Adherence to adjuvant endocrine therapy in estrogen receptor–positive breast cancer patients with regular follow-up

Abstract

Background: Adjuvant hormonal therapy is crucial in the treatment of estrogen receptor-positive breast cancer. The nonadherence rate to hormonal treatment is reported to be as high as 60%. The goal of this study was to evaluate the factors evoked by the patients as well as the demographic and disease-related factors that could be associated with nonadherence to adjuvant hormonal therapy.Methods: All consecutive patients treated for an estrogen receptor-positive breast cancer who showed up for regular follow-up with a single breast specialist between November 2008 and April 2009 were included in the study. We assessed adherence to hormonal therapy (either with tamoxifen or aromatase inhibitor). Reasons for adherence and nonadherence were collected. Records were also reviewed for demographic and cancer characteristics and for treatment components. Results:We included 161 patients in the study; 150 (93.2%) adhered to hormonal treatment. Side effects and absence of conviction were the main reasons for nonadherence. The importance of the diagnosis of cancer, fear of recurrence and regular follow-up were reported as the main reasons for adherence. Conclusion:Severity of disease and side effects are associated with nonadherence to treatment. Strict follow-up appears to be a necessary adjunct in the adherence to treatment. The association between demographic and cancer characteristics and treatment components needs further investigation. However, these factors may help identify patients at risk of nonadherence and help the oncology team.Contexte : Le traitement hormonal adjuvant est crucial dans le traitement du cancer du sein avec récepteurs estrogéniques positifs. Le taux d'inobservance au traitement hormonal atteint 60 %. Le but de cette étude consiste à évaluer les facteurs évoqués par les patientes ainsi que les facteurs démographiques et pathologiques pouvant être associés à l'inobservance au traitement hormonal adjuvant. Méthodes :Toutes les patientes qui ont été traitées pour cancer du sein avec récep-teurs estrogéniques positifs et suivies régulièrement par un spécialiste du cancer du sein de novembre 2008 à avril 2009 ont été incluses dans l'étude. L'adhérence au traitement hormonal (tamoxifène ou inhibiteur de l'aromatase) a été évaluée. Les dossiers des patientes ont aussi été révisés pour colliger les facteurs démographiques, pathologiques et thérapeutiques. Résultats :Il y a eu 161 patientes; 150 (93,2%) ont suivi le traitement hormonal. Les effets secondaires et l'absence de conviction des patientes face au bénéfice du traitement furent les principales raisons évoquées pour ne pas prendre la médication. L'importance du diagnostic de cancer, la peur de récidive et le suivi régulier furent les principales raisons rapportées pour suivre le traitement.Conclusion : La sévérité de la maladie et les effets secondaires sont associés avec l'inobservance au traitement hormonal. Le suivi rigoureux semble s'avérer nécessaire dans l'observance au traitement des patientes. La relation entre les facteurs démographiques,...

Barriers and facilitators to endocrine therapy adherence among underserved hormone-receptor-positive breast cancer survivors: a qualitative study

“…As noted in other studies [13,15,16,18,23], the present study found that the side effects attributed to anti-hormonal medications by survivors were the main barrier for non-adherence. Most side effects described were physical, but some survivors also reported psychological side effects.…”

“…Intolerable side effects are the most common reason patients discontinue using anti-hormonal medication [13,15–18]. Side effects vary by medication and can include weight gain, joint pain, hot flashes, headaches, fatigue [19], decreased libido, mild arthritis, vaginal discharge, abdominal bloating, and bone density loss [15].…”

Medication taking behaviors among breast cancer patients on adjuvant endocrine therapy

“…(6, 52)(16, 53, 54) Psychological factors, such as beliefs, perception, education, source and quality of information, social support, have also been shown to contribute. (14, 16, 18, 55) Although a diagnosis of cancer and the fear of recurrence have been reported by patients as reasons for better adherence(56), higher cancer stage and, thus, higher risk of recurrence, has not been consistently associated with better adherence. (12) The patients’ inherent beliefs about the medicine and side effects also have an impact on adherence rates.…”

Does depression decrease the moderating effect of self‐efficacy in the relationship between illness perception and fear of progression in breast cancer?

“…Fear of progression (or recurrence, hereafter FOP), defined as "fear that the illness will progress (…) or that it will recur" (p. 13), 1 is a prevalent concern among breast cancer patients. 2 While, to a certain degree, the fear that cancer might progress may function as a motivating factor that promotes healthy behavior or adherence, 3 excessive fear might function as an inhibitor. 4 As such, FOP has been the subject of empirical studies and systematic reviews, 5 and theoretical frameworks to understand FOP have been suggested.…”