Why Do Women Reject Potentially Life-Saving Treatments?

“Severe heart damage” resulting in congestive heart failure is a significant impediment to successful treatment with any drug. Similar side effects discourage women from using most of the medications that, in many cases, extend life or even lead to long-term remission from breast cancer. However, when researchers ask women why they don’t take cancer-preventive medication, their answers tend to be:

• Doctor recommendations are taken seriously, but they have to be delivered in the right way.
• Women find out about side effects their doctors failed to mention by searching on the Internet, and become skeptical of the quality of their care.
• Doctors fail to be specific about the risks and benefits of treatment, what are the odds of success, what are the odds of side effects, how much does a treatment add to both quality of life and length of life.

• Women often don’t feel “empowered” to ask questions, although making sure the patient gets enough information is primarily the doctor’s responsibility, not hers.
• Women who know they have BRCA mutations look to mastectomy (and oophorectomy, removal of the ovaries) as primary prevention of cancer.
• Women who already experience hot flashes are less likely to start an estrogen sequestering medication like Tamoxifen, which can cause hot flashes.
• Women  who want estrogen therapy, understandably, are less likely to opt for estrogen-sequestering drugs.
• Any form of treatment that requires more visits to the doctor is likely to be rejected.

On the other hand, starting cancer prevention drugs does not seem to depend on whether or not a woman has passed menopause, what kind of job she has, the number of children a woman has had, or, surprisingly, insurance status.

READ The Relationship Between Breast Cancer and Body Weight

Once women start cancer prevention therapies, about 60 percent continue them for more than six months. Women who are more likely to stick to their cancer prevention programs:

• Tend to have achieved higher educational levels.
• Usually do not smoke.
• Often pursue other, alternative methods of cancer prevention (diet, herbs, alternative therapies).
• Are less depressed about having had cancer or having had a mastectomy. Women who are more depressed are more likely to drop out of treatment.
• Women who regard Tamoxifen, Megace, or Herceptin as “cancer drugs” that remind them or their families of cancer are less likely to stay on their treatments.
• Women who are skeptical of medication in general are less likely to complete a course of treatment.

Income, insurance status (possibly because so many of the studies of the subject were conducted in Europe), the number of children at home, menopause status, marital status, and living alone seem to have little or no effect on how long women stick to their treatment programs. Very few women, less than 14 percent, however, stay on Tamoxifen, Megace, or Herceptin longer than three years. Eventually, most women drop out of treatment.

Doctors need to realize that their “orders” are not necessarily obeyed. Women who want to beat cancer should make every effort to be fully informed of their options and their opportunities for success.