Adjuvant Endocrine Therapy Adherence Research Articles

Modifiable risk factors for adherence to adjuvant endocrine therapy among breast cancer patients

ObjectiveBreast cancer incidence and mortality are declining due to improvements in early detection and treatment. One advance in treatment is the development of adjuvant endocrine therapy (AET) for women with hormone receptor positive breast cancer. Despite strong evidence linking AET to better health outcomes, AET adherence continues to be suboptimal. This study tests the hypothesis that patient beliefs about medication mediate the relationship between frequency of physician communication and AET adherence. MethodsThis cross-sectional study utilizes data from patient self-report and medical chart abstraction (N=200). Survey measures included frequency of physician communication, patient beliefs about medicine, AET adherence, and demographic characteristics. ResultsNecessity beliefs mediated the relationship between frequency of physician communication and medication adherence (necessity beliefs β=.18, p<.05; physician communication β=.13, p>.05). There was no evidence of medication concerns mediating the relationship between frequency of physician communication and medication adherence. ConclusionMore frequent physician communication that shapes what patients believe about AET importance may be associated with greater AET adherence; however, frequent physician communication that shapes patient concerns about side effects may not be associated with greater AET adherence. Practice implicationsResearch is needed to enhance understanding of the type of physician communication that is most consistently associated with patient beliefs about medication and AET adherence.

Adhering to Adjuvant Endocrine Therapy after Breast Cancer: What’s the Problem?

Background: Breast cancer is a major cause of premature mortality in Canadian women. The use of adjuvant endocrine therapy (AET) has dramatically reduced breast cancer recurrence and mortality. Although AET has made a radical difference in breast cancer outcomes, a remarkable 50% of women do not take their prescribed AET regimens as recommended. Purpose: An overview of AET adherence and its impact on breast cancer survivors will be discussed. Gaps in the AET adherence literature will be outlined and a proposed plan of research will be offered. Methods: An integrative review of the literature was undertaken to explore AET non-adherence in breast cancer survivors. Findings: The AET adherence literature has predominately focused on identifying demographic and clinical predictors of non-adherence. As a result, a significant gap exists regarding why an alarming number of women do not adhere to AET. Few studies have attempted to address AET non-adherence that incorporate the perspectives of breast cancer survivors and health-care providers (HCPs). Implications: If effective strategies for targeting suboptimal adherence are to be developed, it is essential that we look beyond the demographic and clinical predictors of non-adherence and conduct an in-depth exploration of the interrelationships between the personal, social and structural factors influencing AET adherence. An understanding of breast cancer survivors’ and HCPs’ experiences and preferences related to AET is an imperative first step in identifying and prioritizing strategies that hold real promise for improving adherence rates and ultimately reducing the risk of breast cancer recurrence.

Changes in adjuvant endocrine therapy over one year among postmenopausal women with early-stage breast cancer initiating aromatase inhibitors.

11 Background: Aromatase inhibitors (AIs) are standard of care for adjuvant endocrine therapy (AET) to prevent recurrence of early stage breast cancer in postmenopausal women. Previous AET adherence research has focused on the 25-96% adherence observed with, but more information is needed about AI adherence, especially regarding the role of arthralgia (joint pain or stiffness) in AET changes. Our objective was to understand AET changes within a year of AI initiation. Methods: We examined AET switching (either to another AI or to tamoxifen), overall changes in AET (including switching and temporary or permanent discontinuation), and physician- and patient-reported arthralgia, using data abstracted from medical records and self-administered surveys among 93 patients initiating AI. We conducted Chi-square and Wilcoxon univariate analyses. Results: Anastrazole was initially prescribed to 64 patients (69%), letrozole to 28 patients (30%), and exemestane to 1 patient. A year after AI initiation, 64 patients (69%) had no change in AET. Among the 29 patients (31%) who had an AET change, 14 switched to at least one other AI, 11 switched to tamoxifen, 9 temporarily discontinued AET, and 7 entirely discontinued AET (categories not mutually exclusive). Average time to first AET switch was 182.7 days. Average number of AET switches was 1.4. Arthralgia was the most common reason for AET changes, noted in the records of 19 patients (66% of those who changed AET). Patients who changed AET reported more severe arthralgia (median pain from 0-10 among 8 joint groups =1.4, interquartile range [IQR]=0.3-2.6) at week 12 than those who did not (median=0.3, IQR=0-1.1), p=0.03. A higher proportion (46%) of the 28 patients who initiated with letrozole changed AET due to arthralgia, compared with 20% of the 64 patients who initiated with anastrazole (p=0.01). Conclusions: A substantial proportion of women initiating AI change AET over one year. Arthralgia appears to play a key role in AET changes, particularly for letrozole as compared with anastrazole. More longitudinal patient-reported arthralgia data are needed to guide clinical decision making about AI initiation and AET changes.