Adherence to tamoxifen over the five-year course.
ABSTRACT 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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ABSTRACT: Background: Tamoxifen has been in use worldwide in the care of breast cancer over decades. It has been found to significantly reduce disease free survival and also reduce the chance of recurrence. The issue of non-adherence (NA) to its usage has not been reported in the black African setting. The aim of this study was to determine the rate and contributory factors to non adherence rate to tamoxifen during the first year of usage in patients with breast cancer in LAUTECH teaching hospital (LTH) Osogbo , Nigeria . Methods: One hundred and fourteen patients (108 females and 6 males) were studied during their various first year of tamoxifen usage at LTH Osogbo, South-Western Nigeria between June 2001 and June 2005.The incidence, indications and variables that might contribute to NA e.g. age, sex, disease stage, occupation etc were assessed. Results; Findings included NA rate of 24.5 % (72% of which occurred in the first 6 months of usage). Adherence tend to worsen with age and higher disease stage (p=0.154 and 0.146 respectively). Non-adherence was commoner in farmers and traders while unbearable side effects and financial constraints are most common reasons. Conclusion: The 24.5% non-adherence rate, though comparable with results from other reports is unacceptably high These patients could not have been receiving full benefits of hormonal treatment, thus adequate counseling and education on benefit and side effects of tamoxifen is strongly advised.
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ABSTRACT: A third of breast cancers (BC) occur in women ≥65 years (seniors). Anti-estrogen therapy (AET) significantly reduces BC recurrence and death. This study characterizes determinants of adherence to AET in seniors with BC. Provincial cancer registry and administrative claims data were accessed for all non-metastatic BC diagnosed in Quebec (1998–2005) to identify seniors treated for 5 years with AET. Multivariate linear regression was used to assess the association with patient, disease, and physician characteristics and the 5-year medication possession ratio (MPR) for each patient. 4,715 women were included (mean age: 72.9). Mean MPR was 83.5%, 79% of patients reached a 5-year MPR of ≥80%, and 34% discontinued AET at some point during treatment. The cumulative probability of discontinuation was 33.8% (mean time to discontinuation 2.3 years). The MPR decreased with increasing age and non-BC related hospitalizations, p < 0.05. Each new medication added during the 5-years decreased the MPR by 0.3% (p < 0.05). Women with in situ disease, on antidepressants at baseline, or treated with Tamoxifen had a lower MPR by 6.5% (p = 0.0002), 4.7% (p = 0.003) and 6% (p = 0.001), respectively. Switching AET type was associated with a lower MPR by 5.3% (p = 0.002) if the switch occurred during the first year. Optimal 5-year adherence to AET in seniors with BC remained a challenge and medication discontinuation rates were high. Advanced age, increasing number of hospitalizations, in situ disease, baseline use of antidepressants, Tamoxifen (versus aromatase inhibitors), early switches of AET type, and newly added medications significantly reduced the MPR.The Breast Journal 09/2014; · 1.43 Impact Factor
Article: Reply to S.A. NarodJournal of Clinical Oncology 11/2010; 28(33):e700-e700. · 17.88 Impact Factor