Adherence to adjuvant endocrine therapy among White British and ethnic minority breast cancer survivors in the United Kingdom

Abstract

Objective Around half of women do not take adjuvant endocrine therapy (AET) as prescribed. Research suggests that adherence rates vary across ethnic groups. This study compared AET adherences rates in White British women and women from minority ethnic groups in the United Kingdom. Methods This is an observational study with 2001 breast cancer survivors recruited from outpatient clinics. Eligible women were diagnosed with primary breast cancer and prescribed AET within the last 3 years. Adherence was measured using the Medication Adherence Rating Scale. Eligible women were asked to complete a questionnaire pack that collected sociodemographic data such as age, relationship status and ethnicity. Independent samples t tests and χ2 tests were used to compare White British women and women from minority ethnic groups on self‐reported adherence to AET. Results Of White British women, 27.8% were classed as non‐adherent, compared to 44.4% of women from minority ethnic groups. A logistic regression controlling for relevant demographics indicated that women from minority ethnic groups had a significantly higher risk of non‐adherence than women who were White British (odds ratio = 1.50, p = 0.03) Conclusion Rates of non‐adherence to AET are higher in women from minority ethnic groups, which may contribute towards racial disparities in breast cancer outcomes. Research with larger and more diverse samples is needed to explore this further and to investigate the psychosocial factors driving differences in adherence.

Beliefs about medicines’ association with endocrine therapy adherence in early breast cancer survivors in Croatia

“…In accordance with heretofore literature (16,29,37,53), a significant proportion of study participants (44.4 %) did not adhere to their prescribed medication regimen among which approximately two-thirds were pertaining to unintentional and one-third to intentional non-adherers. Moreover, our study revealed that non-adherers, specifically intentional non-adherers, had lower beliefs in the necessity of AET and exhibited higher levels of concern towards it, a finding corroborated by previous research (28,29,32).…”

“…Potential reasons for this finding could be attributed to the brevity of the scale, consisting of only 4 to 5 items, and deviation from a normal distribution (40). However, a decrease in Cronbach's alpha due to these factors does not necessarily indicate a lack of reliability in the scale, as previously reported in the literature (16).…”

“…The measure includes five statements about non-adherent behaviour (I forget to take my medicine, I alter the dose of my medicine, I stop taking my medicine for a while, I decide to miss out a dose, I take less than instructed), both intentional and unintentional, and is scored on a 5-point Likert scale where 1 represents always and 5 represents never. Since the scale was positively skewed towards higher adherence, it was dichotomised into adherers (total score of 25) and non-adherers (total score of 24 or below), as recommended by previous researchers (16,36,37). Non-adherers were further divided into intentional (total MARS-5 score < 25, score ≤ 5 on item 1, and score < 5 on items 2-5) and unintentional non-adherers (total MARS-5 score < 25, score < 5 on item 1; "I forget to take my medicine (AET)", score = 5 on items 2-5).…”

“…Nevertheless, literature reports suboptimal adherence and persistence to AET (7)(8)(9)(10)(11)(12), thus consequently lowering its beneficial and protective effects. According to the published literature, adherence to AET ranges between 40-95 % (12)(13)(14)(15)(16)(17)(18)(19) depending on the definition of adherence and the method used to measure it. Moreover, adherence rates on average decrease by 25.5 % between the first and the fifth year of treatment (19), with treatment discontinuation ranging from 31-73 %, measured at the end of the 5-year treatment period (13,14,(18)(19)(20).…”

Evaluation of adherence to pharmacological treatments by undocumented migrants with chronic diseases: a 10-year retrospective cohort study

“…Taking Europeans as the reference geographical group, MA was the highest at 6 months for Asians, but it fell significantly below that of Europeans for all ethnicities at 12 months. It is known that many factors affect MA, including belonging to an ethnic minority,27 28 and having cultural beliefs about medications,29 with even differences between migrants and refugees 30. However, we favour the hypothesis that comparable personal, social and economic determinants are important in our patients independently from their ethnicity and that their interplay is responsible for similar patterns of MA.…”