Tamoxifen Acceptance and Adherence among Patients with Ductal Carcinoma In Situ (DCIS) Treated in a Multidisciplinary Setting

Abstract

Tamoxifen and other endocrine agents have proven benefits for women with ductal carcinoma (DCIS), but low patient acceptance is widely reported. We examined factors associated with tamoxifen acceptance and adherence among DCIS patients who received a recommendation for therapy in a multidisciplinary setting. Using our institutional database, we identified women diagnosed with DCIS, 1998 to 2009, who were offered tamoxifen. We recorded data on demographics, tumor and therapy variables, tamoxifen acceptance, and adherence to therapy for ≥4 years. Univariable and multivariable analyses were conducted using logistic regression to identify factors specific to each group that were related to acceptance and adherence. A total of 555 eligible women identified, of whom 369 were offered tamoxifen; 298 (81%) accepted, among whom 214 (72%) were adherent, 59 of 298 (20%) were nonadherent, and for 25 (8%), adherence was undetermined. After stepwise elimination in adjusted logistic regression models, acceptance of breast radiotherapy was associated with acceptance of tamoxifen [OR, 2.22; 95% confidence interval (CI), 1.26-3.90; < 0.01], as was a medical oncology consultation (OR, 1.76; 95% CI, 0.99-3.15; = 0.05). Insured patients were more likely to adhere to tamoxifen (OR, 6.03; 95% CI, 2.60-13.98; < 0.01). The majority of nonadherent women ( = 38/56, 68%) discontinued the drug during the first year of treatment with 48 (86%) citing adverse effect(s) as the reason. In a multidisciplinary, tertiary care setting, we observed relatively high rates of acceptance and adherence of tamoxifen. Acceptance of tamoxifen and radiotherapy were associated, and adherence was influenced by insurance status. Tamoxifen acceptance and adherence following resection of DCIS of the breast is related to acceptance of radiotherapy and may be improved by confirmation of the recommendation by a medical oncologist. Despite the low cost of tamoxifen, adherence to therapy is significantly impacted by lack of insurance; those who discontinue therapy report adverse effects as a major reason. .

Potentially Modifiable Factors Associated with Adherence to Adjuvant Endocrine Therapy among Breast Cancer Survivors: A Systematic Review

“…Only presence (vs. absence) of symptoms was examined more than 10 times and associated ≥50% of the time in both univariate and multivariate models. Several studies report that when women who discontinue medications are asked why, side effects are the most commonly reported reason [ 99 , 100 , 101 , 102 ]. Clearly, experiencing side effects does not invariably lead to poor adherence or discontinuation—rather the experience of side effects may be universal.…”

Adherence to Adjuvant Endocrine Therapy in Insured Black and White Breast Cancer Survivors: Exploring Adherence Measures in Patient Data

“…While we recognize this as a strength, sampling in this manner limited our ability to generalize findings to uninsured populations across the United States. Underinsured patients may be less likely to remain adherent because of their plan’s limited coverage of medications relative to patients’ ability to pay 35, 53, 54 . It is probable that patients may have filled prescriptions for their AET outside of the integrated health systems network, which may justify the gap in prescription refills.…”

Early participant-reported symptoms as predictors of adherence to anastrozole in the International Breast Cancer Intervention Studies II

“…The National Surgical Adjuvant Breast and Bowel Project (NSABP) B-35 trial showed statistically significant improvements in breast cancer-free interval among women taking anastrozole compared with tamoxifen [ 8 ]. Implementing preventive therapy in routine clinical practice for high-risk women is difficult due to reluctance among clinicians to prescribe the medication [ 9 ], low patient uptake [ 10–12 ], and sub-optimal adherence to therapy [ 10 , 12 , 13 ]. A major factor affecting implementation is side-effects [ 14 , 15 ].…”