Adjuvant endocrine therapy initiation and persistence in a diverse sample of patients with breast cancer

Abstract

Background Adjuvant endocrine therapy for breast cancer reduces recurrence and improves survival rates. Many patients never start treatment or discontinue prematurely. A better understanding of factors associated with endocrine therapy initiation and persistence could inform practitioners how to support patients. Methods We analyzed data from a longitudinal study of 2,268 women diagnosed with breast cancer and reported to the Metropolitan Detroit and Los Angeles SEER cancer registries in 2005-2007. Patients were surveyed approximately both 9 months and 4 years after diagnosis. At 4-years, patients were asked if they had initiated endocrine therapy, terminated therapy, or were currently taking therapy (defined as persistence). Multivariable logistic regression models examined factors associated with initiation and persistence. Results Of the 743 patients eligible for endocrine therapy, 80 (10.8%) never initiated therapy, 112 (15.1%) started therapy but discontinued prematurely, and 551 (74.2%) continued use at the second time point. Compared with whites, Latinas (OR 2.80, 95% CI 1.08-7.23) and black women (OR 3.63, 95% CI 1.22-10.78) were more likely to initiate therapy. Other factors associated with initiation included worry about recurrence (OR 3.54, 95% CI 1.31 – 9.56) and inadequate information about side effects (OR 0.24, 95% CI 0.10 – 0.55). Factors associated with persistence included two or more medications taken weekly (OR 4.19, 95% CI 2.28-7.68) and increased age (OR 0.98, 95% CI 0.95-0.99). Conclusions Enhanced patient education about potential side effects and the effectiveness of adjuvant endocrine therapy in improving outcomes may improve initiation and persistence rates and optimize breast cancer survival.

Costs and mortality of recurrent versus de novo hormone receptor-positive/HER2 - metastatic breast cancer

“…The authors concede that low socioeconomic status and other lifestyle characteristics common to their study population are also associated with poorer breast cancer outcomes, and an association may simply have been too small to detect with their sample. Further research is warranted to establish the role adherence and persistence play in cancer recurrence, given that persistence to therapy may be modifiable through initiatives such as patient education [37]. Research of other potentially modifiable aspects of breast cancer treatment that may influence the likelihood of early recurrence is also warranted, as are studies of ways to improve survival and lower costs within this population.…”

Investigating Associations Between Health-Related Quality of Life and Endocrine Therapy Underuse in Women With Early-Stage Breast Cancer

“…[1][2][3][4] ET, indicated for nearly all HR-positive BCs, is recommended as a daily pill for 5 years after primary BC treatments. [4][5][6] ET is a highly effective adjuvant treatment associated with a 40% reduction in BC recurrence and 30% reduction in BCrelated mortality. [7][8][9][10][11][12] Despite its clinical benefits, 10% to 30%…”

“…17,18 Poorly managed HRQOL during active treatment may contribute to underuse, because poor HRQOL can hinder a woman's ability to cope with the adverse effects of ET as she attempts to acclimate to life after primary BC treatment. 6,13,[18][19][20][21] In this study, we operationalized underuse as not initiating or not adhering to ET. 22 Although studies have collected data on poor HRQOL while women receive ET, to our knowledge, no studies have examined associations between ET initiation and HRQOL before initiation.…”

Symptoms and Symptom Attribution Among Women on Endocrine Therapy for Breast Cancer

“…Side effects from tamoxifen and AIs can negatively affect both health-related and psychosocial quality of life (QOL) and are one of the most commonly cited reasons for nonadherence and discontinuation of ET [5][6][7][8][9]. Side effects generally increase patient concerns about taking therapy and thereby reduce adherence [10].…”