Understanding premature discontinuation of aromatase inhibitor (AI) therapy in postmenopausal breast cancer survivors.

Stricker, CT; Palmer, Steven C.; DeMichele, A.; Mao, Jun J.

doi:10.1200/jco.2010.28.15_suppl.6073

Cited by 3 publications

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“…Despite the survival benefits associated with AIs, 5–36% of BrCa survivors experience joint pain resulting from their AI, referred to as aromatase inhibitor associated musculoskeletal symptoms (AIMSS) . AIMSS has been associated with poor AI adherence and self‐discontinuation of AIs . Poor adherence or self‐discontinuation of AIs because of side effects may attenuate the efficacy of AIs, thereby increasing the likelihood for cancer recurrence .…”

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Aromatase Inhibitor Associated Musculoskeletal Symptoms are associated with Reduced Physical Activity among Breast Cancer Survivors

et al. 2013

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Background Physical activity has numerous health benefits for breast cancer survivors. Recent data suggest that some breast cancer survivors treated with aromatase inhibitors may experience aromatase inhibitor associated musculoskeletal symptoms. It is unknown whether aromatase inhibitor associated musculoskeletal symptoms are associated with reduced physical activity and what other risk factors are associated with such physical activity reductions. Methods We conducted a cross-sectional study at a large university-based breast cancer clinic among breast cancer survivors prescribed an aromatase inhibitor. At routine follow-up, we surveyed participants about aromatase inhibitor associated musculoskeletal symptoms, as well as pre-aromatase inhibitor, and current, physical activity levels. Results Among 300 participants, 90 (30%) reported a reduction of physical activity since the initiation of aromatase inhibitor therapy. Those with aromatase inhibitor associated musculoskeletal symptoms were more likely to report decreased physical activity (62% versus 38%, p=0.001) compared to those without aromatase inhibitor associated musculoskeletal symptoms. In multivariate analyses, aromatase inhibitor associated musculoskeletal symptoms [odds ratio (OR) =2.29 (95% confidence interval (CI): 1.36–3.86)], and body mass index [OR=1.06 (95% CI: 1.02–1.12)] were associated with reductions in physical activity. In subgroup analysis among breast cancer survivors with aromatase inhibitor associated musculoskeletal symptoms, self-reported lower extremity joint pain [OR=1.23 (95% CI: 1.00–1.50)] and impaired lower extremity physical function [OR=1.07 (95% CI: 1.01–1.14)] were associated with reductions in physical activity. Conclusion Breast cancer survivors with aromatase inhibitor associated musculoskeletal symptoms were more likely to report reductions in physical activity since initiating aromatase inhibitor therapy compared to those without aromatase inhibitor associated musculoskeletal symptoms. Our findings suggest that tailored interventions targeting lower extremity functional limitations are needed to enable breast cancer survivors with aromatase inhibitor associated musculoskeletal symptoms to participate in physical activity.

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Aromatase Inhibitor Associated Musculoskeletal Symptoms are associated with Reduced Physical Activity among Breast Cancer Survivors

et al. 2013

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“…In the context of adherence though, can DPs enhance patient-centered communication around adherence? There is evidence that patients who are not asked about the difficulties of adhering to treatment are less likely to be adherent (Stricker et al 2010). However, an observational linguistic study of patients with breast cancer, and their oncologist showed that discussions about hormonal therapy do not tend to address the challenges of adhering to the medication (Davidson, Vogel and Wickerham 2007).…”

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confidence: 99%

Rethinking agency and medical adherence technology: applying Actor Network Theory to the case study of Digital Pills

2015

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Much literature surrounding medical technology and adherence posits that technology is a mechanism for social control. This assumes that the medical establishment can take away patients' agency. Although power relationships and social control can play a key role, medical technology can also serve as an agentive tool to be utilized. We (1) offer the alternative framework of Actor Network Theory to view medical technology, (2) discuss the literature on medication adherence and technology, (3) delve into the ramifications of looking at adherence as a network and (4) use Digital Pills as a case study of dispersed agency.

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Perspectives on Adherence and Persistence With Oral Medications for Cancer Treatment

Hohneker

Shah-Mehta

Brandt

2011

JOP

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Novartis, East Hanover, NJ As oral cancer therapies are developed, a high degree of persistence and adherence is necessary for optimal outcomes. Ensuring persistence, continuing treatment for the prescribed duration, and adherence-taking medication as prescribedhas been a challenge to patient management and health care cost containment in real-world settings. 1 It may appear as though persistence and adherence to oral cancer therapies is superior to that observed with oral noncancer therapies. 2 Indeed, patients with cancer tend to be highly motivated, to prefer oral therapies, and to exhibit high persistence and adherence in clinical trials. 3 However, emerging real-world data indicate otherwise.Persistency rates for oral cancer medications are generally lower in real-world settings compared with in clinical trials (Table 1), 4-20 especially for chronically administered medications. Persistence with tamoxifen at 3.9 years was 71.7% in the Arimidex, Tamoxifen Alone or in Combination (ATAC) trial, 6 but persistence was only 64.8% at 3.5 years among women identified in a pharmacy database. 5 The difference may be more pronounced in the elderly. 9,12 Similarly, persistence with letrozole was 84% at 4.25 years in the Breast International Group 1-98 trial, 5 but it was only 77% at 1 year in an analysis of two large-claims databases (data on file, Novartis, East Hanover, NJ). This difference remains despite inclusion of 23% of patients with a Ն 30-day treatment gap (Figure 1). Differences were not limited to patients with breast cancer. In the IRIS (International Randomized Study of Interferon Versus ST1571) trial, patients with chronic myelogenous leukemia (CML) persisted with imatinib at a rate of 91% at 19 months. 4 By contrast, real-world persistence at 12 and 24 months among patients with CML and GI stromal tumors was 56% and 41%, respectively, when dosing gaps Ն 30 days were disallowed (data on file, Novartis, East Hanover, NJ). In addition, pharmacy records from 4,043 patients demonstrated a decrease in imatinib persistence from 100% to 23% between months 4 and 14 of treatment. 21 There is less information on adherence compared with persistence in clinical trials. In the adherence companion study 60104 to Cancer and Leukemia Group B 49907, adherence to capecitabine in elderly patients with breast cancer was 78% during the prescribed six cycles of therapy. 18 In the real world, a 96.7% adherence was observed. 20 However, capecitabine is not a chronic therapy, and in this study, adherence was measured for only 44.3 days (two cycles). The majority of adherence data is from the real-world setting, and these have shown variability (Table 1). Analysis of claims data demonstrated 89% adherence to imatinib among patients with CML at 1 year when unlimited dosing gaps were allowed (data on file, Novartis, East Hanover, NJ). It was 78% at 2 years according to pharmacy records. 21 Among patients with breast cancer, 54% to 80% of patients receiving hormonal therapy have been shown to adhere to treatment (data on fil...

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Understanding premature discontinuation of aromatase inhibitor (AI) therapy in postmenopausal breast cancer survivors.

Cited by 3 publications

References 0 publications

Aromatase Inhibitor Associated Musculoskeletal Symptoms are associated with Reduced Physical Activity among Breast Cancer Survivors

Aromatase Inhibitor Associated Musculoskeletal Symptoms are associated with Reduced Physical Activity among Breast Cancer Survivors

Rethinking agency and medical adherence technology: applying Actor Network Theory to the case study of Digital Pills

Perspectives on Adherence and Persistence With Oral Medications for Cancer Treatment

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