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Why breast cancer survivors don’t take their medication, and what can be done

For roughly 80% of breast cancer survivors, treatment doesn’t end with surgery, radiation and chemotherapy. Instead, for the next five to 10 years, doctors recommend that they take medication to block sex hormones, which can fuel tumor growth and spark recurrence.

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For roughly 80% of breast cancer survivors, treatment doesn’t end with surgery, radiation and chemotherapy. Instead, for the next five to 10 years, doctors recommend that they take medication to block sex hormones, which can fuel tumor growth and spark recurrence.

The drugs are life-saving: They’ve been shown to cut risk of cancer recurrence by as much as half in patients with hormone receptor-positive tumors (HR+)—the most common form of breast cancer. Yet despite their promised benefits, 40% of patients stop taking them early and a third take them less frequently than directed.

New CU Boulder research, published this month in the Journal of Clinical Oncology, sheds light on why that is and what doctors and the health care system can do about it.

It found that, overall, interventions can increase medication adherence by nearly 1.5 times. But some strategies work better than others.

“Our bottom-line finding is that there are strategies that do work in supporting women to take these life-extending medications, and that we as a cancer care community need to do better,” said senior author Joanna Arch, a professor in the Department of Psychology and Neuroscience and member of the CU Cancer Center on the Anschutz Medical Campus.

Arch noted these so-called “adjuvant endocrine therapies,” like the estrogen-blockers Tamoxifen and aromatase inhibitors, can be costly and come with a host of side effects, including weight gain, sexual side effects, joint pain, depression and sleeplessness.

“Imagine going from your normal estrogen activity to little or no estrogen within days. That’s what these medications do,” she said. “But the women who take them as prescribed also have lower recurrence rates and live longer. It’s a dilemma.”

As more next-generation cancer drugs, including chemotherapy agents, shift from infusions provided in a clinic to oral therapies taken at home, the medical community has grown increasingly interested in developing ways to make sure patients take their pills.

In a sweeping meta-analysis, Arch and her colleagues analyzed 25 studies representing about 368,000 women to gain insight into what works and what doesn’t. 

Educational pamphlets are not enough 

The study found that cost-cutting policy changes, such as providing generic alternatives or requiring insurance companies to cover pills at the same level as infusions, consistently worked. Such “oral parity laws” have been passed in 43 states in recent years.

In one study, participants were asked to create stickers to put on their pill boxes.

Mobile apps and texts to remind patients to take their medication and psychological/coping strategies also yielded modest improvements.

The study’s findings around managing side effects were complicated: Simply educating women on side effects, via pamphlets or verbal explanations, generally failed to increase the likelihood that women took their medication as directed.

But things such as physical therapy, exercise and behavioral counseling aimed at alleviating or managing side effects often worked.

“Education in and of itself is not enough. That is a clear finding,” said Arch, suggesting that doctors write referrals to practitioners who specialize in side effects and follow up with appointment reminders. “Most oncologists, I believe, don’t realize how low adherence is for these women. They assume that if they write the prescription, it’s being taken.”

Addressing mental health is key

One study included in the meta-analysis was Arch’s own.

In it, women were asked to identify their primary motivation for taking their medication—whether it was living to see their child or grandchild grow up, pursuing their art or running a marathon someday. Via an online program, they created a sticker with a photo representing that goal, and the words “I take this for…” below it. Then, they stuck it on their pill box.

Participants were more likely to take their pills, at least for the first month, than those who didn’t.

“Even just a tiny thing like this can help,” said Arch.

Notably, very few studies looked at whether treating depression can help. Arch, aiming to fill this gap, recently launched her own pilot trial.

“One of the most consistent predictors of not adhering to any medication is depression,” she said. “Depression taps motivation.”

The new Journal of Clinical Oncology study is the first meta-analysis to show that interventions can be helpful, and that’s important, said Arch, because insurance companies need data to make decisions about what to cover.

But the study also showed that the effects are relatively modest and that there is room for improvement.

Arch said she hopes the study will spark more research into novel ways to support survivors:

“We have a lot of work to do.”

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Alsons Dev welcomes The Abba’s Orchard to Avia Estate

The country’s largest and most esteemed network of authentic Montessori schools, The Abba’s Orchard, breaks ground on June 14 for its 15th campus located in Avia Estate, a township project in Alabel, Sarangani by Alsons Development and Investment Corporation (Alsons Dev).

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The country’s largest and most esteemed network of authentic Montessori schools, The Abba’s Orchard, breaks ground on June 14 for its 15th campus located in Avia Estate, a township project in Alabel, Sarangani by Alsons Development and Investment Corporation (Alsons Dev).

The expansion reflects the school’s mission of “Discover True Montessori Philippines,” offering high-quality education in the SOCCSKSARGEN Region—a mission that aligns with Alsons Dev’s vision to offer vibrant live-work-play-learn communities where families and businesses can thrive. Recognizing this shared purpose, Alsons Dev partnered with The Abba’s Orchard, contributing a substantial two hectares of land within Avia Estate to make the school a reality.

“We at Alsons Dev are thrilled to partner with The Abba’s Orchard in bringing this exceptional learning environment to Alabel,” said Miguel Dominguez, Alsons Dev Director. “This collaboration aligns with our commitment to fostering growth and development within SOCCSKSARGEN.”

Discover how Avia Estate can let you live your best life. For more information about Avia Estate, visit facebook.com/AviaEstate.

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Optimism wards off procrastination

While procrastinators often admonish themselves for their “bad habit,” it turns out that their worries for the future are more to blame.

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People with an optimistic outlook on the future are less likely to be severe procrastinators, according to new research at the University of Tokyo. While procrastinators often admonish themselves for their “bad habit,” it turns out that their worries for the future are more to blame. Through a survey of nearly 300 young people, researchers found that those who had a positive view about their stress levels decreasing in the future, compared to the past or present, were less likely to experience severe procrastination. Views on personal well-being didn’t appear to have an effect. Improving people’s outlook and readiness for the future could help them overcome procrastination and achieve a less stressful lifestyle. 

How many times have you made a “to do” list, and although the most important task is at the top, you seem to be working your way up from the bottom or distracted by something else entirely? While we might chide ourselves for procrastinating, sometimes the more we try to overcome it, the more stressed we feel and the cycle continues. That is how it was for graduate student Saya Kashiwakura from the Graduate School of Arts and Sciences at the University of Tokyo, so she decided to investigate why.

“I have struggled with procrastination since childhood. I would clean my room when I needed to study for a test and prioritize aikido practice over my postgraduate research. This habit of putting off important tasks has been a constant challenge,” said Kashiwakura. “I wanted to change my behavior, as I realized that I was not confronting the future impact of my actions.”

This inspired Kashiwakura to examine the relationship between procrastination and the procrastinator’s perspective on time, particularly their view of the future. When she began researching procrastination, she was surprised to discover that many more people suffer from it than she had imagined and found it reassuring her problems were not unique.

Previous research has shown that a feature of procrastination is disregard for the future or difficulty linking present actions with future outcomes. However, the reasons for this have been unclear. Kashiwakura and co-author Professor Kazuo Hiraki, also from UTokyo, proposed that it might be because severe procrastinators have a more pessimistic outlook. 

The researchers surveyed 296 participants in Japan in their 20s for their views on stress and well-being, and importantly how these changed over time. This included asking about their experiences from 10 years in the past through to the present, and their expectations for 10 years in the future. From the results, participants were clustered into one of four groups (for example, if they thought their situation would improve or would stay the same), and then each group was divided into severe, middle and low procrastinators. 

“Our research showed that optimistic people — those who believe that stress does not increase as we move into the future — are less likely to have severe procrastination habits,” explained Kashiwakura. “This finding helped me adopt a more light-hearted perspective on the future, leading to a more direct view and reduced procrastination.” 

It was not only the level of stress people experienced, but how their perception of it changed over the 20-year time period discussed, which influenced their procrastination habits. Surprisingly, a relationship wasn’t found between procrastination and negative views on well-being, such as one’s attitude towards oneself, or not yet finding purpose and goals in life.

Using these results, the team wants to develop ways to help people nurture a more optimistic mindset and overcome procrastination. “We hope our findings will be particularly useful in the education sector. We believe that students will achieve better outcomes and experience greater well-being when they can comprehend their procrastination tendencies scientifically, and actively work on improving them, rather than blaming themselves,” said Kashiwakura. 

“Thoughts can change with just a few minutes of watching a video or be shaped by years of accumulation. Our next step is to investigate which approach is appropriate this time, and how we can develop the ‘right’ mindset to lead a happier and more fulfilling life.”

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Study shows how night shift work can raise risk of diabetes, obesity

“When internal rhythms are dysregulated, you have this enduring stress in your system that we believe has long-term health consequences.”

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Just a few days on a night shift schedule throws off protein rhythms related to blood glucose regulation, energy metabolism and inflammation, processes that can influence the development of chronic metabolic conditions.

The finding, from a study led by scientists at Washington State University and the Pacific Northwest National Laboratory, provides new clues as to why night shift workers are more prone to diabetes, obesity and other metabolic disorders.

“There are processes tied to the master biological clock in our brain that are saying that day is day and night is night and other processes that follow rhythms set elsewhere in the body that say night is day and day is night,” said senior study author Hans Van Dongen, a professor in the WSU Elson S. Floyd College of Medicine. “When internal rhythms are dysregulated, you have this enduring stress in your system that we believe has long-term health consequences.”

Though more research is needed, Van Dongen said the study shows that these disrupted rhythms can be seen in as little as three days, which suggests early intervention to prevent diabetes and obesity is possible. Such intervention could also help lower the risk of heart disease and stroke, which is elevated in night shift workers as well.

Published in the Journal of Proteome Research, the study involved a controlled laboratory experiment with volunteers who were put on simulated night or day shift schedules for three days. Following their last shift, participants were kept awake for 24 hours under constant conditions—lighting, temperature, posture and food intake—to measure their internal biological rhythms without interference from outside influences. 

Blood samples drawn at regular intervals throughout the 24-hour period were analyzed to identify proteins present in blood-based immune system cells. Some proteins had rhythms closely tied to the master biological clock, which keeps the body on a 24-hour rhythm. The master clock is resilient to altered shift schedules, so these protein rhythms didn’t change much in response to the night shift schedule.

However, most other proteins had rhythms that changed substantially in night shift participants compared to the day shift participants.

Looking more closely at proteins involved in glucose regulation, the researchers observed a nearly complete reversal of glucose rhythms in night shift participants. They also found that processes involved in insulin production and sensitivity, which normally work together to keep glucose levels within a healthy range, were no longer synchronized in night shift participants.

The researchers said this effect could be caused by the regulation of insulin trying to undo the glucose changes triggered by the night shift schedule. They said this may be a healthy response in the moment, as altered glucose levels may damage cells and organs, but could be problematic in the long run.

“What we showed is that we can really see a difference in molecular patterns between volunteers with normal schedules and those with schedules that are misaligned with their biological clock,” said Jason McDermott, a computational scientist with PNNL’s Biological Sciences Division. “The effects of this misalignment had not yet been characterized at this molecular level and in this controlled manner before.”

The researchers’ next step will be to study real-world workers to determine whether night shifts cause similar protein changes in long-term shift workers.

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