Drug- and patient-related factors are the strongest predictors of endocrine therapy adherence in breast cancer patients

Abstract

Purpose Medication non-adherence to treatment regimens can severely impact the mortality of patients afflicted with breast cancer.The purpose of this study was to identify factors that contribute to non-adherence to endocrine therapy in breast cancer treatment plans. Methods Thirty-two women with a breast cancer diagnosis were surveyed by pharmacists and pharmacy students to identify the patient- related factors (e.g. patient personal beliefs, education level), drug-related factors (e.g. patient drug allergies), socio-economic factors (e.g. patient ability to pay for the medication) and healthcare system factors (e.g. poor patient-healthcare provider relationship) that may impact non-adherence to endocrine therapy in breast cancer treatment plans. Medication adherence rates were measured using the Medication Adherence Rating Scale (MARS-8) system. Associations between adherence rate scores and clinical variables (e.g. age, tobacco use, alcohol consumption, cost of treatment, education level, personal beliefs, drug allergies, patient/provider relationship, adverse events) were carried out using Spearman Correlation, T-Test, Mann-Whitney U Test, and X2 tests. A p value of ≤ 0.05 was considered statistically significant. Results Our study found that 59% of survey respondents were non-adherent to their endocrine therapy in breast cancer treatment plans. Drug allergies ( p = 0.000069), patient ability to pay ( p = 0.005), poor personal beliefs about the prescribed therapy (p = 0.009), low education level ( p = 0.025), adverse drug events ( p = 0.026), and poor patient-provider relationship ( p = 0.05) were found to play a role in patient non-adherence to treatment. Conclusions Our study found that drug- (e.g. allergies), socio-economic (e.g. patient ability to pay), and patient-related factors (e.g. personal beliefs) are the strongest predictors of adherence among breast cancer patients undergoing endocrine therapy. These findings support the need for a better relationship between breast cancer patients and their healthcare providers, including drug experts such as pharmacists.

When lightning strikes twice: Perceptions of oncology social workers about working with families with two members in treatment

“…Unique to this study was that treatment nonadherence of the parent due to prioritizing the child's treatment was identified as a concern. This is in addition to studies that have found finances and the provider‐patient relationship were associated with non‐adherence 18–20 . Respondents noted that healthcare providers must be aware of this and help the parent adhere to their treatment plan.…”

“…This is in addition to studies that have found finances and the provider-patient relationship were associated with nonadherence. [18][19][20] Respondents noted that healthcare providers must be aware of this and help the parent adhere to their treatment plan.…”

Investigation of Factors Affecting Adherence to Adjuvant Hormone Therapy in Early-Stage Breast Cancer Patients: A Comprehensive Systematic Review

“…Depression and anxiety were both negatively associated with adherence [ 10 39 52 62 90 91 92 93 94 95 96 97 98 99 ]; however, one study on anxiety suggested a positive relationship between anxiety and adherence [ 95 ]. A family history of breast or ovarian cancer [ 80 100 ], frailty [ 61 ], pain [ 42 46 101 102 ], poor sleep quality [ 103 104 ], smoking/substance use [ 54 66 85 105 106 ], lower cognitive function [ 48 55 61 67 90 94 107 ], concern belief [ 32 46 105 108 109 110 ], strong belief in the risk of recurrence [ 47 ], negative decisional balance [ 111 112 113 ], and poor personal belief [ 114 ] were negatively associated with adherence to AHT. In contrast, better quality of life [ 115 116 117 118 ], positive necessity [ 10 44 97 119 120 121 ], positive belief/attitude about AHT [ 42 87 115 122 ], greater internal locus of control [ 96 ], high confidence in decision [ 123 ], perceived self-efficacy [ 57 81 88 ...…”

“…A total of 92 studies identified therapy-related factors affecting adherence to AHT, and drug side effects was a dominant factor in this dimension [ 32 43 48 50 54 57 70 71 73 78 88 90 91 93 97 98 99 102 104 109 114 116 117 120 122 130 131 132 133 134 135 136 137 138 139 140 141 ], followed by the type of AHT and administration of other adjuvant chemotherapy. Most of these were negatively associated with adherence; however, vaginal dryness and hair thinning/loss were positively associated with the continuation of therapy [ 130 ].…”

“…Among these, social, familial, and emotional support were the only factors that had a consistently positive association with adherence [ 16 50 71 74 89 92 96 98 112 123 140 152 ]. Employment status [ 32 47 49 50 56 59 82 ], education level [ 32 56 77 100 107 114 134 153 ], and financial [ 10 64 134 141 ] and marital status [ 13 33 40 56 64 74 77 81 107 148 154 155 ] were both positively and negatively associated with adherence to AHT. However, most studies have confirmed that Black people and ethnic minority groups are less adherent to AHT than Caucasians or Asians [ 13 15 37 40 46 47 53 61 64 68 69 83 100 108 156 157 ], with the exception of a few studies [ 66 142 ].…”