Factors influencing 5-year persistence to adjuvant endocrine therapy in young women with breast cancer

Eleonora Pagan¹, Monica Ruggeri², Nadia Bianco³, Eraldo Oreste Bucci⁴, Rossella Graffeo⁵, Markus Borner⁶, Monica Giordano⁷, Lorenzo Gianni⁸, Manuela Rabaglio⁹, Andrea Freschi¹⁰, Elisabetta Cretella¹¹, Elena Seles¹², Alberto Farolfi¹³, Edda Simoncini¹⁴, Mariangela Ciccarese¹⁵, Daniel Rauch¹⁶, Adolfo Favaretto¹⁷, Friedemann Honecker¹⁸, Rossana Berardi¹⁹, Alessandra Franzetti-Pellanda²⁰, Shari Gelber²¹, Ann H Partridge²², Aron Goldhirsch²³, Vincenzo Bagnardi¹, Olivia Pagani²⁴, Karin Ribi²⁵

Affiliations

¹ Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy.
² Program for Young Patients, International Breast Cancer Study Group, a Division of ETOP IBCSG Partners Foundation, Bern, Switzerland.
³ Division of Medical Senology, IEO, European Institute of Oncology IRCCS, Milan, Italy.
⁴ Breast Cancer Unit, Ospedale MultiMedica, Castellanza, VA, Italy.
⁵ Oncology Institute of Southern Switzerland, EOC, Bellinzona, Switzerland.
⁶ Division of Oncology (Oncocare), Klinik Engeried, Lindenhofgruppe, Bern, Switzerland.
⁷ ASST-Lariana, Como, Italy.
⁸ Department of Medical Oncology, Ospedale Infermi, Rimini, AUSL Della Romagna, Italy.
⁹ Department of Medical Oncology, Inselspital, Bern University Hospital, University of Bern, Switzerland.
¹⁰ Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, 33081, Aviano, Italy.
¹¹ Department of Medical Oncology, Azienda Sanitaria Dell'Alto Adige, Bolzano, Italy.
¹² Department of Medical Oncology, Ospedale Degli Infermi, Biella, Italy.
¹³ Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio Dei Tumori (IRST) "Dino Amadori", Meldola, Italy.
¹⁴ Breast Unit, ASST Spedali Civili di Brescia, Brescia, Italy.
¹⁵ Regional Agency for Social and Health Development (AReSS Puglia), Bari, Italy.
¹⁶ Onko-Netz, Thun, Switzerland.
¹⁷ Medical Oncology Unit, Azienda ULSS2, Marca Trevigiana, Treviso, Italy.
¹⁸ Tumor- and Breast Eastern Switzerland, St. Gallen, Switzerland.
¹⁹ Department of Medical Oncology, Università Politecnica Delle Marche, A.O.U. Delle Marche, Ancona, Italy.
²⁰ Radiotherapy Service, Gruppo Ospedaliero Moncucco, Clinica Moncucco, Lugano, Switzerland.
²¹ Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.
²² Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA; Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
²³ International Breast Cancer Study Group, IEO European Institute of Oncology, IRCCS, Milan, Italy.
²⁴ Geneva University Hospitals, Lugano University, Swiss Group for Clinical Cancer Research (SAKK), Switzerland.
²⁵ Quality of Life Office, International Breast Cancer Study Group, a division of ETOP IBCSG Partners Foundation, Bern, Switzerland; Careum School of Health, Part of the Kalaidos University of Applied Sciences, Zurich, Switzerland. Electronic address: karin.ribi@etop.ibcsg.org.

PMID: 39002281
PMCID: PMC11301370
DOI: 10.1016/j.breast.2024.103765

Factors influencing 5-year persistence to adjuvant endocrine therapy in young women with breast cancer

Eleonora Pagan et al. Breast. 2024 Oct.

. 2024 Oct:77:103765.

doi: 10.1016/j.breast.2024.103765. Epub 2024 Jul 4.

Authors

Affiliations

¹ Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy.
² Program for Young Patients, International Breast Cancer Study Group, a Division of ETOP IBCSG Partners Foundation, Bern, Switzerland.
³ Division of Medical Senology, IEO, European Institute of Oncology IRCCS, Milan, Italy.
⁴ Breast Cancer Unit, Ospedale MultiMedica, Castellanza, VA, Italy.
⁵ Oncology Institute of Southern Switzerland, EOC, Bellinzona, Switzerland.
⁶ Division of Oncology (Oncocare), Klinik Engeried, Lindenhofgruppe, Bern, Switzerland.
⁷ ASST-Lariana, Como, Italy.
⁸ Department of Medical Oncology, Ospedale Infermi, Rimini, AUSL Della Romagna, Italy.
⁹ Department of Medical Oncology, Inselspital, Bern University Hospital, University of Bern, Switzerland.
¹⁰ Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, 33081, Aviano, Italy.
¹¹ Department of Medical Oncology, Azienda Sanitaria Dell'Alto Adige, Bolzano, Italy.
¹² Department of Medical Oncology, Ospedale Degli Infermi, Biella, Italy.
¹³ Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio Dei Tumori (IRST) "Dino Amadori", Meldola, Italy.
¹⁴ Breast Unit, ASST Spedali Civili di Brescia, Brescia, Italy.
¹⁵ Regional Agency for Social and Health Development (AReSS Puglia), Bari, Italy.
¹⁶ Onko-Netz, Thun, Switzerland.
¹⁷ Medical Oncology Unit, Azienda ULSS2, Marca Trevigiana, Treviso, Italy.
¹⁸ Tumor- and Breast Eastern Switzerland, St. Gallen, Switzerland.
¹⁹ Department of Medical Oncology, Università Politecnica Delle Marche, A.O.U. Delle Marche, Ancona, Italy.
²⁰ Radiotherapy Service, Gruppo Ospedaliero Moncucco, Clinica Moncucco, Lugano, Switzerland.
²¹ Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.
²² Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA; Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
²³ International Breast Cancer Study Group, IEO European Institute of Oncology, IRCCS, Milan, Italy.
²⁴ Geneva University Hospitals, Lugano University, Swiss Group for Clinical Cancer Research (SAKK), Switzerland.
²⁵ Quality of Life Office, International Breast Cancer Study Group, a division of ETOP IBCSG Partners Foundation, Bern, Switzerland; Careum School of Health, Part of the Kalaidos University of Applied Sciences, Zurich, Switzerland. Electronic address: karin.ribi@etop.ibcsg.org.

PMID: 39002281
PMCID: PMC11301370
DOI: 10.1016/j.breast.2024.103765

Abstract

Purpose: Although younger age has been negatively associated with persistence to adjuvant endocrine therapy (ET), factors contributing to non-persistence remain poorly understood. We assessed factors associated with non-persistence to ET and described the 5-year trajectories of quality of life (QoL) and symptoms in young women (≤40 years) with hormone receptor-positive breast cancer (BC).

Methods: We retrieved data on clinical characteristics and non-persistence from the medical annual records in the European cohort of the "Helping Ourselves, Helping Others: The Young Women's BC Study" (IBCSG 43-09 HOHO). Women completed surveys at baseline, biannually for three years, and annually for another seven years. Data collection included sociodemographic information, QoL aspects assessed by the Cancer Rehabilitation Evaluation System-Short Form and symptoms assessed by the Breast Cancer Prevention Trial symptom scales. Cox regression models were applied to identify factors associated with non-persistence.

Results: The cumulative risk of interrupting ET within 5 years was 27.7 % (95 % CI, 21.5-35.2). The QoL subscale scores remained stable over 5 years, with slight improvements in the physical subscale. Hot flashes decreased (p < 0.001), while vaginal problems intensified (p < 0.001) over time. Being married without children and having difficulties interacting and communicating with the medical team were significantly associated with non-persistence.

Conclusions: Discussing the desire to conceive with partnered childless women and establishing a good relationship with the medical team may be important in addressing the non-persistence in young BC survivors. As recent data suggests the safety of pausing ET to conceive, this approach may be a reasonable future option to limit non-persistence.

Keywords: Adjuvant endocrine therapy; Breast cancer; Persistence; Quality of life; Young women.

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Conflict of interest statement

Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests:Eraldo Oreste Bucci reports a relationship with AstraZeneca R&D that includes: consulting or advisory and travel reimbursement. Eraldo Oreste Bucci reports a relationship with Astellas Pharma Europe Ltd that includes: travel reimbursement. Eraldo Oreste Bucci reports a relationship with Bristol Myers Squibb Co that includes: travel reimbursement. Eraldo Oreste Bucci reports a relationship with Eli Lilly and Company that includes: travel reimbursement. Eraldo Oreste Bucci reports a relationship with Merck Serono that includes: travel reimbursement. Eraldo Oreste Bucci reports a relationship with Roche that includes: travel reimbursement. Eraldo Oreste Bucci reports a relationship with Takeda Oncology that includes: travel reimbursement. Lorenzo Gianni reports a relationship with AstraZeneca that includes: consulting or advisory. Lorenzo Gianni reports a relationship with Seagen Inc that includes: consulting or advisory. Lorenzo Gianni reports a relationship with Pfizer and Novartis that includes: travel reimbursement. Alberto Farolfi reports a relationship with from Janssen Oncology, GSK-Tesaro, Astrazeneca, Clovis that includes: paid expert testimony. Rossana Berardi reports a relationship with AZ, BI, Novartis, MSD, Otsuka, Lilly, Roche, Amgen, GSK, EISAI, Seage that includes: consulting or advisory. Anne Patridge reports a relationship with Wolters Kluwer, Novartis that includes: equity or stocks and funding grants. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

**Fig. 2**
Cumulative risk of ET interruption (non-persistence) over time.

**Fig. 3**
Trajectories of CARES-SF domain scores (panel A) and BCPT symptom scales (panel B) over 5-years of follow-up A. **Note:** mean and corresponding 95 % confidence intervals for CARES-SF domain scores at baseline and during follow-up (lower scores indicating lower problems) and BCPT symptom scales at follow-up (lower scores indicating less symptom burden).

See this image and copyright information in PMC

References

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Factors influencing 5-year persistence to adjuvant endocrine therapy in young women with breast cancer

Affiliations

Factors influencing 5-year persistence to adjuvant endocrine therapy in young women with breast cancer

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

MeSH terms

Substances

LinkOut - more resources

Full Text Sources

Medical

Research Materials