Cognitive function among women with breast cancer receiving endocrine therapy: what are the impacts?

Endocrine therapy (ET) is well established as a treatment in hormone-sensitive breast cancers, which account for approximately 75% of breast cancers. Commonly used endocrine treatments include selective estrogen receptor (ER) modulators (eg, tamoxifen), selective ER degraders (eg, fulvestrant), aromatase inhibitors (AIs; eg, letrozole, anastrozole, exemestane), and ovarian function suppression (eg, goserelin). There is strong evidence to support AIs as the preferred adjuvant treatment for postmenopausal women with ER–positive (ER+) breast cancer, with reductions in breast cancer recurrence and mortality compared with women receiving tamoxifen. Options for premenopausal women are tamoxifen or an AI with ovarian suppression.

Despite the benefits of ET on disease recurrence and mortality, many women discontinue treatment early. Reasons for nonadherence are complex, but side effects, particularly arthralgias with AIs and hot flushes with tamoxifen, are common reasons given for discontinuation...