Oral Endocrine Therapy Agent, Race/Ethnicity, and Time on Therapy Predict Adherence in Breast Cancer Patients in a Large Academic Institution

Hwang, Grace S.; Paranjpe, Rutugandha; Opsomer, Carine; Lu, Kelvin; Abajue, Uzoamaka; Abughosh, Susan; Zaghloul, Hanna; Trivedi, Meghana V.

doi:10.1016/j.clbc.2020.06.004

Cited by 8 publications

(5 citation statements)

References 25 publications

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“…Even before the pandemic, OET adherence was low at only 57% in patients with low SES. This was lower than the OET adherence of 82% at the Houston Methodist Hospital serving insured patients in the same geographic location of Houston before the pandemic in our previous study [ 42 ]. The pandemic further and significantly reduced OET adherence to only 44% of Harris Health patients.…”

Section: Discussioncontrasting

confidence: 63%

Adherence to oral endocrine therapy in racial/ethnic minority patients with low socioeconomic status before and during the COVID-19 pandemic

et al. 2023

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Background Adherence to oral endocrine therapy (OET) is crucial in ensuring its maximum benefit in the prevention and treatment of hormone receptor-positive (HR +) breast cancer (BC). Medication use behavior is suboptimal especially in racial/ethnic minorities with lower socioeconomic status (SES). Aim We aimed to assess the impact of the coronavirus disease 2019 (COVID-19) pandemic on OET adherence and identify demographic and/or clinical characteristics associated with nonadherence in racial/ethnic minorities with lower SES. Method A retrospective study was conducted at the Harris Health System in Houston, Texas. Data were collected during the 6 months before and 6 months after the start of the pandemic. The adherence was assessed using the prescription refill data using the proportion of days covered. A multivariable logistic regression model was used to identify demographic/clinical characteristics associated with nonadherence. Eighteen years or older patients on appropriate doses of OET for prevention or treatment of BC were included. Results In 258 patients, adherence was significantly lower during the pandemic (44%) compared to before the pandemic (57%). The demographic/clinical characteristics associated with OET nonadherence before the pandemic were Black/African American, obesity/extreme obesity, prevention setting, tamoxifen therapy, and 4 or more years on OET. During the pandemic, prevention setting and those not using home delivery were more likely to be nonadherent. Conclusion OET adherence was significantly reduced during the COVID-19 pandemic in racial/ethnic minority patients with low SES. Patient-centered interventions are necessary to improve OET adherence in these patients.

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Section: Discussioncontrasting

confidence: 63%

Adherence to oral endocrine therapy in racial/ethnic minority patients with low socioeconomic status before and during the COVID-19 pandemic

et al. 2023

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“…The association between hot flashes or night sweats and adherence was inconsistent [ 71 99 131 137 138 141 ]. Although the type of AHT also accounted for a substantial portion [ 37 44 59 61 62 63 64 67 75 77 82 85 86 94 101 121 140 142 143 ], whether tamoxifen or AIs discouraged patients from adhering to the prescription was controversial. Unlike taking both tamoxifen and AIs [ 13 ] or initiation with AIs [ 61 85 ], the use of exemestane or letrozole was negatively associated with adherence to AHT [ 42 52 63 91 ].…”

Section: Resultsmentioning

confidence: 99%

“…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 ].…”

Section: Resultsmentioning

confidence: 99%

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

Yang¹,

Park²,

Bae

et al. 2023

J Breast Cancer

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Purpose Adherence and persistence to adjuvant hormone therapy (AHT) are seldom maintained among early-stage hormone receptor-positive breast cancer (BC) survivors, despite the significant clinical benefits of long-term AHT. As the factors influencing adherence to AHT remain unclear, this study aimed to comprehensively identify such factors and classify them into specific dimensions. Methods PubMed, Cochrane Library, Embase, PsycINFO, and CINAHL were searched for qualified articles. The search mainly focused on three components: early-stage (0–III) BC, oral AHT administration, and adherence to AHT, with keywords derived from MeSH and entry terms. The factors identified were then classified into six categories based on a modified WHO multidimensional model. Results Overall, 146 studies were included; the median sample size was 651 (range, 31–40,009), and the mean age of the population was 61.5 years (standard deviation, 8.3 years). Patient- and therapy-related factors were the most frequently investigated factors. Necessity/concern beliefs and self-efficacy among patient-related factors were consistently related to better adherence than depression. Although drug side effects and medication use cannot be modified easily, a refined prescription strategy for the initiation and switching of AHT is likely to increase adherence levels. Conclusion An effective psychological program that encourages positive views and beliefs about medication and management strategies for each therapy may be necessary to improve adherence to AHT. Social support and a sense of belonging can be enhanced through community participation and social media for better adherence to AHT. Patient-centered communication and appropriate recommendations by physicians may be attributable to better adherence outcomes. Findings from systematically organized factors that influence adherence to AHT may contribute to the establishment of intervention strategies to benefit patients with early-stage BC to achieve optimal health.

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“…Except the drug side effects, many other factors are also found to be associated with the low compliance of aET (Hadji et al, 2013;Sawesi et al, 2014;Cahir et al, 2015;Farias and Du, 2017). Given that the medication compliance is a complex and dynamic behavior, it is associated with many aspects such as patient demographic and socio-economic status, patient comorbidity, and patient daily performance, other therapy-related adverse or efficacy, and others (Sawesi et al, 2014;Chirgwin et al, 2016;Farias and Du, 2017;Moon et al, 2017;Paranjpe et al, 2019;Wassermann et al, 2019;Clancy et al, 2020;Hwang et al, 2020). Farias and Du (2017) analyzed 8,688 Medicare BC patients, and found that 36.8% patients were non-adherent to aET, and the racial/ ethnic disparities in aET adherence could be largely explained by women's differences in socioeconomic status and out-of-pocket medication costs.…”

Section: Discussionmentioning

confidence: 99%

“…However, in contrary to these findings, a low compliance of oral aET continues to be a prevalent issue in many countries for different reasons. The reasons behind are often involved with a wide range of numerous elements on patient, physician, side effects, drug cost, and others (Farias and Du 2017;Paranjpe et al, 2019;Clancy et al, 2020;Hwang et al, 2020;Peddie et al, 2021). So far, the majority of studies on the compliance of aET were conducted in the developed countries and mostly among the non-Asian BC patients (Clancy et al, 2020;Peddie et al, 2021).…”

Section: Introductionmentioning

confidence: 99%

Full Compliance of Adjuvant Endocrine Therapy Is Associated with Higher Disease-Free Survival in Hormone Receptor-Positive and HER2-Negative Chinese Breast Cancer Patients with First Tumor Recurrence

Liu

et al. 2022

Asian Pac J Cancer Prev

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Purpose: To characterize the compliance status of adjuvant endocrine therapy (aET) and its relationship with diseasefree survival (DFS) in hormone receptor-positive (HR+) and HER2-negative (HER2−) in Chinese breast cancer (BC) patients with first tumor recurrence. Methods: All women with primary unilateral stage I -III HR+HER2− BC and first tumor recurrence in 2008 -2018 at our institution were identified. Full (vs. none/partial) compliance of aET was classified from records. Multivariate Cox regression estimated the hazard ratio (HR), its 95% confidence interval (CI), and p value. DFS. Covariates included age, T stage, N stage, pathology, tumor grade, LVI, chemotherapy, radiotherapy. Results: A total 258 patients had average age 47.4 years at BC diagnosis and median DFS 31.7 months. Patients with ipsilateral (contralateral) region and organ recurrence were 47.7% (19.8%) and 71.9%. Compared to the patients with none/partial compliance of aET, the full compliance patients (54.3% ) had a higher DFS (median 35.0 vs. 25.2 months, p=0.009). Multivariate analysis showed that the full compliance of aET was associated with a lower HR 0.614 (95%CI 0.467 -0.807, p<0.001) on recurrence. Early discontinuation (67.5%, 56/83) due to the drug side effects was the top reason for partial compliance of aET. Conclusions: Full compliance of aET was quite low in Chinese HR+HER2− BC patients. However, it was associated with a 38.6% lower risk of first tumor recurrence. To search for effective tools to improve the compliance of aET in this population should be stressed.

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Oral Endocrine Therapy Agent, Race/Ethnicity, and Time on Therapy Predict Adherence in Breast Cancer Patients in a Large Academic Institution

Cited by 8 publications

References 25 publications

Adherence to oral endocrine therapy in racial/ethnic minority patients with low socioeconomic status before and during the COVID-19 pandemic

Adherence to oral endocrine therapy in racial/ethnic minority patients with low socioeconomic status before and during the COVID-19 pandemic

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

Full Compliance of Adjuvant Endocrine Therapy Is Associated with Higher Disease-Free Survival in Hormone Receptor-Positive and HER2-Negative Chinese Breast Cancer Patients with First Tumor Recurrence

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