Tal Sella1,2,3, Gabriel Chodick4. 1. Department of Oncology. Sheba Medical Center, Tel Hashomer, Israel. 2. The Pinchas Burstein Talpiot Medical Leadership Program, Sheba Medical Center, Ramat Gan, Israel. 3. Dana Farber Cancer Institute, Boston, Massachusetts, USA. 4. Medical Division, Maccabi Healthcare Services, Tel-Aviv, Israel.
Abstract
BACKGROUND: Adjuvant hormonal therapy (HT) has been consistently proven to improve multiple outcomes in early breast cancer yet rates of adherence and persistence are variable. METHODS: We retrospectively identified women diagnosed with nonmetastatic breast cancer and initiating HT between January 2000 and December 2007 in a large Israeli health provider. Prescription records including the drug name, date of purchase, and the quantity of pills dispensed were collected. We used Cox proportional hazards and binary logistic models to analyze factors associated with early discontinuation (<5 years) and nonadherence (proportion of days covered, PDC <80%) of HT, respectively. RESULTS: A total of 4,178 women with breast cancer were identified with nearly 95% of patients treated with tamoxifen as the initial HT. Over the 5-year follow-up period, early discontinuation was identified in 955 (23%) patients. The mean PDC was 82.9% (SD 0.004). Younger age and low BMI were both associated with an increased risk of early discontinuation and nonadherence. A history of hypertension was associated with a higher likelihood of both outcomes. CONCLUSION: Adherence and persistence with HT among Israeli breast cancer survivors are comparable to those in international reports. Interventions are necessary to identify and prevent suboptimal HT adherence.
BACKGROUND: Adjuvant hormonal therapy (HT) has been consistently proven to improve multiple outcomes in early breast cancer yet rates of adherence and persistence are variable. METHODS: We retrospectively identified women diagnosed with nonmetastatic breast cancer and initiating HT between January 2000 and December 2007 in a large Israeli health provider. Prescription records including the drug name, date of purchase, and the quantity of pills dispensed were collected. We used Cox proportional hazards and binary logistic models to analyze factors associated with early discontinuation (<5 years) and nonadherence (proportion of days covered, PDC <80%) of HT, respectively. RESULTS: A total of 4,178 women with breast cancer were identified with nearly 95% of patients treated with tamoxifen as the initial HT. Over the 5-year follow-up period, early discontinuation was identified in 955 (23%) patients. The mean PDC was 82.9% (SD 0.004). Younger age and low BMI were both associated with an increased risk of early discontinuation and nonadherence. A history of hypertension was associated with a higher likelihood of both outcomes. CONCLUSION: Adherence and persistence with HT among Israeli breast cancer survivors are comparable to those in international reports. Interventions are necessary to identify and prevent suboptimal HT adherence.
Authors: Mitch Dowsett; Jack Cuzick; Jim Ingle; Alan Coates; John Forbes; Judith Bliss; Marc Buyse; Michael Baum; Aman Buzdar; Marco Colleoni; Charles Coombes; Claire Snowdon; Michael Gnant; Raimund Jakesz; Manfred Kaufmann; Francesco Boccardo; Jon Godwin; Christina Davies; Richard Peto Journal: J Clin Oncol Date: 2009-11-30 Impact factor: 44.544
Authors: Christina Davies; Hongchao Pan; Jon Godwin; Richard Gray; Rodrigo Arriagada; Vinod Raina; Mirta Abraham; Victor Hugo Medeiros Alencar; Atef Badran; Xavier Bonfill; Joan Bradbury; Michael Clarke; Rory Collins; Susan R Davis; Antonella Delmestri; John F Forbes; Peiman Haddad; Ming-Feng Hou; Moshe Inbar; Hussein Khaled; Joanna Kielanowska; Wing-Hong Kwan; Beela S Mathew; Indraneel Mittra; Bettina Müller; Antonio Nicolucci; Octavio Peralta; Fany Pernas; Lubos Petruzelka; Tadeusz Pienkowski; Ramachandran Radhika; Balakrishnan Rajan; Maryna T Rubach; Sera Tort; Gerard Urrútia; Miriam Valentini; Yaochen Wang; Richard Peto Journal: Lancet Date: 2013-03-09 Impact factor: 79.321