Influence of Patient and Treatment Factors on Adherence to Adjuvant Endocrine Therapy in Breast Cancer

Abstract

Purpose/Objectives To comprehensively assess the patient and illness or treatment factors that may predict nonadherence to adjuvant endocrine therapy and to explore whether an interaction occurs between these factors in women with breast cancer. Design Repeated-measures design. Setting The Outpatient Services of the Women's Cancer Program at the University of Pittsburgh Cancer Institute and participants' homes. Sample 91 women with early-stage breast cancer who received endocrine therapy. Methods Adherence was assessed continuously for the first 18 months of endocrine therapy. Patient and illness or treatment factors were assessed at four time points (Time 1 to Time 4). Time 1 (baseline) was within two weeks prior to the initiation of endocrine therapy. Times 2–4 occurred at six-month intervals, as many as 18 months after Time 1. Main Research Variables Adherence, patient factors, and illness or treatment factors. Findings Adherence to endocrine therapy declined significantly during the first 18 months of treatment in women with breast cancer. The presence of negative mood and symptoms before starting treatment predicted nonadherence to endocrine therapy over time. Perceptions of financial hardship, symptoms, disease stage, and more complex medication regimens intensified the effect of negative mood on adherence over time. Conclusions Women with breast cancer may be at risk for nonadherence to prescribed endocrine therapy if they experience depression or anxiety and symptoms prior to initiating therapy. Implications for Nursing Oncology nurses should be alert to women with breast cancer who are depressed or anxious or who are experiencing symptoms. Management of negative mood and symptoms may result in better adherence.

Fatores associados à adesão e à persistência na hormonioterapia em mulheres com câncer de mama

“…For Brito et al, although many studies do not associate this variable directly, such relation may be explained by the disease severity and the presence of other comorbidities and side effects, producing different responses to treatment 6 . Presence and severity of disease symptoms are factors that might interfere in the treatment follow-up 35 . We must emphasize that although there has been significance only in the non-adjusted survival analysis, the number of specialized appointments is considered relevant.…”

Investigating Associations Between Health-Related Quality of Life and Endocrine Therapy Underuse in Women With Early-Stage Breast Cancer

“…Some work has evaluated relationships between HRQOL and nonadherence and nonpersistence, but results have been mixed, with some studies reporting no associations and others reporting that poor HRQOL is associated with nonadherence. 18,23,24 Findings from one recent study indicated that worse psychosocial HRQOL and greater patient distress were predictive of ET nonpersistence. 24 Evidence from previous work should be interpreted with caution, because many studies used post-ET initiation HRQOL assessments, which may be confounded by ET adverse effects, and few used BC-specific HRQOL instruments.…”

“…18,21 In addition, all studies were carried out in small cohorts of predominantly non-Hispanic white women. 14,18,23,24 The objectives of our study were to examine associations between pre-ET HRQOL and noninitiation as well as HRQOL during active treatment and nonadherence in a large, racially and socioeconomically diverse, population-based cohort of women with BC. Identifying associations between HRQOL, a modifiable factor, and inappropriate ET use offers opportunities for future interventions to reduce underuse, thus improving BC outcomes among HR-positive women.…”

“Winging It”: How Older Breast Cancer Survivors Persist With Aromatase Inhibitor Treatment

“…[8][9][10] Limited evidence suggests early discontinuation of hormonal treatments is associated with older age 11,12 and adverse effects 13,14 and usually occurs within the first year, but may also occur in subsequent years. 15,16 However, underlying reasons for these decisions remain poorly understood. 13,17 Because AIs are oral medications that are self-administered in the home setting and started during the transitional survivorship period, 18,19 we wanted to understand what factors are associated with persistence and how these medications fit into the broader life context of older breast cancer survivors from the perspectives of the women themselves.…”