Five-Year Adjuvant Endocrine Therapy Adherence Trajectories Among Women With Breast Cancer: A Nationwide French Study Using Administrative Data

Lailler, Grégory; Memoli, Victoria; Benjamin, Christine; Diane, Marc-Karim Ben; Lauzier, Sophie; Mancini, Julien; Bousquet, Philippe; Bouhnik, Anne-Déborah

doi:10.1016/j.clbc.2021.01.007

Cited by 17 publications

(35 citation statements)

References 39 publications

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“… TAM & AI. N = 2682 Implementation MPR≥ 80% Non-persistence ≥90 days gap since last prescription refill Implementation: 78% Persistence: 76% – 1) Low personal social support 2) Low clinical social support Lailler, 2021 (France) a [ 44 ] Retrospective cohort. National Cancer Institute Database.…”

Section: Resultsmentioning

confidence: 99%

“…Older age (N = 7) [ 31 , 36 , 39 , 44 , 46 , 48 , 52 ], younger age (N = 3) [ 31 , 38 , 43 ], and lower financial status (N = 2) [ 30 , 47 ] were associated with lower adherence in AET treatment. Various age ranges were used in the included studies.…”

Section: Resultsmentioning

confidence: 99%

“…Seven studies reported that using AI instead of tamoxifen was associated with better adherence. In addition, better adherence was also associated with patients who had sequential treatment or switched their AET from tamoxifen to AI [ 28 , 30 , 44 ]. Conversely, switching from AI to tamoxifen was associated with lower adherence when compared to patients taking AI only [ 44 ].…”

Section: Resultsmentioning

confidence: 99%

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Factors influencing five-year adherence to adjuvant endocrine therapy in breast cancer patients: A systematic review

et al. 2022

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Purpose This systematic review aimed to determine the rate and identify correlates of adherence and persistence over five years of treatment with adjuvant endocrine therapy in female breast cancer patients. Methods Relevant articles were identified from Medline, Embase, AMED, PsycINFO, International Pharmaceutical Abstracts, and APA PsycArticles. Studies that measured patient adherence in the implementation or persistence phase for a period of at least five years using objective or multiple measures of adherence and investigated correlates of adherence were included. The titles, abstracts and full articles were screened and reviewed by two authors and any discrepancies were discussed with a third author. Results Twenty-six studies were included. Mean rate of adherence at five-year for implementation phase was 66.2% (SD = 17.3%), and mean persistence was 66.8% (SD = 14.5%). On average, adherence decreased by 25.5% (SD = 9.3%) from the first to fifth year. Higher rate of adherence was observed through self-report in comparison to database or medical record. Older age, younger age, higher comorbidity index, depression and adverse effects were associated with lower adherence. Treatment with aromatase inhibitors, received chemotherapy, and prior medication use were associated with improved adherence. Conclusion Adherence to adjuvant endocrine therapy decreased from the first to fifth year of treatment. On average, one-third of patients were not adherent to treatment by the fifth year. Nineteen recurring factors were found to be significantly associated with long-term adherence in multiple studies. Further research using objective or multiple measures of adherence are needed to improve validity of results.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Factors influencing five-year adherence to adjuvant endocrine therapy in breast cancer patients: A systematic review

et al. 2022

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Section: Discussionmentioning

confidence: 99%

“…Notwithstanding these limitations, these national results (patients diagnosed in 2010) are reassuring, and are in contrast to a recent analysis of 33 260 women (diagnosed in 2011) with an adherence of 69% after 5 years. [32][33][34][35] Some limitations of this study exist: First, although 94% of the operated patients with BC also received their systemic treatment in the same centre, patient allocation remains difficult, becoming even worse with the integration and networking of hospitals. The more patients are followed in one centre, the more the data can be trusted.…”

Section: Centres Treating Patients With Breast Cancer and Centre Volume Distributionmentioning

confidence: 99%

Assessment of potential process quality indicators for systemic treatment of breast cancer in Belgium: a population-based study

Walle¹,

Punie

Eycken³

et al. 2021

ESMO Open

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Background: Quality indicators (QIs) for the management of breast cancer (BC) have been published in Europe and internationally. In Belgium, a task force was established to select measurable process indicators of systemic treatment for BC, focusing on appropriateness of delivered care. The objective of this study was to evaluate the results of the selected QIs, both nationally and among individual centres. Patients and Methods: Female Belgian residents with unilateral primary invasive BC diagnosed between 2010 and 2014 were selected from the Belgian Cancer Registry database. The national number enabled linkage with the national reimbursement database, which contains information on all reimbursed medical procedures. A total of 12 process indicators were measured on the population and hospital level. Intercentre variability was assessed by median results and interquartile ranges. Results: A total of 48 872 patients were included in the study. QIs concerning specific BC subtypes only applied to patients diagnosed in 2014 (n ¼ 9855). Clinical stage (cStage) I patients (n ¼ 17 116) were staged with positron emission tomography/computed tomography. Among patients who were pT1aN0 human epidermal growth factor receptor 2 (HER2) positive (n ¼ 47), 25.5% (n ¼ 12) received adjuvant trastuzumab. Among patients with de novo metastatic luminal A/B-like HER2-negative BC (n ¼ 295), 17.3% (n ¼ 51) received upfront chemotherapy. (Neo) adjuvant chemotherapy was administered in 52.4% (n ¼ 12 592) of operated women with cStage I-III, in 37.0% (n ¼ 1270) of operated women with cStage I-III luminal A/B-like HER2-negative BC, and in 19.1% of operated women with cStage I luminal A/B-like HER2-negative BC. In the population of operated patients with cStage I-III, of those younger than 70 years that started adjuvant endocrine therapy (n ¼ 3591), 81.7% (n ¼ 2932) continued treatment for !4.5 years. Among patients in cStage I-III older than 70 years (n ¼ 8544), 19.0% (n ¼ 1622) received (neo) adjuvant chemotherapy, whereas among patients with cStage I-III luminal A/B-like HER2-negative BC (n ¼ 1388), 13.0% (n ¼ 181) received (neo)adjuvant chemotherapy. In patients with cStage I-II luminal A/B-like HER2-negative BC older than 70 years (n ¼ 1477), 11.6% (n ¼ 171) were not operated and received upfront endocrine treatment. Conclusion: Well-considered QIs using population-based data can evaluate quality of care and expose disparities among treatment centres. Their use in daily practice should be implemented in all centres treating BC.

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Dynamic Projection of Medication Nonpersistence and Nonadherence Among Patients With Early Breast Cancer

Rinder,

Marcille,

Sinel-Boucher

et al. 2024

JAMA Netw Open

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ImportanceOral endocrine treatments have been shown to be effective when carefully adhered to. However, in patients with early breast cancer, adherence challenges are notable, with 17% experiencing nonpersistence and 41% nonadherence at least once.ObjectiveTo model the persistence of and adherence to oral anticancer treatment of a patient with localized breast cancer.Design, Setting, and ParticipantsThis cohort study was conducted using anonymous reimbursement data belonging to French female patients with breast cancer, extracted from the French Health Insurance database from January 2013 to December 2018. Data analysis was conducted from January 2021 to May 2022.Main Outcomes and MeasuresThe main outcome was the detection of episodes of nonpersistence and nonadherence 6 months before they happened. Adherence was defined as the ratio between the time covered by a drug purchase and the time between 2 purchases; patients were considered nonadherent if the ratio of their next 3 purchases was less than 80%. Disparities in persistence and adherence based on criteria such as age, treatment type, and income were identified.ResultsA total of 229 695 female patients (median [IQR] age, 63 [52-72] years) with localized breast cancer were included. A deep learning model based on a gated-recurrent unit architecture was used to detect episodes of nonpersistence or nonadherence. This model demonstrated an area under the receiving operating curve of 0.71 for persistence and 0.73 for adherence. Analyzing the Shapley Additive Explanations values also gave insights into the contribution of the different features over the model’s decision. Patients older than 70 years, with past nonadherence, taking more than 1 treatment in the previous 3 months, and with low income had greater risk of episodes of nonpersistence. Age and past nonadherence, including regularity of past adherence, were also important features in the nonadherence model.Conclusions and RelevanceThis cohort study found associations of patient age and past adherence with nonpersistence or nonadherence. It also suggested that regular intervals in treatment purchases enhanced adherence, in contrast to irregular purchasing patterns. This research offers valuable tools for improving persistence of and adherence to oral anticancer treatment among patients with early breast cancer.

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Five-Year Adjuvant Endocrine Therapy Adherence Trajectories Among Women With Breast Cancer: A Nationwide French Study Using Administrative Data

Cited by 17 publications

References 39 publications

Factors influencing five-year adherence to adjuvant endocrine therapy in breast cancer patients: A systematic review

Factors influencing five-year adherence to adjuvant endocrine therapy in breast cancer patients: A systematic review

Assessment of potential process quality indicators for systemic treatment of breast cancer in Belgium: a population-based study

Dynamic Projection of Medication Nonpersistence and Nonadherence Among Patients With Early Breast Cancer

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