Dear OncoLink "Ask The Experts,"
I have always had some difficulty swallowing pills, to the point that I have significant anxiety when I need to swallow a pill. I have completed surgery and radiation for DCIS and my doctor has prescribed 5 years of tamoxifen. While I know this is important to reduce the risk of another breast cancer, the thought of taking this pill for five years has me pretty worked up. What are my alternatives?
Carolyn Vachani RN, MSN, AOCN, OncoLink's Nurse Educator, responds:
You are correct, taking tamoxifen for five years after treatment for DCIS can reduce the risk of recurrence of the original cancer, or the development of another cancer in the same or opposite breast. There are some risks to tamoxifen, so each woman should discuss her individual case with her oncologist to weigh the risks and benefits.
Once a woman decides to take tamoxifen for five years, it is important to stick with it. This may mean dealing with side effects, including vaginal dryness, hot flashes, and weight gain, which your healthcare team can help you manage.
Now, about taking a pill every day for five years. You are not alone. One survey found that 40% of Americans reported difficulty, hesitance, or anxiety with swallowing pills. This was about twice as common in women (51%) as compared to men (27%). Of those who experience difficulty swallowing pills, 14% have delayed taking doses of their medication, 8% have skipped a dose, and 4% stopped taking their medication altogether.
Fortunately for your case, there is a new liquid formulation of tamoxifen available. This formulation is called Soltamox and is flavored with licorice and aniseed. The standard dose of tamoxifen is 20mg each day, which is equivalent to 10 milliliters of Soltamox (2 teaspoons). It can be taken with or without food. It is the same medication as a tamoxifen pill, so the side effects and benefits are the same. See our teaching sheet on tamoxifen for more information on side effects and benefits.
Apr 23, 2014 - New strategies are needed to help cancer patients adhere to their oral chemotherapy regimens, according to "Compliance and Cost: Bitter Pills to Swallow in the Era of Oral Cancer Treatment," a session presented at the annual meeting of the American Society of Clinical Oncology, held from May 29 to June 2 in Orlando, Fla.