Adjuvant endocrine therapy for premenopausal women with breast cancer: Patient adherence and physician prescribing practices in Mexico

Abstract

Background In resource-constrained settings, data regarding breast cancer patients' adherence to endocrine therapy (ET) and physicians’ prescribing practices is limited. This study aims to decrease this knowledge gap in a real-world clinical practice. Methods Premenopausal women with stage 0-III hormone-sensitive breast cancer and receiving adjuvant ET during the past 1–5 years were identified in three Mexican referral centers. Participants' self-reported ET compliance, clinicopathologic characteristics, ET-related knowledge and beliefs, experienced adverse effects, social support, and patient-physician relationships were evaluated. Physician ET prescribing practices were compared with the gold standard according to international and national guidelines to assess clinicians’ adherence to standard-of-care prescription. Results In total, 95/132 (72%) and 35/132 (27%) participants reported complete and acceptable adherence, respectively. Incomplete adherence was mainly attributed to forgetfulness, adverse effects, and unwillingness to take ET. Being employed/studying ( p = 0.042), worrying about long-term ET use ( p = 0.031), and experiencing >7 ET-related symptoms ( p = 0.018) were associated with incomplete adherence. Guideline-endorsed regimens were prescribed in 84/132 (64%) patients, while the rest should have undergone ovarian function suppression (OFS) but instead received tamoxifen monotherapy. Conclusions Premenopausal Mexican women self-report remarkably high rates of adequate ET adherence. However, a considerable proportion misses ≥1 doses/month, usually because of forgetfulness. Notably, only 64% receive standard-of-care ET due to suboptimal prescription of OFS. Interventions that remind patients to take their ET, refine physicians’ knowledge on the importance of OFS in high-risk patients, and increase access to OFS could prove pivotal to enhance optimal ET implementation and adherence, which could translate into improved patient outcomes.

Young Women with Breast Cancer in Resource-Limited Settings: What We Know and What We Need to Do Better

“…The main reasons associated with patients’ low adherence and high discontinuation rates of ET included forgetfulness, adverse effects, and unwillingness to take the medication. 32 , 33 As for physicians’ suboptimal treatment recommendations with OFS, a possible explanation may be the prevailing limited patient access to gonadotropin-releasing hormone analogs (GnRHa), which are not routinely covered by Mexican public healthcare insurance schemes, and are considered expensive. 33 …”

“… 32 , 33 As for physicians’ suboptimal treatment recommendations with OFS, a possible explanation may be the prevailing limited patient access to gonadotropin-releasing hormone analogs (GnRHa), which are not routinely covered by Mexican public healthcare insurance schemes, and are considered expensive. 33 …”

“…Although young age has been associated as a risk factor for low adherence to adjuvant ET in previous studies in HICs, 28 , 29 the scarce available evidence from an upper-middle-income country, Mexico, suggests ET adherence might not be as low as expected in YWBC from LMICs. 32 , 33 However, further research concerning this important topic is needed in other limited-constrained settings as YWBC women potentially have longer life expectancies than their older counterparts, and low adherence rates to ET have been associated with worse long-term survival. 37 Developing setting-adapted strategies to improve physicians’ adherence to guideline recommendations and YWBC’s adherence to adjuvant ET as well as guaranteeing adequate access to optimal ET are urgently needed in limited-resource settings.…”

Adherencia terapéutica y apoyo familiar del paciente con enfermedad renal crónica

“…Fuente: Test de Morisky-Green Elaborado por: Autores De acuerdo a la pregunta de si realiza la actividad o no (olvida tomar su medicina algunas veces), 18 pacientes que corresponden al 50% manifiestan que SI y 18 pacientes que corresponden al 50% manifiestan que NO; respuestas que generan relación a la investigación de Villarreal en su estudio donde afirma; en su mayoría que los pacientes suelen olvidarse de tomar sus medicamentos, hizo referencia a las preocupaciones por los efectos secundarios constantes, los mismos que pueden generar preocupaciones, teniendo como consecuencia el incumplimiento del tratamiento, mientras que la adherencia completa hacía hincapié en los pacientes que están exentos de preocupaciones, es decir no tenían cargas laborales o miedos sobre los efectos o daños que pueda provocar el tratamiento (Villarreal, 2021)…”