Adherence to Newly Implemented Tamoxifen Therapy for Breast Cancer Patients in Rural Western Ethiopia

Abstract

Introduction: Endocrine therapy for breast cancer (BC) patients is highly underutilized in rural Ethiopia and other African countries.

Objective: This study aims to assess the feasibility of and adherence to tamoxifen therapy in rural Ethiopia.

Methods: We ascertained the hormone receptor (HR) status in 101 women diagnosed with BC from January 2010 to December 2015 and who had surgery in Aira Hospital, in rural Ethiopia. From 2013, tamoxifen was offered to patients with HR-positive (HR+) tumors. Prescription refill records and a structured questionnaire were used to assess receipt of and adherence to tamoxifen.

Results: Of the 101 BC patients tested for HR status during the study period, 66 (65%) patients were HR+ and were eligible for tamoxifen treatment. However, 15 of the HR+ patients died before tamoxifen became available in 2013. Of the remaining 51 HR+ patients, 26 (51%) initiated tamoxifen but only 9 of them (35%) adhered to therapy (medication possession rate ≥80%, median observation 16.2 months). After 1 year, 52% of the patients were still adherent, and 9 patients had discontinued therapy. The reasons for non-initiation of tamoxifen included patient factors (n = 5), including financial hardship or lack of transportation, and health care provider factors (n = 12).

Conclusions: Endocrine therapy for BC patients seems feasible in rural Western Ethiopia, although non-adherence due to financial hardship and a less developed health care infrastructure remains a major challenge. We postulate that the implementation of breast nurses could reduce patient and health system barriers and improve initiation of and adherence to endocrine treatment.

Keywords: Africa; Breast neoplasms; Endocrine therapy; Ethiopia; Tamoxifen.

Fig. 1

Patients eligible for analysis from those enrolled in our study over the period January 26, 2010 to December 31, 2015. Tamoxifen treatment was initiated on March 18, 2013 and the adherence assessment period was March 18, 2013 to December 31, 2015. HR, hormone receptor; TAM, tamoxifen.

Fig. 2

Summary of 3-year adherence assessments for the 26 patients who initiated tamoxifen treatment and were censored for prescription refill between March 26, 2013 and March 10, 2016. TAM, tamoxifen; Int., interrupted; OP, operation.

Fig. 3

Kaplan-Meier estimates of the duration of tamoxifen therapy. Discontinuation: no patient contact for more than 6 months, 9 events in 26 patients.