Endocrine Therapy Nonadherence and Discontinuation in Black and White Women

Wheeler, Stephanie B.; Spencer, Jennifer; Pinheiro, Laura C.; Murphy, Caitlin C.; Earp, Jo Anne; Carey, Lisa A.; Olshan, Andrew F.; Tse, Chiu Kit; Bell, Michael; Weinberger, Morris; Reeder‐Hayes, Katherine E.

doi:10.1093/jnci/djy136

Cited by 78 publications

(103 citation statements)

References 59 publications

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“…39,40 Stanton et al 41 surveyed 1371 patients and identified the relationship with the oncologist, the perceived ET necessity, and emotions regarding ET as factors associated with nonadherence to adjuvant ET. Wheeler et al 42 recently found an association between a lack of shared decision making and nonadherence in a cross-sectional survey from the Carolina Breast Cancer Study. Several other publications have highlighted the importance of patient-physician communication for adherence to treatment recommendations and patients' decisions about treatment.…”

Section: Discussionmentioning

confidence: 99%

Nonadherent behaviors among young women on adjuvant endocrine therapy for breast cancer

Wassermann

Gelber

Rosenberg

et al. 2019

Cancer

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BACKGROUND: Young age is a known factor associated with suboptimal adherence to endocrine therapy (ET) for adjuvant breast cancer (BC) treatment. This study was aimed at assessing nonadherent behaviors and associated factors among young women with early-stage hormone receptor-positive BC. METHODS: As part of a multicenter, prospective cohort of women with a diagnosis of BC at or under the age of 40 years, participants were surveyed 30 months after their diagnosis about adherent behaviors. Among those who reported taking ET, adherence was measured with a 3-item Likert-type scale: Do you ever forget to take your ET? If you feel worse when you take your ET, do you stop taking it? Did you take your ET exactly as directed by your doctor over the last 3 months? Women reporting at least 1 nonadherent behavior were classified as nonadherers. Variables with a P value <.20 were included in a multivariable logistic model. RESULTS: Among 384 women, 194 (51%) were classified as nonadherers. Univariate factors that retained significance in the multivariable model included educational level (odds ratio [OR], 0.50 for high vs low; P = .04), level of social support according to the Medical Outcome Study Social Support Survey (OR, 0.98 per 1 point; P = .01), and confidence with the decision regarding ET measured on a 0 to 10 numerical scale (OR, 0.63 for high vs low; P = .04). CONCLUSIONS: Findings from this study could help to identify young patients at higher risk for nonadherence. Interventions adapted to the level of education and aimed at reinforcing support and patients' confidence in their decision to take ET could improve adherence and associated outcomes in this population. Cancer 2019;125:3266-3274.

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Section: Discussionmentioning

confidence: 99%

Nonadherent behaviors among young women on adjuvant endocrine therapy for breast cancer

Wassermann

Gelber

Rosenberg

et al. 2019

Cancer

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“…For women with Endocrine Receptor positive breast cancer, endocrine therapy (ET) medication taken for five to ten years after completion of primary treatments can reduce the risk of cancer recurrence by up to 50% . However, even among those who initiate ET, many women struggle to maintain the daily regimen and some discontinue the medication completely, with estimates of non‐adherence rates ranging from 20% to 50% . Breast cancer recurrence is higher among Black women, young women and low‐income women; ET adherence is also lower in these vulnerable groups …”

Section: Introductionmentioning

confidence: 99%

“…Previous studies have evaluated the extent of ET non‐adherence in self‐report or claims data and have assessed reasons for non‐adherence qualitatively . Qualitative studies highlight a need to improve provider communication, particularly around the benefit of ET in recurrence risk reduction and need to help patients to better manage potential ET side effects .…”

Section: Introductionmentioning

confidence: 99%

“…Qualitative studies highlight a need to improve provider communication, particularly around the benefit of ET in recurrence risk reduction and need to help patients to better manage potential ET side effects . Quantitative studies have identified a number of reasons for non‐adherence and patient characteristics associated with non‐adherence, but reasons for non‐adherence have not been mapped to thematic domains that can be targeted by potential interventions. Further, it is unknown how ET barriers vary for younger, Black, and uninsured or publicly insured women – groups particularly at risk for ET under‐use …”

Section: Introductionmentioning

confidence: 99%

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Factors Associated with Endocrine Therapy Non‐Adherence in Breast Cancer Survivors

et al. 2020

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Background: For women with hormone receptor positive breast cancer, long-term endocrine therapy (ET) can greatly reduce the risk of recurrence, yet adherence is low-particularly among traditionally underserved populations. Methods:The Carolina Breast Cancer Study oversampled Black and young women (<50 years of age). Participants answered an ET-specific medication adherence questionnaire assessing reasons for non-adherence. We used principal factor analysis to identify latent factors describing ET non-adherence. We then performed multivariable regression to determine clinical and demographic characteristics associated with each ET non-adherence factor.Results: 1,231 women were included in analysis, 59% reported at least one barrier to ET adherence. We identified three latent factors which we defined as: habit -challenges developing medication-taking behavior; tradeoffs -high perceived side effect burden and medication safety concerns; and resource barriers -challenges related to cost or accessibility. Older age (50+) was associated with less reporting of habit (Adjusted Risk Ratio (aRR) 0.54[95% CI: 0.43-0.69] and resource barriers (aRR 0.66 [0.43-0.997]), but was not associated with tradeoff barriers. Medicaid-insured women were more likely than privately-insured to report tradeoff (aRR:1.53 [1.10-2.13]) or resource barriers ). Black race was associated with increased reporting of all factors (habit: aRR 1.29[1.09-1.53]; tradeoffs: 1.32 [1.09-1.60], resources: 1.65[1.18-2.30]).Conclusion: Barriers to ET adherence were described by three distinct factors, and strongly associated with sociodemographic characteristics. Barriers to ET adherence appear inadequately addressed for younger, Black, and publicly-insured breast cancer survivors. These findings underscore the importance of developing multi-faceted, patient-centered interventions that address a diverse range of barriers to ET adherence.

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“…The cohort study, led by the Lineberger Comprehensive Cancer Center at the University of North Carolina at Chapel Hill, was published in the Journal of the National Cancer Institute …”

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confidence: 99%

Black women less likely to adhere to hormone therapy for breast cancer

Printz¹

2019

Cancer

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Endocrine Therapy Nonadherence and Discontinuation in Black and White Women

Abstract: Our results highlight important racial differences in ET-adherence behaviors, perceptions of benefits/harms, and shared decision making that may be targeted with culturally tailored interventions.

Cited by 78 publications

References 59 publications

Nonadherent behaviors among young women on adjuvant endocrine therapy for breast cancer

Nonadherent behaviors among young women on adjuvant endocrine therapy for breast cancer

Factors Associated with Endocrine Therapy Non‐Adherence in Breast Cancer Survivors

Black women less likely to adhere to hormone therapy for breast cancer

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