Tamoxifen adherence and its relationship to mortality in 116 men with breast cancer

Abstract

Recent studies have revealed that many, perhaps most women with hormone-responsive breast cancer have low adherence to tamoxifen adjuvant hormonal therapy. However, limited data are available on tamoxifen adherence in male breast cancer (MBC) patients. The goal of this study was to assess tamoxifen adherence and its relationship to mortality in MBC patients. A cohort of 116 men who were diagnosed with receptor-positive breast cancer between June 1987 and July 2012 was recruited for the study using the cancer prevention and treatment system database of Heilongjiang Province. From the 116 patients who received a five-year tamoxifen prescription, only 64.6 % were still taking their medication 1 year later, and this percentage decreased to 46.4 and 28.7 % after 2 and 3 years, respectively, to 25.8 % after 4 years, and to 17.7 % in the last year. After multivariate adjustment, factors that significantly decreased tamoxifen adherence were low social support [Hazard ratio (HR) = 2.45, 95 % CI 1.32-4.55], age (HR = 1.10, 95 % CI 1.01-1.21), and adverse effects (HR = 2.19, 95 % CI 1.57-3.04). The primary endpoints in the adherence or low-adherence groups from this study were overall survival (OS) and disease-free survival (DFS) of the MBC patients. The five- and ten-year OS of the patients was 97.9 and 79.6 %, respectively, in the adherence group, and 84.7 and 50.4 %, respectively, in the low-adherence group (p = 0.008). The five- and ten-year DFS of the patients was 95.4 and 72.8 %, respectively, in the adherence group, and 72.6 and 42.3 %, respectively, in the low-adherence group (p = 0.007). The consequences of low treatment adherence in men, who have a potentially long life expectancy, may be significant. In light of these findings, there is an urgent need to acknowledge and tackle the issue of tamoxifen adherence in this patient group.

Male breast cancer in the United States: Treatment patterns and prognostic factors in the 21st century

“…Although there was an overall increase in the use of adjuvant endocrine therapy during the study period, nearly one‐third of men with ER+ breast cancer did not receive any endocrine therapy. Furthermore, we were unable to assess long‐term compliance or duration of use in the current study, both of which may be an issue in men . Further studies evaluating factors influencing the decision to use or not use adjuvant endocrine therapy, which to our knowledge is the most effective form of systemic therapy for ER+ breast cancer, are needed.…”

“…6B). It is possible that radiotherapy may be more beneficial in this subgroup of men compared with women due to poor compliance with endocrine therapy 35,36 or to the unique tumor biology in men. 37 In terms of the postmastectomy setting, we observed that radiotherapy was associated with poor overall survival in the entire cohort on univariate analysis, which we believed was most likely due to higher risk disease features in those patients because this difference was not noted on multivariate analysis adjusting for disease stage, reflecting the appropriate use of postmastectomy radiotherapy in patients with more advanced tumors.…”

Nonadherent behaviors among young women on adjuvant endocrine therapy for breast cancer

“…46,47 However, the median age in those studies was between 57 and 63 years. Although variables related to menopausal symptoms were close to statistical significance in univariate analyses, they did not reach the prespecified threshold to be included in our multivariable analysis.…”

Adherence to Endocrine Therapy in Breast Cancer Adjuvant and Prevention Settings

“…36; Table 2). In a small study of 116 men with breast cancer, overall survival was greater in those adherent to tamoxifen adjuvant therapy (37).…”