Early discontinuation and nonadherence to adjuvant hormonal therapy in a cohort of 8,769 early-stage breast cancer patients

Dawn L. Hershman, Lawrence H. Kushi, Theresa Shao, Donna Buono, Aaron Kershenbaum, Wei Yann Tsai, Louis Fehrenbacher, Scarlett Lin Gomez, Sunita Miles, Alfred I. Neugut

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Abstract

Purpose: While studies have found that adjuvant hormonal therapy for hormone-sensitive breast cancer (BC) dramatically reduces recurrence and mortality, adherence to medications is suboptimal. We investigated the rates and predictors of early discontinuation and nonadherence to hormonal therapy in patients enrolled in Kaiser Permanente of Northern California health system. Patients and Methods: We identified women diagnosed with hormone-sensitive stage I-III BC from 1996 to 2007 and used automated pharmacy records to identify hormonal therapy prescriptions and dates of refill. We used Cox proportional hazards regression models to analyze factors associated with early discontinuation and nonadherence (medication possession ratio < 80%) of hormonal therapy. Results: We identified 8,769 patients with BC who met our eligibility criteria and who filled at least one prescription for tamoxifen (43%), aromatase inhibitors (26%), or both (30%) within 1 year of diagnosis. Younger or older age, lumpectomy (v mastectomy), and comorbidities were associated with earlier discontinuation, while Asian race, being married, earlier year at diagnosis, receipt of chemotherapy or radiotherapy, and longer prescription refill interval were associated with completion of 4.5 years of therapy. Of those who continued therapy, similar factors were associated with full adherence. Women age younger than 40 years had the highest risk of discontinuation (hazard ratio, 1.51; 95% CI, 1.23 to 1.85). By 4.5 years, 32% discontinued therapy, and of those who continued, 72% were fully adherent. Conclusion: Only 49% of patients with BC took adjuvant hormonal therapy for the full duration at the optimal schedule. Younger women are at high risk of nonadherence. Interventions to improve adherence and continuation of hormonal therapy are needed, especially for younger women.

Original languageEnglish (US)
Pages (from-to)4120-4128
Number of pages9
JournalJournal of Clinical Oncology
Volume28
Issue number27
DOIs
StatePublished - Sep 20 2010
Externally publishedYes

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Breast Neoplasms
Prescriptions
Therapeutics
Medication Adherence
Hormones
Aromatase Inhibitors
Segmental Mastectomy
Mastectomy
Tamoxifen
Proportional Hazards Models
Statistical Factor Analysis
Comorbidity
Appointments and Schedules
Radiotherapy
Recurrence
Drug Therapy
Mortality
Health

ASJC Scopus subject areas

  • Cancer Research
  • Oncology
  • Medicine(all)

Cite this

Hershman, D. L., Kushi, L. H., Shao, T., Buono, D., Kershenbaum, A., Tsai, W. Y., ... Neugut, A. I. (2010). Early discontinuation and nonadherence to adjuvant hormonal therapy in a cohort of 8,769 early-stage breast cancer patients. Journal of Clinical Oncology, 28(27), 4120-4128. https://doi.org/10.1200/JCO.2009.25.9655

Early discontinuation and nonadherence to adjuvant hormonal therapy in a cohort of 8,769 early-stage breast cancer patients. / Hershman, Dawn L.; Kushi, Lawrence H.; Shao, Theresa; Buono, Donna; Kershenbaum, Aaron; Tsai, Wei Yann; Fehrenbacher, Louis; Lin Gomez, Scarlett; Miles, Sunita; Neugut, Alfred I.

In: Journal of Clinical Oncology, Vol. 28, No. 27, 20.09.2010, p. 4120-4128.

Research output: Contribution to journalArticle

Hershman, DL, Kushi, LH, Shao, T, Buono, D, Kershenbaum, A, Tsai, WY, Fehrenbacher, L, Lin Gomez, S, Miles, S & Neugut, AI 2010, 'Early discontinuation and nonadherence to adjuvant hormonal therapy in a cohort of 8,769 early-stage breast cancer patients', Journal of Clinical Oncology, vol. 28, no. 27, pp. 4120-4128. https://doi.org/10.1200/JCO.2009.25.9655
Hershman, Dawn L. ; Kushi, Lawrence H. ; Shao, Theresa ; Buono, Donna ; Kershenbaum, Aaron ; Tsai, Wei Yann ; Fehrenbacher, Louis ; Lin Gomez, Scarlett ; Miles, Sunita ; Neugut, Alfred I. / Early discontinuation and nonadherence to adjuvant hormonal therapy in a cohort of 8,769 early-stage breast cancer patients. In: Journal of Clinical Oncology. 2010 ; Vol. 28, No. 27. pp. 4120-4128.
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abstract = "Purpose: While studies have found that adjuvant hormonal therapy for hormone-sensitive breast cancer (BC) dramatically reduces recurrence and mortality, adherence to medications is suboptimal. We investigated the rates and predictors of early discontinuation and nonadherence to hormonal therapy in patients enrolled in Kaiser Permanente of Northern California health system. Patients and Methods: We identified women diagnosed with hormone-sensitive stage I-III BC from 1996 to 2007 and used automated pharmacy records to identify hormonal therapy prescriptions and dates of refill. We used Cox proportional hazards regression models to analyze factors associated with early discontinuation and nonadherence (medication possession ratio < 80{\%}) of hormonal therapy. Results: We identified 8,769 patients with BC who met our eligibility criteria and who filled at least one prescription for tamoxifen (43{\%}), aromatase inhibitors (26{\%}), or both (30{\%}) within 1 year of diagnosis. Younger or older age, lumpectomy (v mastectomy), and comorbidities were associated with earlier discontinuation, while Asian race, being married, earlier year at diagnosis, receipt of chemotherapy or radiotherapy, and longer prescription refill interval were associated with completion of 4.5 years of therapy. Of those who continued therapy, similar factors were associated with full adherence. Women age younger than 40 years had the highest risk of discontinuation (hazard ratio, 1.51; 95{\%} CI, 1.23 to 1.85). By 4.5 years, 32{\%} discontinued therapy, and of those who continued, 72{\%} were fully adherent. Conclusion: Only 49{\%} of patients with BC took adjuvant hormonal therapy for the full duration at the optimal schedule. Younger women are at high risk of nonadherence. Interventions to improve adherence and continuation of hormonal therapy are needed, especially for younger women.",
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T1 - Early discontinuation and nonadherence to adjuvant hormonal therapy in a cohort of 8,769 early-stage breast cancer patients

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AU - Kushi, Lawrence H.

AU - Shao, Theresa

AU - Buono, Donna

AU - Kershenbaum, Aaron

AU - Tsai, Wei Yann

AU - Fehrenbacher, Louis

AU - Lin Gomez, Scarlett

AU - Miles, Sunita

AU - Neugut, Alfred I.

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N2 - Purpose: While studies have found that adjuvant hormonal therapy for hormone-sensitive breast cancer (BC) dramatically reduces recurrence and mortality, adherence to medications is suboptimal. We investigated the rates and predictors of early discontinuation and nonadherence to hormonal therapy in patients enrolled in Kaiser Permanente of Northern California health system. Patients and Methods: We identified women diagnosed with hormone-sensitive stage I-III BC from 1996 to 2007 and used automated pharmacy records to identify hormonal therapy prescriptions and dates of refill. We used Cox proportional hazards regression models to analyze factors associated with early discontinuation and nonadherence (medication possession ratio < 80%) of hormonal therapy. Results: We identified 8,769 patients with BC who met our eligibility criteria and who filled at least one prescription for tamoxifen (43%), aromatase inhibitors (26%), or both (30%) within 1 year of diagnosis. Younger or older age, lumpectomy (v mastectomy), and comorbidities were associated with earlier discontinuation, while Asian race, being married, earlier year at diagnosis, receipt of chemotherapy or radiotherapy, and longer prescription refill interval were associated with completion of 4.5 years of therapy. Of those who continued therapy, similar factors were associated with full adherence. Women age younger than 40 years had the highest risk of discontinuation (hazard ratio, 1.51; 95% CI, 1.23 to 1.85). By 4.5 years, 32% discontinued therapy, and of those who continued, 72% were fully adherent. Conclusion: Only 49% of patients with BC took adjuvant hormonal therapy for the full duration at the optimal schedule. Younger women are at high risk of nonadherence. Interventions to improve adherence and continuation of hormonal therapy are needed, especially for younger women.

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