Adjuvant hormonal therapy use among women with ductal carcinoma in situ

Jennifer C. Livaudais, E. Shelley Hwang, Leah Karliner, Anna Nápoles, Susan Stewart, Joan Bloom, Celia P. Kaplan

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

Objective: In the absence of consistent guidelines for the use of adjuvant hormonal therapy (HT) in treating ductal carcinoma in situ (DCIS), our purpose was to explore a variety of factors associated with discussion, use, and discontinuation of this therapy for DCIS, including patient, tumor, and treatment-related characteristics and physician-patient communication factors. Methods: We identified women from eight California Cancer Registry regions diagnosed with DCIS from 2002 through 2005, aged ≥18 years, of Latina or non-Latina white race/ethnicity. A total of 744 women were interviewed an average of 24 months postdiagnosis about whether they had (1) discussed with a physician, (2) used, and (3) discontinued adjuvant HT. Results: Although 83% of women discussed adjuvant HT with a physician, 47% used adjuvant HT, and 23% of users reported discontinuation by a median of 11 months. In multivariable adjusted analyses, Latina Spanish speakers were less likely than white women to discuss therapy (odds ratio [OR] 0.36, 95% confidence interval [CI] 0.18-0.69) and more likely to discontinue therapy (OR 2.67, 95% CI 1.05-6.81). Seeing an oncologist for follow-up care was associated with discussion (OR 5.10, 95% CI 3.14-8.28) and use of therapy (OR 4.20, 95% CI 2.05-8.61). Similarly, physician recommendation that treatment was necessary vs. optional was positively associated with use (OR 11.2, 95% CI 6.50-19.4) and inversely associated with discontinuation (OR 0.38, 95% CI 0.19-0.73). Conclusions: Physician recommendation is an important factor associated with use and discontinuation of adjuvant HT for DCIS. Differences in discussion and discontinuation of therapy according to patient characteristics, particularly ethnicity/language, suggest challenges to physician-patient communication about adjuvant HT across a language barrier.

Original languageEnglish (US)
Pages (from-to)35-42
Number of pages8
JournalJournal of Women's Health
Volume21
Issue number1
DOIs
StatePublished - Jan 1 2012
Externally publishedYes

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Carcinoma, Intraductal, Noninfiltrating
Odds Ratio
Confidence Intervals
Physicians
Therapeutics
Hispanic Americans
Communication
Communication Barriers
Aftercare
Registries
Neoplasms
Language

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Livaudais, J. C., Hwang, E. S., Karliner, L., Nápoles, A., Stewart, S., Bloom, J., & Kaplan, C. P. (2012). Adjuvant hormonal therapy use among women with ductal carcinoma in situ. Journal of Women's Health, 21(1), 35-42. https://doi.org/10.1089/jwh.2011.2773

Adjuvant hormonal therapy use among women with ductal carcinoma in situ. / Livaudais, Jennifer C.; Hwang, E. Shelley; Karliner, Leah; Nápoles, Anna; Stewart, Susan; Bloom, Joan; Kaplan, Celia P.

In: Journal of Women's Health, Vol. 21, No. 1, 01.01.2012, p. 35-42.

Research output: Contribution to journalArticle

Livaudais, JC, Hwang, ES, Karliner, L, Nápoles, A, Stewart, S, Bloom, J & Kaplan, CP 2012, 'Adjuvant hormonal therapy use among women with ductal carcinoma in situ', Journal of Women's Health, vol. 21, no. 1, pp. 35-42. https://doi.org/10.1089/jwh.2011.2773
Livaudais, Jennifer C. ; Hwang, E. Shelley ; Karliner, Leah ; Nápoles, Anna ; Stewart, Susan ; Bloom, Joan ; Kaplan, Celia P. / Adjuvant hormonal therapy use among women with ductal carcinoma in situ. In: Journal of Women's Health. 2012 ; Vol. 21, No. 1. pp. 35-42.
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AU - Livaudais, Jennifer C.

AU - Hwang, E. Shelley

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AU - Stewart, Susan

AU - Bloom, Joan

AU - Kaplan, Celia P.

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N2 - Objective: In the absence of consistent guidelines for the use of adjuvant hormonal therapy (HT) in treating ductal carcinoma in situ (DCIS), our purpose was to explore a variety of factors associated with discussion, use, and discontinuation of this therapy for DCIS, including patient, tumor, and treatment-related characteristics and physician-patient communication factors. Methods: We identified women from eight California Cancer Registry regions diagnosed with DCIS from 2002 through 2005, aged ≥18 years, of Latina or non-Latina white race/ethnicity. A total of 744 women were interviewed an average of 24 months postdiagnosis about whether they had (1) discussed with a physician, (2) used, and (3) discontinued adjuvant HT. Results: Although 83% of women discussed adjuvant HT with a physician, 47% used adjuvant HT, and 23% of users reported discontinuation by a median of 11 months. In multivariable adjusted analyses, Latina Spanish speakers were less likely than white women to discuss therapy (odds ratio [OR] 0.36, 95% confidence interval [CI] 0.18-0.69) and more likely to discontinue therapy (OR 2.67, 95% CI 1.05-6.81). Seeing an oncologist for follow-up care was associated with discussion (OR 5.10, 95% CI 3.14-8.28) and use of therapy (OR 4.20, 95% CI 2.05-8.61). Similarly, physician recommendation that treatment was necessary vs. optional was positively associated with use (OR 11.2, 95% CI 6.50-19.4) and inversely associated with discontinuation (OR 0.38, 95% CI 0.19-0.73). Conclusions: Physician recommendation is an important factor associated with use and discontinuation of adjuvant HT for DCIS. Differences in discussion and discontinuation of therapy according to patient characteristics, particularly ethnicity/language, suggest challenges to physician-patient communication about adjuvant HT across a language barrier.

AB - Objective: In the absence of consistent guidelines for the use of adjuvant hormonal therapy (HT) in treating ductal carcinoma in situ (DCIS), our purpose was to explore a variety of factors associated with discussion, use, and discontinuation of this therapy for DCIS, including patient, tumor, and treatment-related characteristics and physician-patient communication factors. Methods: We identified women from eight California Cancer Registry regions diagnosed with DCIS from 2002 through 2005, aged ≥18 years, of Latina or non-Latina white race/ethnicity. A total of 744 women were interviewed an average of 24 months postdiagnosis about whether they had (1) discussed with a physician, (2) used, and (3) discontinued adjuvant HT. Results: Although 83% of women discussed adjuvant HT with a physician, 47% used adjuvant HT, and 23% of users reported discontinuation by a median of 11 months. In multivariable adjusted analyses, Latina Spanish speakers were less likely than white women to discuss therapy (odds ratio [OR] 0.36, 95% confidence interval [CI] 0.18-0.69) and more likely to discontinue therapy (OR 2.67, 95% CI 1.05-6.81). Seeing an oncologist for follow-up care was associated with discussion (OR 5.10, 95% CI 3.14-8.28) and use of therapy (OR 4.20, 95% CI 2.05-8.61). Similarly, physician recommendation that treatment was necessary vs. optional was positively associated with use (OR 11.2, 95% CI 6.50-19.4) and inversely associated with discontinuation (OR 0.38, 95% CI 0.19-0.73). Conclusions: Physician recommendation is an important factor associated with use and discontinuation of adjuvant HT for DCIS. Differences in discussion and discontinuation of therapy according to patient characteristics, particularly ethnicity/language, suggest challenges to physician-patient communication about adjuvant HT across a language barrier.

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