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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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5 Tips to upgrade your sleep

Sleep contributes to better brain function, memory, concentration and lower stress. According to the National Institutes of Health, most adults need 7-9 hours of sleep every night to achieve maximum health benefits.

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Good sleep isn’t just about waking up feeling rested and ready for the day. Quality sleep, and plenty of it, is important for your overall health. While you sleep, your body naturally recharges itself, which puts you at lower risk for cardiovascular problems and chronic conditions like diabetes, as well as improving your immune system.

Sleep also contributes to better brain function, memory, concentration and lower stress. According to the National Institutes of Health, most adults need 7-9 hours of sleep every night to achieve maximum health benefits.

If you’re falling short of the recommended amount of sleep, you may be able to make some adjustments that help you reap the health benefits of better rest. Learn what you can do to improve your sleep with these tips from the experts in safer, healthier sleep at Naturepedic.

Reduce Light Exposure
Your body’s natural circadian rhythms are closely aligned with light and dark. When your body senses light, it sends signals to your brain that it’s time to be awake. Light also suppresses your body’s production of melatonin, a hormone linked to sleep. Cutting back on bright lights and avoiding devices at least an hour before bed can tell your body it’s time to wind down, and sleeping in a dark room promotes better rest.

Invest in the Right Mattress
Your mattress plays a major role in your comfort through the night, so making sure it fits your needs is an important step toward getting better rest. Take control of your comfort with a quality mattress such as Naturepedic’s EOS (Ergonomic Organic Sleep) mattress, which is handcrafted and made without polyurethane foam, formaldehyde, flame retardants or fiberglass. The breathable layers of certified organic cotton, wool and GOTS-approved latex ensure better temperature regulation while naturally contouring the body. An added feature is the ability to customize each side of the bed by opening the zippers and adjusting the layered components for the perfect comfort combination.

Find the Right Sheets
Sheets that are too stiff, scratchy or otherwise unpleasant make it nearly impossible to settle in for a good night’s rest. Higher thread counts tend to be softer, higher quality sheets. However, you may need to experiment to find which material suits you best.

Set a Comfortable Temperature
When you’re too hot or cold, your mind tends to focus on those sensations rather than allowing you to slip into a slumber. Set your thermostat at a comfortable temperature, adding fans or adjusting the layers of bedding as necessary to achieve the perfect level of cozy comfort.

Use a Sound Machine
If you’re a light sleeper, noise can wreak havoc on your rest. Many people find sound machines offer two key benefits: They provide a soothing sound, such as rain or ocean waves, that allows you to relax and ease into slumber and constant background noise, so additional sounds are less disruptive.

Find more solutions for achieving better sleep at Naturepedic.com.

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What you should know about IBD

Two common conditions are irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD). They’re often confused for one another, but these are actually two different GI disorders.

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It may not be something you like to talk about, but if you have gastrointestinal (GI) problems, your symptoms may be far more common than you think. According to data from the American Gastroenterological Association, 60-70 million people living in the United States have gut health concerns.

Two common conditions are irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD). They’re often confused for one another, but these are actually two different GI disorders.

IBS is a syndrome; it is defined by a group of symptoms, does not cause inflammation and rarely requires hospitalization or surgery. IBD, on the other hand, is an umbrella term used to describe disorders that cause chronic inflammation of your GI tract.

The disease is more common than you may realize; a study led by the Crohn’s & Colitis Foundation found nearly 1 in 100 people living in the U.S. have IBD. The two most common forms of IBD are Crohn’s disease and ulcerative colitis.

Understanding IBD Symptoms
Because it poses serious health risks and can cause permanent damage to your intestines, it’s important to be aware of what IBD is and recognize the symptoms. Your primary care doctor or gastroenterologist can help if you have concerns about these symptoms:

  • Intense, crampy pain that doesn’t go away in a day or two or has been present on and off for weeks or longer
  • A notable change in bowel movement frequency, whether more or less often
  • Frequent diarrhea over several weeks, or loose stools multiple times a day
  • Frequent constipation, or constipation alternating with diarrhea
  • Urgency on a regular basis or inability to hold back the bowel movement before reaching the bathroom
  • Blood with bowel movements
  • Mucus in your stool regularly or paired with pain or other symptoms
  • Always feeling as though you aren’t fully emptying your bowels

Other symptoms that may have a variety of causes but need extra attention especially if you notice them along with any of the symptoms above include pain outside of the gut, fatigue, loss of appetite and weight loss. In addition, children with IBD may have delays in growth and the onset of puberty.

Diagnosing IBD
No single test can confirm a Crohn’s or ulcerative colitis diagnosis. Your medical history and information obtained from diagnostic testing can exclude other potential causes of your symptoms, since gastrointestinal symptoms are common and can have a variety of causes.

Your first tests will likely include blood and stool laboratory tests. Further testing could include imaging studies of your gastrointestinal tract or a look inside your GI tract through an endoscope.

Identifying Treatment Options
Once an IBD diagnosis is confirmed, you can partner with your doctor to manage your disease. Treatment plans are highly personalized, as what works for one person may not for another. Medication and managing your diet and nutrition are two common treatment recommendations. In some cases, surgery can help improve your quality of life.

Clinical trials may also be an option for treating your IBD. Through clinical trials, researchers find new ways to improve treatments and quality of life. In fact, clinical trials represent the final stages of a long and careful research process to make new and improved treatment options for patients available.

However, an important part of clinical trials for IBD is patient participation. Without the enrollment of patients in clinical trials, new treatment options for IBD can be delayed or never become available.

Equally important to this process is having a diverse representation of patients that considers race, age or other categories. This helps researchers develop treatments that meet the needs of a vast IBD patient community.

If you’re interested in participating in a clinical trial, ask your doctor to help you find a trial that is right for you, and visit crohnscolitisfoundation.org to learn more about IBD and treatment options, including clinical trials.

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Unlocking the science of sleep: How rest enhances language learning

Getting eight hours of sleep every night helps the brain to store and learn a new language.

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Sleep is critical for all sorts of reasons, but a team of international scientists has discovered a new incentive for getting eight hours of sleep every night: it helps the brain to store and learn a new language.

A study led by the University of South Australia (UniSA) and published in the Journal of Neuroscience has revealed that the coordination of two electrical events in the sleeping brain significantly improves our ability to remember new words and complex grammatical rules.

In an experiment with 35 native English-speaking adults, researchers tracked the brain activity of participants learning a miniature language called Mini Pinyin that is based on Mandarin but with similar grammatical rules to English.

Half of the participants learned Mini Pinyin in the morning and then returned in the evening to have their memory tested. The other half learned Mini Pinyin in the evening and then slept in the laboratory overnight while their brain activity was recorded. Researchers tested their progress in the morning.

Those who slept performed significantly better compared to those who remained awake.

Lead researcher  Dr Zachariah Cross, who did his PhD at UniSA but is now based at Northwestern University in Chicago, says sleep-based improvements were linked to the coupling of slow oscillations and sleep spindles – brainwave patterns that synchronise during NREM sleep.

“This coupling likely reflects the transfer of learned information from the hippocampus to the cortex, enhancing long-term memory storage,” Dr Cross says.

“Post-sleep neural activity showed unique patterns of theta oscillations associated with cognitive control and memory consolidation, suggesting a strong link between sleep-induced brainwave co-ordination and learning outcomes.”

UniSA researcher Dr Scott Coussens says the study underscores the importance of sleep in learning complex linguistic rules.

“By demonstrating how specific neural processes during sleep support memory consolidation, we provide a new perspective on how sleep disruption impacts language learning,” Dr Coussens says. “Sleep is not just restful; it’s an active, transformative state for the brain.”

The findings could also potentially inform treatments for individuals with language-related impairments, including autism spectrum disorder (ASD) and aphasia, who experience greater sleep disturbances than other adults.

Research on both animals and humans shows that slow oscillations improve neural plasticity – the brain’s ability to change and adapt in response to experiences and injury.

“From this perspective, slow oscillations could be increased via methods such as transcranial magnetic stimulation to accelerate aphasia-based speech and language therapy,” Dr Cross says.

In future, the researchers plan to explore how sleep and wake dynamics influence the learning of other complex cognitive tasks.

“Understanding how the brain works during sleep has implications beyond language learning. It could revolutionize how we approach education, rehabilitation, and cognitive training.”

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