Anna Weiss

@AnnSurgOncol A9: the Alliance has a clinical trial, PI is Katie Reeder-Hayes, examining an interactive phone app, with alerts, reminders, etc aimed at increasing adherence. Fingers crossed it's a positive trial! #ASOchat

Q9: Life-altering adverse effects decrease the adherence to endocrine therapy. What types of patient education programs or resources, when starting therapy, improve adherence? Should additional education be given during the duration of the therapy? #ASOchat

@AndreaLMerrill @AnnSurgOncol @The_BMC Yes I think networking/support groups can be clutch

@AnnSurgOncol A9: we have some great survivor groups at @The_BMC which can help patients manage symptoms together. I think it's also important to provide ongoing education and reinforcement. Endocrine therapy is more than "just a pill" #ASOchat

@AnnSurgOncol A9: this is tough. There aren't many proven effective interventions. It is clear that just passing out information does not help though. Bidirectional interventions, like programs including mychart responses etc can help #ASOchat

@AnnSurgOncol A8: for invasive disease, we are about to submit a trial via the Alliance looking at low dose tam in patients with low risk invasive breast cancer, but I personally would not try it outside of a trial

Q8: Do you switch patients to low dose Tamoxifen (e.g. 5mg daily) and what prompts that change? Do you use low dose Tamoxifen for breast cancer risk reduction, adjuvant therapy after breast cancer, both or neither? #ASOchat

@AnnSurgOncol A8: premenopausal patients the data is not as clear, but if they cannot tolerate 20mg, I will decrease

@AnnSurgOncol A8: I use low dose tamoxifen for post Menopausal patients in the prevention setting. Our co author Laura Spring cannot join, but she said 'something is better than nothing' #ASOchat

@AnnSurgOncol A7: we manage! Baseline dexa then every 2 years. If treatment is needed, use injectable bisphosphonates (reclast, prolia too). If bone loss continues despite these we refer #ASOchat

Q7: How do you manage patients with osteopenia or osteoporosis? What is the management strategy for patients with persistent low bone density and do you refer to a specialist, e.g. endocrinologist? #ASOchat

@AnnSurgOncol #ASOchat There is no RELIABLE evidence that vaginal hormones increase the risk of #breastcancer recurrence. The original pharmacokinetics studies of vaginal estrogen used doses 5x higher than what we use today

@AnnSurgOncol A6: I heard there were reports of vaginal lasers causing burns, perhaps worsening strictures. I would be cautious

Q6: There has been a long-standing controversy of treating genitourinary syndrome of menopause (GSM) & vaginal dryness with vaginal estrogen, what are your recommendations regarding vaginal estrogen and treating GSM? Are there any treatments you do NOT recommend? #ASOchat

@AnnSurgOncol I'm going to let @kristinrojasmd take this one! #ASOchat

@AnnSurgOncol A5: let's talk about sex baby! I bring it up in every new patient consultation re long term issues that can arise from breast cancer treatment. Remove irritants, moisturize, lubricate! If anatomical issues I do refer

Q5: For the clinicians joining us today, how comfortable do you feel discussing sexual health as it related to endocrine therapy with your patients? Do you ask them about it at every follow up visit? Do you feel comfortable managing these symptoms? #ASOchat

@AnnSurgOncol A4: acupuncture! Was proven effective in a randomized sham controlled clinical trial. I recommend this all the time to my patients. We offer it the integrative oncology center supported @PlutaCancerFdn @UR_Med #ASOchat

Q4: Arthralgias affect 1/3 of patients on AIs, what are some proven treatments for AI-related joint pain? Do surgeons typically recommend these or do you send to your medical oncologist? #ASOchat

@puneetsinghmd @AndreaLMerrill @kristinrojasmd @AnnSurgOncol @puneetsinghmd this is a huge point. It needs to be tolerable! They need to take it if we arent going to do slnb, radiate,etc #ASOchat

@AndreaLMerrill @kristinrojasmd @AnnSurgOncol A2: certainly is and as an aside I think it's something to consider if we de-escalate other therapies for breast cancer such as radiation, presuming that the patient will be able to complete 5 years of endocrine therapy #ASOchat

Q2: For the surgeons joining us, how comfortable do you feel managing side effects of endocrine therapy in your breast cancer patients? #ASOchat

@AnnSurgOncol A3: gabapentin, venlafaxine, oxybutinin are medical options. #ASOchat

Q3: 35-40% of patients experience vasomotor symptoms (aka hot flashes), what are some recommended interventions for these symptoms? #ASOchat

@adwilliams5 @AnnSurgOncol I think getting comfortable with the discussion is so important, so when the med onc tells them about vaginal dryness, for example, it's not the first time a patient is hearing it

@AnnSurgOncol Not exceedingly comfortable! I do try to discuss possible AEs with patients in general terms both at initial consultation and postoperative visit (at which point referral is made to medical oncology). #ASOChat

@AnnSurgOncol A2: pretty comfortable 😁 but, I will say I often curbside collaborating groups, like our sexual wellness or bone health experts @UR_Med #ASOchat

@AnnSurgOncol Oops A1

Q1: To those joining us tonight, who primarily manages endocrine therapy for breast cancer at your institution? Surgeons, medical oncologists? Both? Other? #ASOchat

@AnnSurgOncol Highly trained midlevel providers, overseen by me

Don't forget - next week's @AnnSurgOncol's Tweet Chat on Endorine Therapy for Breast Surgoens is next Wednesday Oct 18 at 630pm EST! #breastcancer @ASBrS @kristinrojasmd @DrAnnaWeiss @drrachelrubin @Liz_ORiordan

Don't be fooled! On #AprilFoolsDay, we're busting common myths related to cancer. While anyone can get #breastcancer, those with a family history do have an increased risk. Have questions about your own risk? Our Breast Health Program can help: urmc.info/SR #ROC