Adherence and discontinuation of oral hormonal therapy in patients with hormone receptor positive breast cancer

Ayres, Lorena Rocha; Baldoni, André Oliveira; Borges, Anna Paula de Sá; Pereira, Leonardo Régis Leira

doi:10.1007/s11096-013-9833-5

Cited by 59 publications

(56 citation statements)

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“…The findings are somewhat mixed considering aromatase inhibitor adherence in clinical practices (23,24); however, in the United Kingdom general practice database, the 1-year discontinuation rate for adjuvant aromatase inhibitor use was 5% compared with about 10% for tamoxifen in women >49 years old and 20% for tamoxifen in women <40 years old (25). Similarly, in the Disease Analyses database (IMS Health), among 16,865 patients with breast cancer, 3-year discontinuation rates were 52% for tamoxifen, 47% for anastrozole, and 44% for letrozole (26).…”

Section: Adjuvant Endocrine Therapy Adherence In Clinical Trials and mentioning

confidence: 99%

Adherence to Endocrine Therapy in Breast Cancer Adjuvant and Prevention Settings

Chlebowski

Kim

Haque

2014

Cancer Prevention Research

146

142

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Adherence to oral endocrine therapy in adjuvant breast cancer settings is a substantial clinical problem. To provide current perspective on adherence to oral endocrine therapies, a comprehensive literature review was conducted. In adjuvant trials, endocrine therapy adherence is relatively high with greater adherence for aromatase inhibitors compared with tamoxifen. In contrast, adherence to adjuvant therapy in clinical practice is relatively poor, with only about 50% of women successfully completing 5-year therapy. Importantly, good adherence (>80% use) has been associated with lower recurrence risk. Endocrine therapy adherence in primary breast cancer prevention trials parallels that seen in adjuvant trials. Factors associated with nonadherence include low recurrence risk perception, side effects, age extremes, medication cost, suboptimal patient-physician communication, and lack of social support. Few prospective studies have evaluated interventions designed to improve adherence. Interventions currently proposed reflect inferences from clinical trial procedures in which clinical contacts are commonly greater than in usual practice settings. In conclusion, for optimal breast cancer outcome, adherence to endocrine therapy must improve. Although general recommendations likely to improve adherence can be made based on clinical trial results and preliminary prospective trial findings, research specifically targeting this issue is needed to establish effective intervention strategies. Cancer Prev Res; 7(4); 378-87. Ó2014 AACR.

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Section: Adjuvant Endocrine Therapy Adherence In Clinical Trials and mentioning

confidence: 99%

Adherence to Endocrine Therapy in Breast Cancer Adjuvant and Prevention Settings

Chlebowski

Kim

Haque

2014

Cancer Prevention Research

146

142

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“…(1) Yet, adherence to adjuvant endocrine therapy, which is prescribed as a daily oral tablet, is not optimal – even in the clinical trial setting. (2, 3) Up to 50% of women will stop taking the prescribed medication by the 5 th year of planned therapy. (4) As time passes after starting endocrine therapy, there is less adherence(4–6); Partridge et al showed that 13% of patients fill less than 80% of their prescription during the first year and that this proportion increases to 80% during the 4 th year.…”

Section: Inroductionmentioning

confidence: 99%

Medication taking behaviors among breast cancer patients on adjuvant endocrine therapy

et al. 2015

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Purpose To explore how symptoms and psychosocial factors are related to intentional and unintentional non-adherent medication taking behaviors. Methods Included were postmenopausal women with hormone receptor positive, stage I-IIIA breast cancer, who had completed surgery, chemotherapy, and radiation, and were taking endocrine therapy. Self-administered, standardized measures were completed during a routine clinic visit: Brief Fatigue Inventory, Brief Pain Inventory, Menopause Specific Quality of Life Questionnaire, Functional Assessment of Cancer Therapy General and Neurotoxicity scales, and Self-Efficacy for Appropriate Medication Use Scale. Regression analyses were performed to determine the degree to which demographic, medical, symptom, and psychosocial variables, explain intentional, such as changing one’s doses or stopping medication, and unintentional, such as forgetting to take one’s medication, non-adherent behaviors. Results Participants were 112 women: mean age 64 (SD=9) years; 81% white; mean time from surgery 40 (SD=28) months; 49% received chemotherapy (39% including a taxane); mean time on endocrine therapy, 35 (SD=29.6) months; 82% taking an aromatase inhibitor. Intentional and unintentional non-adherent behaviors were described in 33.9% and 58.9% of participants, respectively. Multivariate analysis showed that higher self-efficacy for taking medication was associated with lower levels of unintentional (p=0.002) and intentional (p=0.004) non-adherent behaviors. The presence of symptoms (p=0.03) and lower self-efficacy for physician communication (p=0.009) were associated with higher levels of intentional non-adherent behaviors. Conclusions These results suggest that women who report greater symptoms, lower self-efficacy for communicating with their physician, and lower self-efficacy for taking their medication are more likely to engage in both intentional and unintentional non-adherent behaviors.

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“…Despite evidence linking utilization of adjuvant endocrine therapy (AET) to reduced recurrence and improved survival outcomes among ER+ BC survivors who have completed primary treatment (e.g., surgery, chemotherapy, radiation) [2-5], studies indicate that nearly 59% of ER+ BC survivors are non-adherent to AET, and over 50% discontinue use prematurely [3,6-10]. Poor AET adherence may be partly attributed to AET-related side effects, including pain, hot flashes, fatigue, sexual dysfunction, and mood changes [11-15].…”

Section: Introductionmentioning

confidence: 99%

Provider perspectives on barriers and facilitators to adjuvant endocrine therapy-related symptom management

Samuel

Turner

Donovan

et al. 2017

Support Care Cancer

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Purpose Adjuvant endocrine therapy (AET) utilization is linked to improved clinical outcomes among breast cancer survivors (BCS); yet, AET adherence rates remain suboptimal. Little is known about provider perspectives regarding barriers and facilitators to AET-related symptom management (SM). In this study, we examined provider perspectives on the barriers and facilitators to AET-related SM among BCS and opportunities for improvement. Methods We conducted three focus groups (FGs) with a multidisciplinary group of health care providers (n=13) experienced in caring for BCS undergoing AET. We utilized semi-structured discussion guides to elicit provider perspectives on AET-related SM. FGs were audiotaped, transcribed, and analyzed using qualitative software to identify key themes. Results Providers described patient-, provider-, and system- level barriers and facilitators to AET-related SM. At the patient-level, barriers included competing demands, limited time/resources, and possible misattribution of some symptoms to AET, while family/social relationships and insurance emerged as important facilitators. Discomfort with SM, limited time, and challenges distinguishing AET-related symptoms from other conditions were key provider-level barriers. Provider-level facilitators included routine symptom documentation and strong provider relationships. Care fragmentation and complexity of the cancer care delivery system were described as system-level barriers; however, survivor clinics were endorsed by providers. Conclusions Provider perspectives on AET-related SM can shed light on SM barriers and facilitators spanning multiple levels of the cancer care delivery system. Strategies for improving AET-related SM in BCS include increasing patients' knowledge and engagement in SM, equipping providers with efficient SM strategies, and improving coordination of symptom-related services through survivorship programs.

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Adherence and discontinuation of oral hormonal therapy in patients with hormone receptor positive breast cancer

Cited by 59 publications

References 50 publications

Adherence to Endocrine Therapy in Breast Cancer Adjuvant and Prevention Settings

Adherence to Endocrine Therapy in Breast Cancer Adjuvant and Prevention Settings

Medication taking behaviors among breast cancer patients on adjuvant endocrine therapy

Provider perspectives on barriers and facilitators to adjuvant endocrine therapy-related symptom management

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