Pretreatment Predictors of Short-Term Nonadherence to Oral Hormonal Therapy for Women With Breast Cancer

Abstract

Background Adjuvant treatment with oral hormonal therapy improves clinical outcomes for breast cancer, but women have difficulty adhering to the five-year regimen. Objective To explore pretreatment predictors of short-term nonadherence to oral hormonal therapy for women with early stage breast cancer from the pretreatment assessment to six months after initiation of hormonal therapy. Method A secondary analysis was performed using data collected from 198 women enrolled in one of two longitudinal studies. Nonadherence was defined as the percentage of prescribed doses of hormonal therapy not taken during the first six months of therapy measured using electronic medication event monitoring. Information on predictor variables was measured at pretreatment using self-report and medical record review. Linear regression analysis was performed to examine associations between predictor variables and six-month nonadherence in a bivariate manner to first identify candidate predictors variables at p < .20 and then multivariately considering candidate predictors identified through stepwise and backward elimination regression methods. Results Participants were white (98.3%), well educated (M = 15.0; SD = 2.9 years of schooling), and on average 59.1 years of age (SD = 7.5). Mean nonadherence was 11.3%. Stepwise and backward elimination modeling algorithms identified a similar set of predictors associated with six-month nonadherence and explained 13.0% of the variance (adjusted R2 = .11, standard error of the estimate = 0.28). Ductal carcinoma in situ tumor type (p = .004) and higher weight concern scores (p = .003) were associated with nonadherence. Discussion The findings suggest that additional examinations of associations of tumor type and symptom burden with nonadherence are indicated.

Influence of Patient and Treatment Factors on Adherence to Adjuvant Endocrine Therapy in Breast Cancer

“…The symptoms that predicted nonadherence to endocrine therapy were self-reported cognitive symptoms (p < 0.05), musculoskeletal pain (p < 0.05), weight concerns (p < 0.01), and gynecologic symptoms (p < 0.01). Several studies stated that self-reported symptoms were related to nonadherence (Wickersham et al, 2013) and higher endocrine therapy discontinuation rates (Demissie et al, 2001; Fink et al, 2004; Grunfeld et al, 2005; Kahn et al, 2007). Grunfeld et al (2005) reported that 46% of women who discontinued tamoxifen therapy did so because of the symptoms experienced.…”

“…The presence of greater number of comorbidities (Owusu et al, 2008; Sedjo & Devine, 2011) and concomitant medications (Fink, 2004; Grunfeld, Hunter, Sikka, & Mittal, 2005; Lash et al, 2006) have been associated with nonadherence to endocrine therapy. Women with lower disease stage (Lebovits et al, 1990; Wickersham, Sereika, & Bender, 2013) and who did not receive chemotherapy before endocrine therapy (Fink et al, 2004) were more likely to discontinue therapy; however, women who had breast-conserving surgery (Owusu et al, 2008) and changed endocrine therapy agents (Sedjo & Devine, 2011) were more likely to be nonadherent to therapy. One of the most common reasons for a prescribed change in endocrine therapy agents was the presence and severity of disease- and treatment-related symptoms.…”

“…One of the most common reasons for a prescribed change in endocrine therapy agents was the presence and severity of disease- and treatment-related symptoms. Most investigators have found that disease- and treatment-related symptoms are associated with nonadherence to endocrine therapy in women with breast cancer (Demissie et al, 2001; Fink et al, 2004; Grunfeld et al, 2005; Kahn et al, 2007; Wickersham et al, 2013). Ziller et al (2009) found no relationship between disease- and treatment-related symptoms and nonadherence; however, adherence was measured via self-report and symptoms were documented by medical record review.…”

“…Studies that examined the influence of patient and illness or treatment factors on nonadherence to endocrine therapy in women with breast cancer have produced conflicting results (Chlebowski & Geller, 2006; Owusu et al, 2008; Wickersham et al, 2013). The basis of these conflicting results is likely, in part, because of differences in the approaches of conceptualizing and measuring adherence.…”

Manejo Nutricional em Paciente com Metástase Gástrica de Câncer de Mama: um Relato de Caso

“…a metástase gástrica do câncer de mama, quando presente, é de difícil diagnóstico, já que os sinais clínicos são geralmente inespecíficos ou mesmo inexistentes ou ainda podem ser mascarados pelos efeitos colaterais oriundos do tratamento do tumor primário 4 . um exemplo é o uso de terapia hormonal oral (como tamoxifeno), a qual pode desencadear efeitos colaterais gastrointestinais 16 . Maximizando o fato de que mulheres com câncer de mama metastático para estômago têm pior prognóstico 4 .…”