How soon after completing radiation should anti-estrogen medication start?

I do not have a strong preference. For some high risk patients, the oncologist is eager to start, even during radiation. For a standard risk patient, waiting until following the peak reaction is my usual recommendation (~1-2 weeks post RT). This is to avoid the potential for the patient to have both...

I like the review @Dr. First Last cited above. I have no real preference although some of my oncology colleagues do so I accommodate them. However there is some data of synergy with Tamoxifen during radiation. I actually like to have patients start during radiation so I can monitor the side effects ...

There is no preferred time. Recommendations are driven by individual preferences or practice patterns and most places give the same recommendations to all patients.

The NSABP analyzed local control in their older hormone studies and found no detriment to concurrent tamoxifen. In the lab, I recall reading about increased fibrosis with tamoxifen given concurrently. No data for the aromatase inhibitors.

The NSABP countered the idea that tamoxifen caused decreased...

Compliance is a problem with our patients so we make sure they either start the AI/tamoxifen the day after XRT or make sure they have apt within two weeks with Med Onc to discuss/start AI.

We document the start date of AI in our EMR and put the info in the COT note as well.