Clinical Profiles Predict Early Nonadherence to Adjuvant Endocrine Treatment in a Prospective Breast Cancer Cohort

Abstract

Nonadherence to adjuvant endocrine breast cancer treatment adversely affects disease-free and overall survival. Clinical predictors of nonadherence may allow for specific interventions to reduce nonadherence and improve survival. The aim was to investigate whether clinical characteristics predict nonadherence. Clinical characteristics and information on adherence were obtained from 417 patients with breast cancer in a population-based prospective cohort from southern Sweden using patient charts, pathology reports, and questionnaires filled out at the 1-and 2-year follow-up visits. At the 1-and 2-year follow-up visits, 36 (8.6%) and 33 (9.7%) patients were nonadherent, respectively. Thirteen of the nonadherent patients declined treatment and were never prescribed endocrine treatment. A body mass index (BMI) < 25 kg/m 2 , preoperative current smoking, and drinking alcohol less often than twice a month predicted nonadherence at the 1-year [relative risk (RR), 5.24; 95% confidence interval (CI), 2.75-9.97] and the 2-year visits (RR, 4.07; 95% CI, 2.11-7.84) in patients with at least two of these clinical characteristics. When low histologic grade (I) was added to the model, having at least two of these four clinical characteristics predicted nonadherence at the 1-year (RR, 4.94; 95% CI, 2.46-10.00) and the 2-year visits (RR, 4.74; 95% CI, 2.28-9.87), the two profiles had a sensitivity ranging from 60.6% to 72.7%, whereas the specificity ranged from 68.0% to 78.4%. Nonadherence at the 1-year visit was associated with an increased risk for early breast cancer events (HR, 2.97; 95% CI, 1.08-8.15), adjusted for age and tumor characteristics. In conclusion, two clinical profiles predicted early nonadherence and may allow for targeted interventions to increase adherence if validated in an independent cohort. Cancer Prev Res; 5(5); 735-45. Ó2012 AACR.

Coffee prevents early events in tamoxifen-treated breast cancer patients and modulates hormone receptor status

“…None of these potential confounders could explain the results of this study. A recent publication based on this cohort reported that poor adherence was associated with early events [45]. However, coffee intake was not associated with duration of endocrine therapy and could thus not explain the results.…”

Given breast cancer, is fat better than thin? Impact of the estrogen receptor beta gene polymorphisms

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Factors Influencing Adherence to Imatinib in Indian Chronic Myeloid Leukemia Patients: A Cross-Sectional Study

“…First, we might have missed additional patient related and psychological factors that might have found to be related to adherence in patients with other diseases 25. Second, we used non validated questionnaire to assess the factors influencing adherence except depression and third, it is possible that additional measures of adherence could have further contributed to a more sensitive definition of adherence in our study.…”