treatment . METHODS Participants , identified within 1 month after surgery ( registration ) , provided demographic information and limited measures of quality of life . They were followed until they finished primary treatment ( enrollment ) , at which time they completed a mailed baseline survey that included st and ardized measures of quality of life ( including st and ardized scales of physical and emotional functioning ) , mood , symptoms , and sexual functioning .  A total of 558 patients ( mean age = 56.9 years ) were enrolled in the study between July 1 , 1999 , and June 30 , 2002 . Health outcomes were examined according to treatment received : mastectomy with and without chemotherapy , and lumpectomy with and without chemotherapy . All statistical tests were two-sided . RESULTS Among all treatment groups , patients who had a mastectomy had the poorest physical functioning at registration ( P<.001 ) and at enrollment ( P=.05 ) . At enrollment , mood and emotional functioning were similar among all patients , with no differences by type of treatment received . At enrollment , symptoms , including muscle stiffness , breast sensitivity , aches and pains , tendency to take naps , and difficulty concentrating , were common among patients in all groups and were statistically significantly associated with poor physical functioning and emotional well-being . Sexual functioning was worse for women who received chemotherapy than for those who did not , regardless of type of surgery ( P<.001 ) . CONCLUSIONS At the end of primary treatment for breast cancer , women in all treatment groups report good emotional functioning but report decreased physical functioning , particularly among women who have a mastectomy or receive chemotherapy . Clinical interventions to address common symptoms associated with treatment should be considered to improve physical and emotional functioning at the end of primary treatment for breast cancer BACKGROUND Early discontinuation of adjuvant endocrine therapy may affect the outcome of treatment in breast cancer patients . The aim of this study was to assess age-specific persistence and age-specific survival outcome based on persistence status . METHODS Patients enrolled in the Tamoxifen Exemestane Adjuvant Multinational trial were included . Nonpersistence was defined as discontinuing the assigned endocrine treatment within 1 year of follow-up because of adverse events , intercurrent illness , patient refusal , or other reasons . Endpoints were the breast cancer-specific and overall survival times . Analyses were stratified by age at diagnosis ( < 65 years , 65 - 74 years , ≥75 years ) . RESULTS Overall , 3,142 postmenopausal breast cancer patients were included : 1,682 were aged < 65 years , 951 were aged 65 - 74 years , and 509 were aged ≥75 years . Older age was associated with a higher proportion of nonpersistence within 1 year of follow-up . In patients aged < 65 years , nonpersistent patients had lower breast cancer-specific and overall survival probabilities . In patients aged 65 - 74 years and patients aged ≥75 years , the survival times of persistent and nonpersistent patients were similar . CONCLUSION Nonpersistence within 1 year of follow-up was associated with lower breast cancer-specific and overall survival probabilities in patients aged < 65 years , but it was not associated with survival outcomes in patients aged 65 - 74 years or in patients aged ≥75 years . These results suggest that extrapolation of outcomes from a young to an elderly breast cancer population may be insufficient and urge age-specific breast cancer studies Summary Background Hot flushes and night sweats ( HFNS ) affect 65–85 % of women after breast cancer treatment ; they are distressing , causing sleep problems and decreased quality of life . Hormone replacement therapy is often either undesirable or contraindicated . Safe , effective non-hormonal treatments are needed . We investigated whether cognitive behavioural therapy ( CBT ) can help breast cancer survivors to effectively manage HFNS . Methods In this r and omised controlled trial , we recruited women from breast clinics in London , UK , who had problematic HFNS ( minimum ten problematic episodes a week ) after breast-cancer treatment . Participants were r and omly allocated to receive either usual care or usual care plus group CBT ( 1:1 ) . R and omisation was done in blocks of 12–20 participants , stratifying by age ( younger than 50 years , 50 years or older ) , and was done with a computer-generated sequence . The trial statistician and research ers collecting outcome measures were masked to group allocation . Group CBT comprised one 90 min session a week for 6 weeks , and included psycho-education , paced breathing , and cognitive and behavioural strategies to manage HFNS . Assessment s were done at baseline , 9 weeks , and 26 weeks after r and omisation . The primary outcome was the adjusted mean difference in HFNS problem rating ( 1–10 ) between CBT and usual care groups at 9 weeks after r and omisation . Analysis of the primary endpoint was done by modified intention to treat . The trial is registered , IS RCT N13771934 , and was closed March 15 , 2011 . Findings Between May 5 , 2009 , and Aug 27 , 2010 , 96 women were r and omly allocated to group CBT ( n=47 ) or usual care ( n=49 ) . Group CBT  significantly reduced HFNS problem rating at 9 weeks after r and omisation compared with usual care ( mean difference −1·67 , 95 % CI −2·43 to −0·91 ; p<0·0001 ) and improvements were maintained at 26 weeks ( mean difference −1·76 , −2·54 to −0·99 ; p<0·0001 ) . We recorded no CBT-related adverse events . Interpretation Group CBT seems to be a safe and effective treatment for women who have problematic HFNS after breast cancer treatment with additional benefits to mood , sleep , and quality of life . The treatment could be incorporated into breast cancer survivorship programmes and delivered by trained breast cancer nurses . Funding Cancer Research UK Treatment with the selective estrogen receptor modulator ( SERM ) tamoxifen for 5 years has produced dramatic breast cancer – related benefits in ( a ) the adjuvant setting , with 30 % to 50 % reductions in recurrence , contralateral disease , and mortality and ( b ) the prevention setting of healthy high-risk women , where tamoxifen reduces the risk of invasive and noninvasive breast cancer by 50 % . Despite these striking data , adherence to tamoxifen is low , and low adherence is associated with poor survival . Although toxicity is a major predictor of poor adherence after starting therapy , pretreatment ( baseline ) predictors of poor tamoxifen adherence have been minimally studied . The adherence – survival link underscores the critical need to identify early predictors of poor adherence , and recent work is beginning to address this need . A major baseline predictor of poor adherence to prevention is current smoking , which is interestingly absent from studies of adherence to adjuvant therapy . Other important prevention adherence factors include breast cancer risk , extremes of age , non-white ethnicity , low socioeconomic status , and alcohol use . The strongest adjuvant therapy predictors are age ( especially very young ) , ethnicity , and socioeconomic status . Future studies involving prospect i ve systematic evaluation of these and other potential predictors in endocrine chemoprevention ( e.g. , other SERMs and aromatase inhibitors ) are critical , as is the development of effective/targeted interventions to improve adherence and thus treatment outcomes in at-risk women . Cancer Prev Res ; 4(9 ) ; 1360–5 . © 2011 AACR Adjuvant hormonal therapy for non-metastatic hormone receptor (HR)-positive breast cancer decreases risk of breast cancer recurrence and increases survival . However , some women do not initiate this life-saving treatment . We used a prospect i ve cohort design to investigate factors related to non-initiation of hormonal therapy among women with newly diagnosed , non-metastatic HR-positive breast cancer recruited from three U.S. sites .  Serial interviews were conducted at baseline and during treatment to examine sociodemographic factors , tumor characteristics , and treatment decision-making factors . Multivariate modeling 
    Output:
    
Extremes of age ( older or younger ) , increasing out-of-pocket costs , follow-up care with a general practitioner ( vs. oncologist ) , higher CYP2D6 activity , switching from one form of therapy to another , and treatment side effects were negatively associated with adherence and /or persistence .
Taking more medications at baseline , referral to an oncologist , and earlier year at diagnosis were positively associated with adherence and /or persistence .
Adherence and persistence to adjuvant hormonal therapy among breast cancer survivors is suboptimal .