Predictors of Tamoxifen Discontinuation Among Older Women With Estrogen Receptor–Positive Breast Cancer

Owusu, Cynthia; Buist, Diana S.M.; Field, Terry S.; Lash, Timothy L.; Thwin, Soe Soe; Geiger, Ann M.; Quinn, Virginia P.; Frost, Floyd J.; Prout, Marianne N.; Yood, Marianne Ulcickas; Wei, Feifei; Silliman, Rebecca A.

doi:10.1200/jco.2006.10.1022

Cited by 283 publications

(274 citation statements)

References 31 publications

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“…Although several studies performed in clinical practise settings (Waterhouse et al, 1993;Demissie et al, 2001;Silliman et al, 2002;Partridge et al, 2003Partridge et al, , 2008Fink et al, 2004;Grunfeld et al, 2005;Atkins and Fallowfield, 2006;Lash et al, 2006;Barron et al, 2007;Owusu et al, 2008) and clinical trials (Fisher et al, 1989;Coombes et al, 2004;Coates et al, 2007;Forbes et al, 2008) have addressed non-adherence to endocrine therapy for breast cancer, the conclusions that can be drawn from the currently available evidence are significantly limited. The reported rates of nonadherent patients in adjuvant endocrine therapy of breast cancer range considerably from 15 to 50%.…”

Section: Discussionmentioning

confidence: 94%

“…Patient refusal to initiate the recommended antihormonal medication and non-adherence to therapy (defined as a composite of compliance and persistence: the patient started therapy, but discontinued the planned treatment) are important, but are not the only contributors. Both factors were evaluated in several studies, in clinical trials (Fisher et al, 1989;Coombes et al, 2004;Coates et al, 2007;Forbes et al, 2008) and in clinical practise settings (Waterhouse et al, 1993;Demissie et al, 2001;Silliman et al, 2002;Partridge et al, 2003Partridge et al, , 2008Fink et al, 2004;Grunfeld et al, 2005;Atkins and Fallowfield, 2006;Lash et al, 2006;Barron et al, 2007;Owusu et al, 2008). These studies, however, evaluated only selected populations and failed to describe all the possible situations that determine compliance and adherence to therapy in everyday clinical settings.…”

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confidence: 99%

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Target and reality of adjuvant endocrine therapy in postmenopausal patients with invasive breast cancer

Güth

Huang

Schötzau³

et al. 2008

Br J Cancer

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Previous research evaluating the use of adjuvant endocrine therapy among postmenopausal breast cancer patients showed with 15 -50% wide ranges of non-adherence rates. We evaluated this issue by analysing an unselected study group comprising of 325 postmenopausal women, diagnosed from 1997 to 2003 with hormonal receptor-positive invasive breast cancer. The different clinical situations that led to the discontinuation of adjuvant endocrine therapy were clearly defined and differentiated: non-adherence was not simply the act of stopping medication, but rather the manifestation of an intentional behaviour of the patient. Of the 287 patients who initiated endocrine therapy, 191 (66.6%) fully completed this treatment. Thirty-one patients (10.8%) showed non-adherence to therapy. Patients who had follow-up with a general practitioner, rather than in an oncologic unit, were more likely to be non-adherent (P ¼ 0.0088). Of 25 patients who changed medication due to therapy-related adverse effects, 20 (80%) patients fully completed the therapy after drug change. In adjuvant endocrine therapy, a lowering of the non-adherence rate to 10.8%, the lowest reported in the literature, is realistic when patients are cared for by a specialised oncologic unit focusing on the individual needs of the patients.

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Section: Discussionmentioning

confidence: 94%

mentioning

confidence: 99%

Target and reality of adjuvant endocrine therapy in postmenopausal patients with invasive breast cancer

Güth

Huang

Schötzau³

et al. 2008

Br J Cancer

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“…By year 4 or 5 of treatment, the full adherence rate drops to 50% (14,16). Similarly, nonpersistence with adjuvant tamoxifen is about 20% to 30% at year 1 or 2 (15,17,18) and climbs to as high as 49% before the completion of 5 years (15,16,19). Available data on the association between adherence to adjuvant tamoxifen therapy and breast cancer outcomes have suggested that poor tamoxifen adherence contributes to therapeutic failure with an increased risk for poor outcomes.…”

Section: Early Disease/adjuvant Therapymentioning

confidence: 99%

“…Severe adverse events and side effects, or concerns about their development, are certainly likely to cause women to discontinue the treatment (9, 10). There is some evidence that ethnicity, demographic factors, including socioeconomic status, education level, and age, especially extremes of age under 40-45 and over 75-85, have also been linked to lower adherence (14,16,19,(22)(23)(24) (Table 1). Of the 2 pivotal adherence analyses in the adjuvant setting, Partridge and colleagues (14) found that age younger than 45 years or 85 years or older and nonwhite ancestry were the major predictors for poor (<80%) adherence to tamoxifen at 4 years in 2,378 adjuvant patients.…”

Section: Early Disease/adjuvant Therapymentioning

confidence: 99%

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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“…Elderly patients with comorbidity do not receive standard cancer therapy because aging often involves a decline in tumor aggressiveness and a corresponding decline in the effectiveness of treatment such as chemotherapy [34][35][36]. The chance of completing the course of treatment is also lower among these patients [37]. Large randomized trials usually exclude elderly patients with breast cancer, as well as people with comorbidities, thus there is an insufficient evidence for the treatment of such patients [38][39][40][41].…”

Section: Discussionmentioning

confidence: 99%

Survival Analysis of Women with Triple Negative Breast Cancer Using EMRLinked Cancer Registry Data in Florida

Xiao¹

2017

Journal of Women’s Health and Gynecology

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Background: Triple negative breast cancer (TNBC) is an aggressive tumor phenotype which has limited therapeutic options. Epidemiological studies suggested a number of risk factors that are associated with the prognosis of TNBC. Survival difference exists among patients diagnosed with TNBC after adjusting these risk factors. This study aims to investigate the survival of women with triple negative phenotype breast cancer (BC).

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Predictors of Tamoxifen Discontinuation Among Older Women With Estrogen Receptor–Positive Breast Cancer

Abstract: Attention to nonadherence among older women at risk of discontinuation, particularly those receiving BCS without radiotherapy, might improve breast cancer outcomes for these women.

Cited by 283 publications

References 31 publications

Target and reality of adjuvant endocrine therapy in postmenopausal patients with invasive breast cancer

Target and reality of adjuvant endocrine therapy in postmenopausal patients with invasive breast cancer

Predicting Adherence to Tamoxifen for Breast Cancer Adjuvant Therapy and Prevention

Survival Analysis of Women with Triple Negative Breast Cancer Using EMRLinked Cancer Registry Data in Florida

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