Adherence to tamoxifen over the 5-year course

Department of Epidemiology, Boston University School of Public Health, Boston, MA 02118, USA.
Breast Cancer Research and Treatment (Impact Factor: 3.94). 10/2006; 99(2):215-20. DOI: 10.1007/s10549-006-9193-0
Source: PubMed


To estimate the proportion of older women who fail to complete 5 years of tamoxifen therapy and to identify predictors of non-adherence.
We followed 462 women 65-years-old or older with stage I-IIIA breast cancer diagnosed in four US regions between 1996 and 1999 and who initiated tamoxifen therapy. We interviewed patients annually to assess tamoxifen adherence and collected information about predictors of adherence by medical record review, patient interview, and physician questionnaire.
Thirty-one percent of patients who started tamoxifen failed to complete the recommended 5-year course. Patients who had initial severe side effects [hazard ratio (HR) per side effect=1.2, 95% confidence interval (CI) 0.97, 1.5] or developed them (HR per new side effect=1.3, 95% CI 1.0, 1.6) were more likely to discontinue. Patients with more prescription medications at baseline were less likely to discontinue (HR per baseline prescription equaled 0.90, 95% CI 0.81, 0.99), whereas patients who added a prescription were more likely to discontinue (HR per new prescription equaled 1.2, 95% CI 1.0, 1.4). Patients with positive views of tamoxifen at baseline (HR for a 10-point higher score=0.93, 95% CI 0.83, 1.0) and an improving view over follow-up (HR for a 10-point positive change=0.93, 95% CI 0.87, 1.0) were less likely to discontinue.
Five years of tamoxifen confers a significant benefit beyond 1-2 years of tamoxifen, so physicians should ask patients about side effects, other prescriptions, and beliefs about tamoxifen and should educate them about the benefits of completing adjuvant therapy.

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    • "There is also evidence of therapy-related factors being associated with adherence. Research suggests that adverse events, more complex treatment regimens, and higher cost of medication are associated with non-adherence to AET [14] [15] [16] [17]. However, much less is known about provider level factors that are associated with adherence. "
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    ABSTRACT: Objective Breast 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. Methods This 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. Results Necessity 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. Discussion More 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 Implications Research is needed to enhance understanding of the type of physician communication that is most consistently associated with patient beliefs about medication and AET adherence.
    Patient Education and Counseling 04/2014; 95(1). DOI:10.1016/j.pec.2013.12.019 · 2.20 Impact Factor
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    • "Previous studies have identified multiple risk factors for therapy noncompliance including extremes of age (Barron et al. 2007), concomitant antidepressant use (Demissie et al. 2001), lack of social support (Kahn et al. 2007), and side effects experienced (Lash et al. 2006; Murphy et al. 2012). Ethnic and racial variations in medication compliance have also been demonstrated. "
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    ABSTRACT: Studies have demonstrated lower rates of breast cancer survival for Black versus White women. Factors implicated include later stages at diagnosis, differences in tumor biology, and lower compliance rates to adjuvant hormone therapy (AHT) among Black women with hormone sensitive breast cancer. We examined factors associated with compliance to AHT among Black and White women with invasive breast cancer. Women with estrogen receptor positive (ER+), non-metastatic breast cancer were identified by the cancer registry at the University of Chicago Hospital and asked to complete a mail-in survey. Compliance was defined by self-reported adherence to AHT ≥80% at the time of the survey plus medical record verification of persistence (completion of 5 years of AHT). Logistic regression was used to determine factors associated with compliance to AHT. 197 (135 White and 62 Black) women were included in the analysis. 97.4% of patients reported adherence to therapy. 87.4% were found to be persistent to therapy. Overall compliance was 87.7% with no statistically significant racial difference seen (87.9% in White and 87.0% in Black, P = 0.87). For both Black and White women, compliance was strongly associated with both perceived importance of AHT (OR =2.1, 95% CI:1.21-3.68,P = 0.009) and the value placed on their doctor's opinion about the importance of AHT (OR = 4.80, 95% CI: 2.03-11.4, P < 0.001). In our cohort of Black and White women, perceived importance of AHT and the degree to which they valued their doctor's opinion correlated with overall compliance. This suggests that Black and White women consider similar factors in their decision to take AHT.
    SpringerPlus 07/2013; 2(1):356. DOI:10.1186/2193-1801-2-356
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    • "The most robust data come from studies of women with breast cancer taking oral hormonal therapy (Banning, 2012) and patients with CML (Jabbour et al., 2012) taking imatinib. Seminal work in breast cancer (Fink et al., 2004; Hershman et al., 2010; Lash et al., 2006; Partridge et al., 2008; 2003; Waterhouse et al., 1993) has provided the basis for research examining adherence to targeted OAMs, particularly for " chronically critically ill " individuals with cancer (e.g., lung cancer, renal cell carcinoma). Research concerning adherence for women with breast cancer taking oral hormonal therapies has been well summarized; therefore, in this review, we focus on studies of adherence to molecularly targeted OAMs for persons with cancer (Table 3). "
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    ABSTRACT: The use of targeted oral anticancer medications (OAMs) is becoming increasingly prevalent in cancer care. Approximately 25-30% of the oncology drug pipeline involves oral agents and there are now over 50 OAMs approved by the Food and Drug Administration. This change represents a major shift in management of patients with cancer from directly observed, intermittent intravenous therapy to self-administered, oral chronic therapy. The increased prevalence of OAMs raises the issue of adherence in oncology, including understanding the challenges of adherence to OAMs. This review focuses on studies of adherence for patients taking molecularly targeted OAMs for breast cancer, chronic myelogenous leukemia (CML), gastrointestinal stromal tumors (GIST), non-small cell lung cancer (NSCLC), and renal cell carcinoma (RCC). We then discuss barriers to adherence and studies performed to date testing interventions for improving adherence. Finally, we discuss future areas of investigation needed to define and improve adherence to OAMs in targeted therapy for cancer.
    Discovery medicine 04/2013; 15(83):231-41. · 3.63 Impact Factor
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