Predicting Compliance in a Breast Cancer Prevention Trial

Maurice, Andrew; Howell, Anthony; Evans, D. Gareth; O'Neil, Alison C.; Scobie, S.

doi:10.1111/j.1075-122x.2006.00295.x

Cited by 19 publications

(30 citation statements)

References 13 publications

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“…Adherence data in smokers were obtained at 8 time points during the 36 months, showing a gradual decline in adequate adherence that became highly significant at 3 years. These smoking and adherence data are consistent with a small adherence substudy (n ¼ 100) of IBIS-1 (30) and with data from the NSABP STAR showing an association of smoking history with decreased adherence to either tamoxifen or raloxifene (31). Of interest, tamoxifen adverse events (e.g., depression and migraines) correlated with current smoking (vs. nonsmoking) in a separate study (32), and a previous study by Land and colleagues showed a strong association of smoking with an increased risk of breast cancer (P ¼ 0.007; ref.…”

Section: Healthy High Risk/preventionsupporting

confidence: 86%

Predicting Adherence to Tamoxifen for Breast Cancer Adjuvant Therapy and Prevention

Zhang

Manson

2011

Cancer Prevention Research

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Treatment with the selective estrogen receptor modulator (SERM) tamoxifen for 5 years has produced dramatic breast cancer-related benefits in (a) the adjuvant setting, with 30% to 50% reductions in recurrence, contralateral disease, and mortality and (b) the prevention setting of healthy high-risk women, where tamoxifen reduces the risk of invasive and noninvasive breast cancer by 50%. Despite these striking data, adherence to tamoxifen is low, and low adherence is associated with poor survival. Although toxicity is a major predictor of poor adherence after starting therapy, pretreatment (baseline) predictors of poor tamoxifen adherence have been minimally studied. The adherence-survival link underscores the critical need to identify early predictors of poor adherence, and recent work is beginning to address this need. A major baseline predictor of poor adherence to prevention is current smoking, which is interestingly absent from studies of adherence to adjuvant therapy. Other important prevention adherence factors include breast cancer risk, extremes of age, non-white ethnicity, low socioeconomic status, and alcohol use. The strongest adjuvant therapy predictors are age (especially very young), ethnicity, and socioeconomic status. Future studies involving prospective systematic evaluation of these and other potential predictors in endocrine chemoprevention (e.g., other SERMs and aromatase inhibitors) are critical, as is the development of effective/targeted interventions to improve adherence and thus treatment outcomes in at-risk women.

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Section: Healthy High Risk/preventionsupporting

confidence: 86%

Predicting Adherence to Tamoxifen for Breast Cancer Adjuvant Therapy and Prevention

Zhang

Manson

2011

Cancer Prevention Research

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“…3 The significant association between persistence with treatment and increasing numbers of prescribed medications has been observed in previous studies of tamoxifen persistence 13,14 and more recently in reports from the international breast intervention study, IBIS-I. 31 It has been suggested that patients with a large medication burden develop routines to promote adherence. 13,31 It is also possible that the healthy drug user effect 32 may play a role in this association, whereby patients with good health-seeking behavior who are in turn more likely to seek and receive medical treatment for conditions are also those patients with good medication-taking behavior.…”

Section: Discussionmentioning

confidence: 91%

“…31 It has been suggested that patients with a large medication burden develop routines to promote adherence. 13,31 It is also possible that the healthy drug user effect 32 may play a role in this association, whereby patients with good health-seeking behavior who are in turn more likely to seek and receive medical treatment for conditions are also those patients with good medication-taking behavior.…”

Section: Discussionmentioning

confidence: 99%

Early discontinuation of tamoxifen

Barron

Connolly

Bennett

et al. 2007

Cancer

261

248

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BACKGROUND.Five years of treatment provides the optimum duration of tamoxifen therapy for the prevention of breast cancer recurrence and mortality. Durations of adjuvant tamoxifen therapy less than 5 years are associated with poorer outcomes for breast cancer patients. The purpose of the study was to assess rates of tamoxifen nonpersistence (early discontinuation) in women aged 35 years or older using prescription refill data from a national prescribing database.METHODS.A cohort of 2816 women commencing tamoxifen as initial hormonal therapy was identified between January 2001 and January 2004. The cumulative tamoxifen persistence rate was calculated for these women and the relation between nonpersistence and clinical and demographic variables assessed.RESULTS.Within 1 year of commencing treatment the cumulative tamoxifen nonpersistence rate was 22.1%. This is twice the rate of treatment discontinuation observed in other studies by this time. By the end of follow‐up at 3.5 years, the cumulative nonpersistence rate had increased to 35.2%. Determinants of nonpersistence identified included age and a history of antidepressant use.CONCLUSIONS.The rate of nonpersistence with tamoxifen therapy is higher than previously reported. This study demonstrates that persistence with tamoxifen cannot be assumed and raises concerns about persistence with other oral hormonal therapies for breast cancer and oral antineoplastics in general. Oncologists need to identify those at risk of nonpersistence and develop strategies to combat this barrier to treatment success. Cancer 2007. © 2007 American Cancer Society.

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“…problem, reaching rates as high as 60%, 20,23,24,[28][29][30][31][32] and places patients at risk of inadequate clinical benefit. [24][25][26][27]40,41 The primary goal of the present study was to evaluate the compliance of patients with breast cancer with hormonal therapy when treatment involved regular follow-up with a breast specialist. Although the literature remains scarce concerning the contribution of the required type of follow-up, the need to provide information to the patients remains crucial.…”

Section: Discussionmentioning

confidence: 99%

Adherence to adjuvant endocrine therapy in estrogen receptor–positive breast cancer patients with regular follow-up

et al. 2014

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Background: Adjuvant hormonal therapy is crucial in the treatment of estrogen receptor-positive breast cancer. The nonadherence rate to hormonal treatment is reported to be as high as 60%. The goal of this study was to evaluate the factors evoked by the patients as well as the demographic and disease-related factors that could be associated with nonadherence to adjuvant hormonal therapy.Methods: All consecutive patients treated for an estrogen receptor-positive breast cancer who showed up for regular follow-up with a single breast specialist between November 2008 and April 2009 were included in the study. We assessed adherence to hormonal therapy (either with tamoxifen or aromatase inhibitor). Reasons for adherence and nonadherence were collected. Records were also reviewed for demographic and cancer characteristics and for treatment components. Results:We included 161 patients in the study; 150 (93.2%) adhered to hormonal treatment. Side effects and absence of conviction were the main reasons for nonadherence. The importance of the diagnosis of cancer, fear of recurrence and regular follow-up were reported as the main reasons for adherence. Conclusion:Severity of disease and side effects are associated with nonadherence to treatment. Strict follow-up appears to be a necessary adjunct in the adherence to treatment. The association between demographic and cancer characteristics and treatment components needs further investigation. However, these factors may help identify patients at risk of nonadherence and help the oncology team.Contexte : Le traitement hormonal adjuvant est crucial dans le traitement du cancer du sein avec récepteurs estrogéniques positifs. Le taux d'inobservance au traitement hormonal atteint 60 %. Le but de cette étude consiste à évaluer les facteurs évoqués par les patientes ainsi que les facteurs démographiques et pathologiques pouvant être associés à l'inobservance au traitement hormonal adjuvant. Méthodes :Toutes les patientes qui ont été traitées pour cancer du sein avec récep-teurs estrogéniques positifs et suivies régulièrement par un spécialiste du cancer du sein de novembre 2008 à avril 2009 ont été incluses dans l'étude. L'adhérence au traitement hormonal (tamoxifène ou inhibiteur de l'aromatase) a été évaluée. Les dossiers des patientes ont aussi été révisés pour colliger les facteurs démographiques, pathologiques et thérapeutiques. Résultats :Il y a eu 161 patientes; 150 (93,2%) ont suivi le traitement hormonal. Les effets secondaires et l'absence de conviction des patientes face au bénéfice du traitement furent les principales raisons évoquées pour ne pas prendre la médication. L'importance du diagnostic de cancer, la peur de récidive et le suivi régulier furent les principales raisons rapportées pour suivre le traitement.Conclusion : La sévérité de la maladie et les effets secondaires sont associés avec l'inobservance au traitement hormonal. Le suivi rigoureux semble s'avérer nécessaire dans l'observance au traitement des patientes. La relation entre les facteurs démographiques,...

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Predicting Compliance in a Breast Cancer Prevention Trial

Cited by 19 publications

References 13 publications

Predicting Adherence to Tamoxifen for Breast Cancer Adjuvant Therapy and Prevention

Predicting Adherence to Tamoxifen for Breast Cancer Adjuvant Therapy and Prevention

Early discontinuation of tamoxifen

Adherence to adjuvant endocrine therapy in estrogen receptor–positive breast cancer patients with regular follow-up

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