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Adherence to adjuvant hormonal therapy and its relationship to breast cancer recurrence and survival among low-income women.

ABSTRACT: Although clinical trials have demonstrated the benefit of adjuvant hormonal therapy for hormone receptor-positive breast cancer, it is not known whether poor medication adherence might impact outcomes, particularly in the context of a low-income population traditionally underrepresented in clinical trials. We explored the relationship between adherence to tamoxifen or selective aromatase inhibitors with cancer recurrence and death in a low-income, Medicaid-insured population.Using a Medicaid claims-tumor registry and National Death Index data, we evaluated adherence to adjuvant hormonal therapy [defined by the medication possession ratio (MPR)], cancer recurrence, and cancer-specific survival for female breast cancer diagnosed from 1998 to 2002, in North Carolina. Multivariate Cox proportional hazards models and logistic regression models were used to examine the role of adherence on cancer recurrence and survival.The sample consisted of 857 cases, mean age 67.7 years, 56.9% white, 60.9% local stage, with a mean follow-up of 4.4 years. Mean first-year MPR was 77%. MPR adherence was not significantly associated with cancer-related death [adjusted hazards ratio=1.18 (95% confidence interval, 0.54-2.59)], or recurrence [adjusted odds ratio=1.49 (95% confidence interval, 0.78-2.84)]. There was also no significant interaction between adherence and use of concurrent CYP2D6 enzyme inhibitors.Hormonal therapy adherence was not associated with breast cancer outcomes in this low-income population with relatively poor adherence. Although suboptimal adherence is considered to be an important clinical problem, its effects on breast cancer outcomes may be masked by patient genetic profiles, tumor characteristics, and behavioral factors.

SUBMITTER: Weaver KE

PROVIDER: S-EPMC3355198 | biostudies-literature | 2013 Apr

REPOSITORIES: biostudies-literature

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Adherence to adjuvant hormonal therapy and its relationship to breast cancer recurrence and survival among low-income women.

Weaver Kathryn E KE Camacho Fabian F Hwang Wenke W Anderson Roger R Kimmick Gretchen G

American journal of clinical oncology 20130401 2

<h4>Objectives</h4>Although clinical trials have demonstrated the benefit of adjuvant hormonal therapy for hormone receptor-positive breast cancer, it is not known whether poor medication adherence might impact outcomes, particularly in the context of a low-income population traditionally underrepresented in clinical trials. We explored the relationship between adherence to tamoxifen or selective aromatase inhibitors with cancer recurrence and death in a low-income, Medicaid-insured population.< ...[more]

PMID: 22314001

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Project description:BackgroundCurrent clinical guidelines recommend that hormone receptor-positive breast cancer survivors take adjuvant hormonal therapy (AHT) for 5 to 10 years, following the end of definitive treatment. However, fewer than half of patients adhere to the guidelines, and suboptimal adherence to AHT is associated with an increased risk of breast cancer mortality. Research has extensively documented sociodemographic and disease-specific factors associated with adherence to AHT, but very little evidence exists on behavioral factors (eg, knowledge, patient-provider communication) that can be modified and targeted by interventions.ObjectiveThe goal of this study is to develop and test a theory-based, multilevel intervention to improve adherence to AHT among breast cancer survivors from racially and socioeconomically disadvantaged backgrounds (eg, Medicaid-insured). The specific aims are to (1) explore multilevel (eg, patient, health care system) factors that influence adherence to AHT; (2) develop a theory-based, multilevel intervention to improve adherence to AHT; and (3) pilot test and evaluate the intervention developed in Aim 2.MethodsFor Aim 1, we will recruit breast cancer survivors and health care professionals to participate in semistructured interviews to gain their perspectives about barriers and facilitators to AHT use. We will conduct a directed content analysis of the Aim 1 qualitative interview data. For Aim 2, we will integrate Aim 1 findings and current literature into the design of a multilevel intervention using an Intervention Mapping approach. For Aim 3, we will recruit Medicaid-insured breast cancer survivors to assess the feasibility of the pilot intervention.ResultsFrom May 2016 to July 2018, we completed interviews with 19 breast cancer survivors and 23 health care professionals in South Carolina. We will conduct a directed content analysis of the qualitative interview data. Results from this analysis will be used, in combination with current literature, to design (Aim 2) and pilot test a theory-based multilevel intervention (Aim 3) in Summer 2021. Results of the pilot are expected for Fall 2021.ConclusionsThis study will provide a deeper understanding of how to improve adherence to AHT, using a novel and multilevel approach, among socioeconomically disadvantaged breast cancer survivors who often experience disproportionate breast cancer mortality.International registered report identifier (irrid)DERR1-10.2196/17742.

Project description:Adjuvant hormonal therapy significantly improves long-term survival of breast cancer patients with hormone receptor-positive disease. Despite the proven clinical efficacy of tamoxifen and aromatase inhibitors, many breast cancer survivors either fail to take the correct dosage at the prescribed frequency (adherence) or discontinue therapy (persistence). This systematic review aims to: (1) determine the prevalence of adherence and persistence to adjuvant hormonal therapy among breast cancer survivors in clinical practice, and (2) identify correlates of adherence and persistence. We searched Medline, PubMed, PsycINFO, and CINAHL for studies that measured rates and/or correlates of adherence and/or persistence to adjuvant hormonal therapy. Studies were reviewed in a multi-step process: (1) the lead author screened titles and abstracts of all potentially eligible studies; (2) each coauthor reviewed a random 5 % sample of abstracts; and (3) two sets of coauthors each reviewed half of all "maybe" abstracts. Any disagreements were discussed until consensus was reached. Twenty-nine studies met inclusion criteria. Prevalence of adherence ranged from 41 to 72 % and discontinuation (i.e., nonpersistence) ranged from 31 to 73 %, measured at the end of 5 years of treatment. Extremes of age (older or younger), increasing out-of-pocket costs, follow-up care with a general practitioner (vs. oncologist), higher CYP2D6 activity, switching from one form of therapy to another, and treatment side effects were negatively associated with adherence and/or persistence. Taking more medications at baseline, referral to an oncologist, and earlier year at diagnosis were positively associated with adherence and/or persistence. Adherence and persistence to adjuvant hormonal therapy among breast cancer survivors is suboptimal. Many of the correlates of adherence and persistence studied to date are not modifiable. Our review reveals a critical need for further research on modifiable factors associated with adherence to adjuvant hormonal therapy, and the development of behavioral interventions to improve adherence in this population.

Project description:BackgroundTo identify whether adjuvant transarterial chemoembolization (TACE) can improve prognosis in HCC patients with a low risk of recurrence (tumor size ≤ 5 cm, single nodule, no satellites, and no microvascular or macrovascular invasions) after hepatectomy.MethodsThe data of 489 HCC patients with a low risk of recurrence after hepatectomy from Shanghai Cancer Center (SHCC) and Eastern Hepatobiliary Surgery Hospital (EHBH) were retrospectively reviewed. Recurrence-free survival (RFS) and overall survival (OS) were analyzed with Kaplan-Meier curves and Cox proportional hazards regression models. The effects of selection bias and confounding factors were balanced using propensity score matching (PSM).ResultsIn the SHCC cohort, 40 patients (19.9%, 40/201) received adjuvant TACE, and in the EHBH cohort, 113 patients (46.2%, 133/288) received adjuvant TACE. Compared to the patients without adjuvant TACE after hepatectomy, patients receiving adjuvant TACE had significantly shorter RFS (P=0.022; P=0.014) in both cohorts before PSM. However, no significant difference existed in OS (P=0.568; P=0.082). Multivariate analysis revealed that serum alkaline phosphatase and adjuvant TACE were independent prognostic factors for recurrence in both cohorts. Furthermore, significant differences existed in tumor size between the adjuvant TACE and non-adjuvant TACE groups in the SHCC cohort. There were differences in transfusion, Barcelona Clinic Liver Cancer stage and tumor-node-metastasis stage in the EHBH cohort. These factors were balanced by PSM. After PSM, patients with adjuvant TACE after hepatectomy still had significantly shorter RFS than those without (P=0.035; P=0.035) in both cohorts, but there was no difference in OS (P=0.638; P=0.159). Adjuvant TACE was the only independent prognostic factor for recurrence in multivariate analysis, with hazard ratios of 1.95 and 1.57.ConclusionsAdjuvant TACE may not improve long-term survival and might promote postoperative recurrence in HCC patients with a low risk of recurrence after hepatectomy.

Dataset Information

Adherence to adjuvant hormonal therapy and its relationship to breast cancer recurrence and survival among low-income women.

Publications

Adherence to adjuvant hormonal therapy and its relationship to breast cancer recurrence and survival among low-income women.

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