Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Apr:3:1-9.
doi: 10.1200/CCI.18.00091.

Simulating Time-Dependent Patterns of Nonadherence by Patients With Breast Cancer to Adjuvant Oral Endocrine Therapy

Eileen H Shinn  1 , Gordon Broderick  2 , Bryan Fellman  1 , Ainslee Johnson  1 , Elizabeth Wieland  1 , Stacy Moulder  1 , William Fraser Symmans  1
Affiliations

Simulating Time-Dependent Patterns of Nonadherence by Patients With Breast Cancer to Adjuvant Oral Endocrine Therapy

Eileen H Shinn et al. JCO Clin Cancer Inform. 2019 Apr.

Abstract

Purpose: Nearly 40% of patients with breast cancer discontinue their adjuvant oral endocrine treatment (ET). We measured discontinuation rates of ET at a comprehensive cancer center. We then used an iterative approach to model patterns of determinants associated with discontinuation of ET.

Methods: Patients with nonmetastatic breast cancer receiving active adjuvant ET were approached by nurse practitioners to complete an anonymous survey at one time point. We simulated a prospective model by iteratively regressing adverse effects onto adherence status across windowed time periods of 2 to 3 consecutive years, bootstrapping the smaller group of nonadherent patients and subsampling the larger adherent group.

Results: From February to April 2013, 216 participants were enrolled in the study. Forty patients (18.5%) reported that they had discontinued ET during the first 5 years of ET, and an additional four patients (1.9%) missed > 20% of their doses. Using two-sided significance tests, simulations showed that all 13 ET adverse effects and reasons for discontinuation were significantly related to discontinuation at some time point during ET. Worry about ET cost (odds ratio [OR], 1.79), emotional distress (OR, 1.72), and bone and joint pain (OR, 1.69) were the three most impactful reasons for discontinuation, with varying patterns of influence over time.

Conclusion: These analyses provide preliminary evidence that there are varying patterns of discontinuation of ET. Although some reasons for discontinuation exerted a steady influence over the 6-year ET trajectory (ie, bone and joint pain), other reasons, such as cost, cognitive complaints, and general dislike of pills, became more important in the later years of ET.

PubMed Disclaimer

Conflict of interest statement

Eileen H. Shinn

Stock and Other Ownership Interests: Pfizer

Stacy Moulder

Honoraria: Novartis, Pfizer (I)

Research Funding: Oncothyreon (Inst), Pfizer (Inst), Novartis (Inst), Genentech (Inst), Takeda Pharmaceuticals (Inst), Bayer HealthCare Pharmaceuticals (Inst), EMD Serono (Inst)

Travel, Accommodations, Expenses: Novartis, Pfizer (I)

William Fraser Symmans

Stock and Other Ownership Interests: ISIS Pharmaceuticals, Nuvera Biosciences, Delphi Diagnostics

Consulting or Advisory Role: Merck Sharp & Dohme

Patents, Royalties, Other Intellectual Property: Intellectual property

Travel, Accommodations, Expenses: Luminex, Merck Sharp & Dohme

No other potential conflicts of interest were reported.

Figures

FIG 1.
FIG 1.
Response rate. ET, endocrine treatment.
FIG 2.
FIG 2.
Distribution of all participants at time they completed questionnaire. (*) Excludes the four participants who reported missing ≥ 20% of endocrine treatment (ET) doses.
FIG 3.
FIG 3.
Self-reported year of endocrine treatment (ET) discontinuation (n = 40).
FIG 4.
FIG 4.
Nonrandom change in impact over time on nonadherence to endocrine treatment (ET).
See this image and copyright information in PMC

References

    1. Hershman DL, Shao T, Kushi LH, et al. Early discontinuation and non-adherence to adjuvant hormonal therapy are associated with increased mortality in women with breast cancer. Breast Cancer Res Treat. 2011;126:529–537. - PMC - PubMed
    1. Moore S. Nonadherence in patients with breast cancer receiving oral therapies. Clin J Oncol Nurs. 2010;14:41–47. - PubMed
    1. Hadji P. Improving compliance and persistence to adjuvant tamoxifen and aromatase inhibitor therapy. Crit Rev Oncol Hematol. 2010;73:156–166. - PubMed
    1. Ma AM, Barone J, Wallis AE, et al. Noncompliance with adjuvant radiation, chemotherapy, or hormonal therapy in breast cancer patients. Am J Surg. 2008;196:500–504. - PubMed
    1. Yood MU, Owusu C, Buist DS, et al. Mortality impact of less-than-standard therapy in older breast cancer patients. J Am Coll Surg. 2008;206:66–75. - PubMed

Publication types

Substances