Nearly 20% of Breast Cancer Patients Don't Complete Endocrine Therapy

New research finds that roughly 1 in 5 breast cancer patients do not complete endocrine therapy as prescribed.

The study, set to be presented at the ESMO Asia 2016 Congress, held Dec. 16-19 in Singapore, included 5544 women with estrogen receptor (ER) positive breast cancer who collected at least 1 prescription of aromatase inhibitors or tamoxifen, and had 5 years of follow-up data. The authors identified participants and obtained prescription information through the regional registers of Uppsala-Örebro, Stockholm-Gotland, and Northern Sweden. The data was linked to Swedish national registers with information about factors which could influence adherence. Adherence was calculated from the drugs dispensed. For example, patients were classified as non-adherent if they received less than 80% of the drugs needed over 5 years.
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In that 5-year span, 20% of the participants became non-adherent, with younger age, previous use of hormone replacement therapy (HRT), marital status, and socioeconomic status (measured by type of employment) emerging as the strongest independent predictors of non-adherence. Women younger than 50 years were 50% more likely to be non-adherent than those in the 50-65 age range, with 5% of all non-adherent cases attributable to being in the younger age group.

Women who had used HRT were 57% more likely to be non-adherent than those who had not, while unmarried women were 33% more likely to be non-adherent than married women. With respect to employment, unemployed women had 60% higher odds to be non-adherent compared to blue collar workers, with white-collar women found slightly less likely to adhere to endocrine treatment compared to blue-collar patients. However, the absolute difference was negligible, according to the authors.

"For primary care practitioners, it is important to ensure patients' understanding about the benefit and consequences of long-term endocrine treatment, and any concerns they may have, especially among subgroups which are more likely to be non-adherents such as younger women," said Wahyu Wulaningsih, MD, research associate, MRC Unit for Lifelong Health and Ageing at University College London, and co-founder of Philippine and Indonesian Scholars (PILAR) Research and Education. "Such discussions need to take place not only at the beginning of treatment but also repeatedly during the course of treatment.

—Mark McGraw

Reference

Wulaningsih W, Garmo H, Ahlgren J et al. Non-adherence to adjuvant endocrine treatment and its determinants among early stage breast cancer patients [presented at ESMO Asia 2016, December 2016]. Abstract 620_PR.