Estrogen Deprivation Effects of Endocrine Therapy in Breast Cancer Patients: Incidence, Management and Outcome

Endocrine therapy (ET) is crucial for treating hormone receptor-positive early breast cancer but leads to significant side effects due to estrogen deprivation, impacting patients' quality of life and treatment adherence. Common side effects include vasomotor symptoms, musculoskeletal disorders, genitourinary syndrome, fatigue, psychological disorders, ocular toxicity, dysmetabolic effects, and bone density loss. Alopecia affects up to 9% of patients on tamoxifen and 2.5% on aromatase inhibitors, with minoxidil being effective for management. The review emphasizes a multidisciplinary approach, using both pharmacological and non-pharmacological strategies, to manage these adverse events. It also notes that testosterone and omega-3 fatty acids may alleviate some symptoms but not joint pain from aromatase inhibitors. The POSITIVE trial indicates that temporary ET suspension for pregnancy is safe, and lifestyle interventions are recommended for managing side effects, as effective pharmacological solutions are limited.