Breast Cancer Treatment: Tamoxifen And Recurrence Essay.

Pico-Analysis

Write about the Breast Cancer Treatment.

Tamoxifen is a medication that is provided orally to the patients who are suffering from breast cancer. Previous guidelines have instructed physicians to prescribe the medicines for only two to five years as various complaints of side effects were associated with the medication (Ganz et al. 2014). However, the medicine is an excellent inhibitors of the cell cycling systems that prevents apoptosis if the cancerous cells. In turn they promote various factors that increase the rate of apoptosis of the cancer cells and are therefore more effective in treatment of patients (Leyland-Jones et al. 2015).

A case study was provided where a patient is seen to recur the symptoms of breast cancer after her stoppage of the taking of the medication after five years. Therefore the report will mainly contain literature reviews that will shed light in the reason about the recurrence of the breast cancer symptoms and what should be done so that similar patients do not get recur their breast cancer after recovery from it.

In order to find the correct articles that will help us to know the main reason for the recurrence of breast cancer in the patient after 5 years. In order to find correct articles, a proper Pico question is to be prepared which would help in answering the research topic properly.

The Pico question which is to be formed is that “whether early stoppage of taking tamofexin for women suffering from breast cancer causes recurrence of the disorder in comparison to those who have continued the medication for about five to ten years”

Different databases have been searched in order to get the correct articles. This usually involves the Google scholars, Cinhal, Cochrane library, Wiley online library, Elsevier, Science direct and others. The main key words which were used are ‘effect of stoppage of tamoxifen’, ‘tamoxifen for breast cancer patient, ‘Cancer recurrence for tamoxifen stoppage’, ‘side effects of tamoxifen’ and others.

In the works of Rajput et al., one can clearly understand the working mechanism of tamoxifen in the treatment of breast cancer. XIAP protein called the X-linked inhibitor of apoptotic protein which mainly functions in the inhibition of apoptosis. They mainly inactivate caspase 3, caspase 7 as well as caspase 9 which are responsible for carrying out successful apoptosis. In this case, the researchers have proved that with the help of another medicine called thymoquinone, tamoxifen take an active part in the cell apoptosis system of breast cancer. They have mainly reached the conclusion after they had conducted experiments to confirm the anti-angiogenic as well as the anti-invasive potential of the TQ as well as the TAM mainly through a large number of in vitro studies. They have suggested that the medication mainly works by lowering the expression of XIAP expression at a molecular level. This helps in the binding followed the activation of the caspase 9 in the cascade of apoptosis. They further interfere with the survival of the cells through the PI-K/Akt pathway (Jordan 2014). They mainly inhibit the Akt phosphorylation. Thereby in course of time, caspase 9 gets cleaved which then processes a list of other cellular death substrates. This includes the PARP. This makes the entire mechanism shift from the phosphorylation mechanism to apoptosis. Not only are this they are also found to effect the Akt Phosphorylation pathway. They down regulate the pathway by acting on the downstream effectors like the Bcl-xL, Bcl-2. They in turn increase the expression of other factors like Bax, AIF, cytochrome C and p-27. This mainly leads to regulation of a large number of cell signaling mechanism that in turn results in the activation of the AKT as well as XIAP degradation (Feng et al., 2014). Therefore, this made the author to come to a conclusion where the both the medicines play an important role by inhibiting XIAP and this was confirmed through the siRNA-XIAP cotransfection studies. Herein one can easily understand that indeed tamoxifen plays a very crucial part in treating of breast cancer in patients.

Databases and Keywords

Another important experiments was carried out by a large number of scientists is the year 2013 as a large randomized trail recruiting more than 12000 participants were included suffering from breast cancer. Davies eta l. in the year 2013 had laid down many important facts that might be helpful for the providing more light to the case. The researcher has stated that previously tamoxifen was prescribed to the patient for only two years which showed recurrence of the cancer disorder. Therefore the period of the administration of tamoxifen was increased to four years and then it was increased to five years . While this experiment was conducted I had shown that effects of the tamoxifen can contribute for up to 15 years showing great amount of reduction in not only recurrence rate but also in mortality rates. However they have clearly mentioned that there was reduction in recurrence rate in comparison to control but they have never mentioned that it had completely stopped recurrence of the disease. Further they have also stated that they had also conducted experiment where they had made the participants to continue the medication up to 10 to 15 years and they have clearly stated astonishing results. They have stated that continuing it for longer number of times had resulted in further decrease in the rate of recurrence and mortality than using it for 5 years. Therefore in the case of the patient of the case study, she has recurred breast cancer may be due to the hereditary instances as the literature of the article shows that the people who have used tamoxifen have very few evidences of recurrence. Therefore it cannot be exactly said that whether the occurrence of the disorder has been mainly due to withdrawal of the tamoxifen or due to heredity factors. However this literature review have suggested that the side effects are indeed visible after five years and therefore if the medication is continued for ten years the side effects may also increase but it will however reduce the recurrence rate and recurrence chances further by a large number. Therefore if the patient had continued it for large number of year’s her chance of recurrence would have been decreased. Therefore it can be concluded from the paper that she should have continued the medication for 10 years to completely eradicate the chance of recurrence of the cancer (Li et al. 2013) .

Literature Review

A study conducted by the Early Breast Cancer Trialists' Collaborative Group (EBCTCG) in the year 2015 had also provided extensive information about the affectivity of the use of tamoxifen in breast cancer. They have clearly stated that if treatment is conducted by the use of tamoxifen in breast cancer patients, the medication is found to reduce the rate of recurrence by about half especially during the time of treatment. Not only is that it also believed that they can reduce the chance of occurrence by one third in the subsequent five years (Sandell et al. 2017). They have also supported the view that if the treatment is conducted properly they can further reduce the rate of mortality by almost one third throughout the first fifteen years. It has been also found that the authors have stated that if the treatment is conducted for about 10 to 14 years, there will be further reduction in mortality rate. Although the present concern in the case study is not considering the menopausal women but in order to mention the researchers view it can be said that they had stated that if tamoxifen is followed by aromatase inhibitor after 2 to 3 days of follow up by tamoxifen, it would provide better results.

Another very good article has been found that had been provided by Flanagan et al. in the year 2012 who has provided a large number of important facts that had been extremely helpful in reaching the conclusion of the case. The researchers have stated that anti estrogen therapy had been found to be extremely helpful and tamoxifen and aromatase inhibitors have been extremely helpful. Tamoxifen as said by them is extremely helpful as it can work irrespective of the age and the menopausal status of the woman. They are not only helpful is treating estrogen positive cases of breast cancer and node positive breast cancer, they are also helpful for reducing the risk for contra lateral breast cancers. Just like the previous authors, those have also stated that Aromatase inhibitors are extremely helpful for treating menopausal women with breast cancer especially by following the treatment of tamoxifen and then starting it after two to five years. Herein the authors had exactly discussed the main query of the case study that one needs to solve. The author had stated that a large number of side effects have been found to be associated with the treatment of tamoxifen like arthralgias, weight gain and fatigue. The patients have also complained of changes in mood, hot flashes, decreased libido as well as changes in memory. The researchers have stated that it had greatly affected the capability of the woman to adhere to the treatment and therefore they are often seen to coax their guides to withdraw the medication after prescribed years. Non adherence rates had been noted to be about 25% in the first year and to about 50% after fourth year. Many women who have stopped the use of the medication due to the side effects have resulted in the increase of the mortality rates. On the other hand it was found that women who experienced higher side effects had better chanced of survivability rate. Stopping treatment earlier die to side effects had the potential to decrease the rate of the patient’s survival from breast cancer. They gad got evidences which suggest that the patients suffering from greater side effects are actually gaining better treatment effect. Therefore the author had advised the nurses to understand the physiological and psychosocial necessities of the women so that they can assess the patients’ response in ongoing treatments, improve their surveillance care and overall provide quality care to develop the quality of their lives.

Another important article was found which was provided by Burstein et al., in the year 2014. Here the researchers have conducted a systematic review of different trials including the biggest three historic trials in order to develop the clinical practice guidelines that are present on the adjuvant endocrine therapy utilized in breast cancer in patients. They have provided a number of recommendations that are indeed necessary to be followed by the nurses. The nurses should then guide the patients accordingly. The patients who are suffering from the disease are in need of conducting the medication regime up to ten years of in the premenopausal stage which is unlike the previous guidelines which stated that the menopause should be conducted for only 5 years. Moreover they have also recommended that for post menopausal women, the treatment should contain 5 years of tamoxifen followed by switching to aromatase inhibitor which would lead to a total of 10 years of treatment.

Discussions and Conclusion:

From the above reviews provided from different important articles it was found that most for the researchers are of the opinion that although the trials have shown that a 5 year tamoxifen treatment to be effective but no one has confirmed that it would never result in the recurrence of the breast cancer, however it had been mostly seen that most of the researchers have stated that it would be right to continue the treatment for about up to ten years to reduce the risk of recurrence and also the mortality rate of the patients. Therefore the patient of the case study should not have stopped her medication after the side effects became intense. Breast cancer is hereditary and there remains a high chance of the occurrence of the disorder but none of the authors have pointed this fact to be the reason of the recurrence. They have mainly stated that in order to reduce the risk of the breast cancer, the nurses should educate the patients to manage their side effects and continue the important medication of tamoxifen.

References:

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