Race and Patient-reported Symptoms in Adherence to Adjuvant Endocrine Therapy: A Report from the Women's Hormonal Initiation and Persistence Study

Abstract

Background: Adjuvant endocrine therapy (AET) improves outcomes in women with hormonereceptor positive (HR+) breast cancer (BC). Suboptimal AET adherence is common but data are lacking about symptoms and adherence in racial/ethnic minorities. We evaluated adherence by race and the relationship between symptoms and adherence.Methods: The Women's Hormonal Initiation and Persistence (WHIP) study included women diagnosed with non-recurrent HR+ BC who initiated AET. AET adherence was captured using validated items. Data regarding patient (e.g., race), medication-related (e.g., symptoms), cancer care delivery (e.g., communication), and clinicopathologic factors (e.g., chemotherapy) were collected via surveys and medical charts. Multivariable logistic regression models were employed to calculate odds ratios and 95% CIs associated with adherence.Results: Of the 570 participants, 92% were privately insured and nearly 1/3 were Black. Thirtysix percent reported nonadherent behaviors. In multivariable analysis, women less likely to report adherent behaviors were Black (vs. White) (OR: 0.43, 95%,

Racial Differences in Patient-Reported Symptoms and Adherence to Adjuvant Endocrine Therapy Among Women With Early-Stage, Hormone Receptor–Positive Breast Cancer

“…We evaluated all 60 symptom items collected from the PCM survey, and classified them into 7 physical and 2 psychological clusters according to previous literature and the clinical expertise from oncologists in our study team. 29 These 9 clusters are gastrointestinal symptoms, gynecological symptoms, neuropsychological symptoms, vasomotor symptoms, musculoskeletal symptoms, integumentary symptoms, cardiorespiratory symptoms, distress symptoms, and despair symptoms. A detailed list of individual symptoms in each cluster is provided in eTable 3 in the Supplement .…”

“…Prior studies 26 , 27 , 28 comparing symptom burden differences by race were unable to adjust for differences in baseline symptom severity or evaluate symptom burden changes during AET treatment. One recent study 29 assessed AET-related symptoms collected from a cross-sectional patient survey and found that after adjusting for symptom severity, Black women were still less likely to adhere to AET than White women. Evidence of symptom burden changes after starting AET and how differences in symptom burden changes are associated with differences in adherence by race is lacking.…”

Longitudinal Associations Among Physical Activity and Sitting with Endocrine Symptoms and Quality of Life in Breast Cancer Survivors: A Latent Growth Curve Analysis

“…Women with better QOL at baseline may have increased their sitting as they began to experience sideeffects of treatment. Furthermore, our prior ndings indicated that women who were the most adherent to AET had the highest levels of sitting time [34], perhaps suggesting that these women would experience side effects of AET early and these symptoms would then level off or increase more slowly over time.…”

King Abdulaziz University Breast Cancer Mammogram Dataset (KAU-BCMD)

“…A mammogram is the most widely used and reliable tool for breast cancer screening, exceeding even US as a tool for breast cancer detection. Breast US is rarely used as a diagnostic method for breast cancer as it does not detect early signs of cancer, such as microcalcifications (tiny calcium deposits) [7,8].…”

“…Therefore, local and public mammogram datasets are needed to help researchers detect and classify automatic breast cancer systems in women in Saudi Arabia, especially in the early stages. Some factors affect the probability of increasing breast cancer in Saudi more or less than other countries, such as health-related characteristics, menstrual history, obesity, and lack of exercise [8,12,20,21]. Early detection of breast cancer increases the probability of a cure to 92-96% [1,3].…”