Phillip S Blanchette1,2, Melody Lam3, Lucie Richard3, Britney Allen3, Salimah Z Shariff3, Ted Vandenberg4, Kathleen I Pritchard5, Kelvin K W Chan5,6, Alexander V Louie7, Danielle Desautels8, Jacques Raphael4, Craig C Earle9. 1. Division of Medical Oncology, London Regional Cancer Program, London Health Sciences Centre, University of Western Ontario, 800 Commissioners Road East, London, ON, N6A 4L6, Canada. phillip.blanchette@lhsc.on.ca. 2. ICES Western, London, ON, Canada. phillip.blanchette@lhsc.on.ca. 3. ICES Western, London, ON, Canada. 4. Division of Medical Oncology, London Regional Cancer Program, London Health Sciences Centre, University of Western Ontario, 800 Commissioners Road East, London, ON, N6A 4L6, Canada. 5. Division of Medical Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada. 6. Canadian Centre for Applied Research in Cancer Control, Toronto, ON, Canada. 7. Division of Radiation Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada. 8. Division of Medical Oncology, Cancer Care Manitoba, University of Manitoba, Winnipeg, MB, Canada. 9. ICES, University of Toronto, Toronto, ON, Canada.
Abstract
PURPOSE: Adherence to adjuvant endocrine therapy among post-menopausal breast cancer patients is an important survivorship care issue. We explored factors associated with endocrine therapy adherence and survival in a large real-world population-based study. METHODS: We used health administrative databases to follow women (aged ≥ 66 years) who were diagnosed with breast cancer and started on adjuvant endocrine therapy from 2005 to 2010. Adherence was measured by medical possession ratio (MPR) and characterized as low (< 39% MPR), intermediate (40-79% MPR), or high (≥ 80% MPR) over a 5-year period. We investigated factors associated with adherence using a multinomial logistic regression model. Factors associated with all-cause mortality (5 years after starting endocrine therapy) were investigated using a multivariable Cox proportional hazards model. RESULTS: We identified 5692 eligible patients starting adjuvant endocrine therapy who had low, intermediate, and high adherence rates of 13% (n = 749), 13% (n = 733), and 74% (n = 4210), respectively. Lower rates of adherence were associated with increased age [low vs. high adherence: odds ratio (OR) 1.03, 95% CI 1.02-1.05 (per year); intermediate vs. high adherence: OR 1.02, 95% CI 1.01-1.04 (per year)]. High adherence was associated with previous use of adjuvant chemotherapy (low versus high adherence OR 0.42, 95% CI 0.30-0.59) and short-term follow-up with a medical oncologist within 4 months of starting endocrine therapy (low versus high adherence OR 0.83, 95% CI 0.69-0.99). Unadjusted analysis showed increased survival among patients with high endocrine therapy adherence. However, an independent association was no longer clearly detected after controlling for confounders. CONCLUSION: Interventions to improve adjuvant endocrine therapy adherence are warranted. Non-adherence may be a more significant issue among elderly patients. Short-term follow-up visit by a patient's medical oncologist after starting endocrine therapy may help to improve compliance.
PURPOSE: Adherence to adjuvant endocrine therapy among post-menopausal breast cancerpatients is an important survivorship care issue. We explored factors associated with endocrine therapy adherence and survival in a large real-world population-based study. METHODS: We used health administrative databases to follow women (aged ≥ 66 years) who were diagnosed with breast cancer and started on adjuvant endocrine therapy from 2005 to 2010. Adherence was measured by medical possession ratio (MPR) and characterized as low (< 39% MPR), intermediate (40-79% MPR), or high (≥ 80% MPR) over a 5-year period. We investigated factors associated with adherence using a multinomial logistic regression model. Factors associated with all-cause mortality (5 years after starting endocrine therapy) were investigated using a multivariable Cox proportional hazards model. RESULTS: We identified 5692 eligible patients starting adjuvant endocrine therapy who had low, intermediate, and high adherence rates of 13% (n = 749), 13% (n = 733), and 74% (n = 4210), respectively. Lower rates of adherence were associated with increased age [low vs. high adherence: odds ratio (OR) 1.03, 95% CI 1.02-1.05 (per year); intermediate vs. high adherence: OR 1.02, 95% CI 1.01-1.04 (per year)]. High adherence was associated with previous use of adjuvant chemotherapy (low versus high adherence OR 0.42, 95% CI 0.30-0.59) and short-term follow-up with a medical oncologist within 4 months of starting endocrine therapy (low versus high adherence OR 0.83, 95% CI 0.69-0.99). Unadjusted analysis showed increased survival among patients with high endocrine therapy adherence. However, an independent association was no longer clearly detected after controlling for confounders. CONCLUSION: Interventions to improve adjuvant endocrine therapy adherence are warranted. Non-adherence may be a more significant issue among elderly patients. Short-term follow-up visit by a patient's medical oncologist after starting endocrine therapy may help to improve compliance.
Entities:
Keywords:
Adherence; Breast cancer; Endocrine therapy
Authors: Erin J Aiello Bowles; Cody Ramin; Diana S M Buist; Heather Spencer Feigelson; Sheila Weinmann; Lene H S Veiga; Clara Bodelon; Rochelle E Curtis; Jacqueline B Vo; Amy Berrington de Gonzalez; Gretchen L Gierach Journal: Breast Cancer Res Treat Date: 2022-03-11 Impact factor: 4.872
Authors: Christine Brezden-Masley; Kelly E Fathers; Megan E Coombes; Behin Pourmirza; Cloris Xue; Katarzyna J Jerzak Journal: Breast Cancer Res Treat Date: 2020-10-16 Impact factor: 4.872
Authors: Vicente F Gil-Guillen; Alejandro Balsa; Beatriz Bernárdez; Carmen Valdés Y Llorca; Emilio Márquez-Contreras; Juan de la Haba-Rodríguez; Jose M Castellano; Jesús Gómez-Martínez Journal: Int J Environ Res Public Health Date: 2022-09-23 Impact factor: 4.614