Breast Cancer Research and Treatment

, Volume 169, Issue 1, pp 153–162 | Cite as

Adjuvant hormonal therapy for early breast cancer: an epidemiologic study of medication adherence

  • Charlotte Pourcelot
  • Emeline Orillard
  • Gilles Nallet
  • Camille Dirand
  • François Billion-Rey
  • Garance Barbier
  • Sarah Chouk
  • Samuel Limat
  • Philippe Montcuquet
  • Julie Henriques
  • Sophie Paget-Bailly
  • Amélie Anota
  • Loïc Chaigneau
  • Virginie Nerich
Epidemiology

Abstract

Purpose

The aim of this study was to determine the prevalence of adherence to adjuvant hormonal therapy (AHT) and to identify risk factors for medication non-adherence in clinical practice in patients with early-stage hormone receptor (HR)-positive breast cancer (BC) previously treated with chemotherapy.

Methods

We carried out a cross-sectional, observational, prospective, and multicenter survey based on a structured self-report postal questionnaire (35 items investigating six areas). A sample of 474 patients was drawn from 676 patients potentially eligible. The structured and validated Morisky Medication Adherence Scale-4 items was used for measuring medication adherence. An analysis of risk factors for non-adherence to AHT was performed using a two-step approach: univariate, then multivariate analysis.

Results

A total of 280 patients out of the 428 analyzed patients participated in the survey, yielding a response rate of 65.4% [60.9–69.9]. The prevalence of adherence to AHT was estimated at 68.6% [63.1–74.0], corresponding to a high level of adherence. Three risk factors for non-adherence to AHT were identified: > 2 medications to treat comorbidities (p-value = 0.003), age less than 65 years (p-value = 0.008), and patient management in a university hospital setting (p-value = 0.014).

Conclusions

Non-adherence is a common, complex, and multidimensional healthcare problem. This better understanding and knowledge of risk factors will allow healthcare providers (such as oncologists, general practitioners, pharmacists) to more easily identify patients at risk for non-adherence and help them provide appropriate information about AHT and its management, thus improving medication adherence in their patients.

Keywords

Adjuvant hormonal therapy Aromatase inhibitors Breast cancer Medication adherence Tamoxifen 

Notes

Acknowledgements

We would like to thank all patients, pharmacists and oncologists of the IRFC-FC participating in this study. We also thank Ms Pamela Albert for English assistance in the correction of the manuscript.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest related to the content of this manuscript.

References

  1. 1.
    Institut national du cancer (2017) Les cancers en France, édition 2016, collection Les DonnéesGoogle Scholar
  2. 2.
    Senkus E, Kyriakides S, Ohno S et al (2015) Primary breast cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 26(Suppl 5):v8–30.  https://doi.org/10.1093/annonc/mdv298 CrossRefPubMedGoogle Scholar
  3. 3.
    Early Breast Cancer Trialists’ Collaborative Group (1998) Tamoxifen for early breast cancer: an overview of the randomised trials. Lancet 351:1451–1467CrossRefGoogle Scholar
  4. 4.
    Early Breast Cancer Trialists’ Collaborative Group (EBCTCG), Davies C, Godwin J et al (2011) Relevance of breast cancer hormone receptors and other factors to the efficacy of adjuvant tamoxifen: patient-level meta-analysis of randomised trials. Lancet 378:771–784.  https://doi.org/10.1016/S0140-6736(11)60993-8 CrossRefGoogle Scholar
  5. 5.
    Davies C, Pan H, Godwin J et al (2013) Long-term effects of continuing adjuvant tamoxifen to 10 years versus stopping at 5 years after diagnosis of oestrogen receptor-positive breast cancer: ATLAS, a randomised trial. Lancet 381:805–816.  https://doi.org/10.1016/S0140-6736(12)61963-1 CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Gray RG, Rea D, Handley K et al (2013) aTTom: long-term effects of continuing adjuvant tamoxifen to 10 years versusversusversus stopping at 5 years in 6953 women with early breast cancer. J Clin Oncol 31:5.  https://doi.org/10.1200/jco.2013.31.15_suppl.5 CrossRefGoogle Scholar
  7. 7.
    Goss PE, Ingle JN, Pritchard KI et al (2016) Extending aromatase-inhibitor adjuvant therapy to 10 years. N Engl J Med.  https://doi.org/10.1056/NEJMoa1604700 PubMedPubMedCentralGoogle Scholar
  8. 8.
    Winer EP, Hudis C, Burstein HJ et al (2005) American Society of Clinical Oncology technology assessment on the use of aromatase inhibitors as adjuvant therapy for postmenopausal women with hormone receptor-positive breast cancer: status report 2004. J Clin Oncol 23:619–629.  https://doi.org/10.1200/JCO.2005.09.121 CrossRefPubMedGoogle Scholar
  9. 9.
    McCowan C, Shearer J, Donnan PT et al (2008) Cohort study examining tamoxifen adherence and its relationship to mortality in women with breast cancer. Br J Cancer 99:1763–1768.  https://doi.org/10.1038/sj.bjc.6604758 CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Early Breast Cancer Trialists’ Collaborative Group (EBCTCG) (2005) Effects of chemotherapy and hormonal therapy for early breast cancer on recurrence and 15-year survival: an overview of the randomised trials. Lancet 365:1687–1717.  https://doi.org/10.1016/S0140-6736(05)66544-0 CrossRefGoogle Scholar
  11. 11.
    Lebovits AH, Strain JJ, Schleifer SJ et al (1990) Patient noncompliance with self-administered chemotherapy. Cancer 65:17–22CrossRefPubMedGoogle Scholar
  12. 12.
    Brier MJ, Chambless D, Gross R et al (2015) Association between self-report adherence measures and oestrogen suppression among breast cancer survivors on aromatase inhibitors. Eur J Cancer 51:1890–1896.  https://doi.org/10.1016/j.ejca.2015.06.113 CrossRefPubMedGoogle Scholar
  13. 13.
    Murphy CC, Bartholomew LK, Carpentier MY et al (2012) Adherence to adjuvant hormonal therapy among breast cancer survivors in clinical practice: a systematic review. Breast Cancer Res Treat 134:459–478.  https://doi.org/10.1007/s10549-012-2114-5 CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Verbrugghe M, Verhaeghe S, Lauwaert K et al (2013) Determinants and associated factors influencing medication adherence and persistence to oral anticancer drugs: a systematic review. Cancer Treat Rev 39:610–621.  https://doi.org/10.1016/j.ctrv.2012.12.014 CrossRefPubMedGoogle Scholar
  15. 15.
    Puts MTE, Tu HA, Tourangeau A et al (2014) Factors influencing adherence to cancer treatment in older adults with cancer: a systematic review. Ann Oncol 25:564–577.  https://doi.org/10.1093/annonc/mdt433 CrossRefPubMedGoogle Scholar
  16. 16.
    Tralongo P, Ferraù F, Borsellino N et al (2011) Cancer patient-centered home care: a new model for health care in oncology. Ther Clin Risk Manag 7:387–392.  https://doi.org/10.2147/TCRM.S22119 PubMedPubMedCentralGoogle Scholar
  17. 17.
    Morisky DE, Green LW, Levine DM (1986) Concurrent and predictive validity of a self-reported measure of medication adherence. Med Care 24:67–74CrossRefPubMedGoogle Scholar
  18. 18.
    Morisky DE, Ang A, Krousel-Wood M, Ward HJ (2008) Predictive validity of a medication adherence measure in an outpatient setting. J Clin Hypertens 10:348–354CrossRefGoogle Scholar
  19. 19.
    Korb-Savoldelli V, Gillaizeau F, Pouchot J et al (2012) Validation of a French version of the 8-item Morisky medication adherence scale in hypertensive adults. J Clin Hypertens 14:429–434.  https://doi.org/10.1111/j.1751-7176.2012.00634.x CrossRefGoogle Scholar
  20. 20.
    Etter JF, Perneger TV (1997) Analysis of non-response bias in a mailed health survey. J Clin Epidemiol 50:1123–1128CrossRefPubMedGoogle Scholar
  21. 21.
    van den Akker M, Buntinx F, Metsemakers JF, Knottnerus JA (1998) Morbidity in responders and non-responders in a register-based population survey. Fam Pract 15:261–263CrossRefPubMedGoogle Scholar
  22. 22.
    Korkeila K, Suominen S, Ahvenainen J et al (2001) Non-response and related factors in a nation-wide health survey. Eur J Epidemiol 17:991–999CrossRefPubMedGoogle Scholar
  23. 23.
    Haynes RB, Sackett DL, Taylor DW et al (1977) Manipulation of the therapeutic regimen to improve compliance: conceptions and misconceptions. Clin Pharmacol Ther 22:125–130CrossRefPubMedGoogle Scholar
  24. 24.
    Darkow T, Henk HJ, Thomas SK et al (2007) Treatment interruptions and non-adherence with imatinib and associated healthcare costs: a retrospective analysis among managed care patients with chronic myelogenous leukaemia. PharmacoEconomics 25:481–496CrossRefPubMedGoogle Scholar
  25. 25.
    Partridge AH, Wang PS, Winer EP, Avorn J (2003) Nonadherence to adjuvant tamoxifen therapy in women with primary breast cancer. J Clin Oncol 21:602–606CrossRefPubMedGoogle Scholar
  26. 26.
    Partridge AH (2006) Non-adherence to endocrine therapy for breast cancer. Ann Oncol 17:183–184.  https://doi.org/10.1093/annonc/mdj141 CrossRefPubMedGoogle Scholar
  27. 27.
    Owusu C, Buist DSM, Field TS et al (2008) Predictors of tamoxifen discontinuation among older women with estrogen receptor-positive breast cancer. J Clin Oncol 26:549–555.  https://doi.org/10.1200/JCO.2006.10.1022 CrossRefPubMedGoogle Scholar
  28. 28.
    Makubate B, Donnan PT, Dewar JA et al (2013) Cohort study of adherence to adjuvant endocrine therapy, breast cancer recurrence and mortality. Br J Cancer 108:1515–1524.  https://doi.org/10.1038/bjc.2013.116 CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Osterberg L, Blaschke T (2005) Adherence to medication. N Engl J Med 353:487–497.  https://doi.org/10.1056/NEJMra050100 CrossRefPubMedGoogle Scholar
  30. 30.
    Cramer JA, Mattson RH, Prevey ML et al (1989) How often is medication taken as prescribed?: a novel assessment technique. JAMA 261:3273–3277.  https://doi.org/10.1001/jama.1989.03420220087032 CrossRefPubMedGoogle Scholar
  31. 31.
    Kruse W, Koch-Gwinner P, Nikolaus T et al (1992) Measurement of drug compliance by continuous electronic monitoring: a pilot study in elderly patients discharged from hospital. J Am Geriatr Soc 40:1151–1155CrossRefPubMedGoogle Scholar
  32. 32.
    Nguyen T-M-U, La Caze A, Cottrell N (2014) What are validated self-report adherence scales really measuring?: a systematic review. Br J Clin Pharmacol 77:427–445.  https://doi.org/10.1111/bcp.12194 CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Chlebowski RT, Geller ML (2006) Adherence to endocrine therapy for breast cancer. Oncology 71:1–9.  https://doi.org/10.1159/000100444 CrossRefPubMedGoogle Scholar
  34. 34.
    Font R, Espinas JA, Gil-Gil M et al (2012) Prescription refill, patient self-report and physician report in assessing adherence to oral endocrine therapy in early breast cancer patients: a retrospective cohort study in Catalonia, Spain. Br J Cancer 107:1249–1256.  https://doi.org/10.1038/bjc.2012.389 CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Walter T, Wang L, Chuk K et al (2013) Assessing adherence to oral chemotherapy using different measurement methods: lessons learned from capecitabine. J Oncol Pharm Pract 20:249–256.  https://doi.org/10.1177/1078155213501100 CrossRefPubMedGoogle Scholar
  36. 36.
    Waterhouse DM, Calzone KA, Mele C, Brenner DE (1993) Adherence to oral tamoxifen: a comparison of patient self-report, pill counts, and microelectronic monitoring. J Clin Oncol 11:1189–1197CrossRefPubMedGoogle Scholar
  37. 37.
    Brito C, Portela MC, de Vasconcellos MTL (2014) Adherence to hormone therapy among women with breast cancer. BMC Cancer 14:397.  https://doi.org/10.1186/1471-2407-14-397 CrossRefPubMedPubMedCentralGoogle Scholar
  38. 38.
    Bhatta SS, Hou N, Moton ZN et al (2013) Factors associated with compliance to adjuvant hormone therapy in Black and White women with breast cancer. SpringerPlus 2:356.  https://doi.org/10.1186/2193-1801-2-356 CrossRefPubMedPubMedCentralGoogle Scholar
  39. 39.
    Hershman DL, Kushi LH, Shao T et al (2010) Early discontinuation and nonadherence to adjuvant hormonal therapy in a cohort of 8769 early-stage breast cancer patients. J Clin Oncol 28:4120–4128.  https://doi.org/10.1200/JCO.2009.25.9655 CrossRefPubMedPubMedCentralGoogle Scholar
  40. 40.
    Ayres LR, de Oliveira Baldoni A, de Sá Borges AP, Pereira LR (2014) Adherence and discontinuation of oral hormonal therapy in patients with hormone receptor positive breast cancer. Int J Clin Pharm 36:45–54.  https://doi.org/10.1007/s11096-013-9833-5 CrossRefPubMedGoogle Scholar
  41. 41.
    Liu Y, Malin JL, Diamant AL et al (2013) Adherence to adjuvant hormone therapy in low-income women with breast cancer: the role of provider-patient communication. Breast Cancer Res Treat 137:829–836.  https://doi.org/10.1007/s10549-012-2387-8 CrossRefPubMedGoogle Scholar
  42. 42.
    Jacob Arriola KR, Mason TA, Bannon KA et al (2014) Modifiable risk factors for adherence to adjuvant endocrine therapy among breast cancer patients. Patient Educ Couns 95:98–103.  https://doi.org/10.1016/j.pec.2013.12.019 CrossRefPubMedGoogle Scholar
  43. 43.
    Kimmick G, Anderson R, Camacho F et al (2009) Adjuvant hormonal therapy use among insured, low-income women with breast cancer. J Clin Oncol 27:3445–3451.  https://doi.org/10.1200/JCO.2008.19.2419 CrossRefPubMedPubMedCentralGoogle Scholar
  44. 44.
    Gold DT, McClung B (2006) Approaches to patient education: emphasizing the long-term value of compliance and persistence. Am J Med 119:S32–S37.  https://doi.org/10.1016/j.amjmed.2005.12.021 CrossRefPubMedGoogle Scholar
  45. 45.
    Felton MA, van Londen GJ, Marcum ZA (2016) Medication adherence to oral cancer therapy: the promising role of the pharmacist. J Oncol Pharm Pract 22:378–381.  https://doi.org/10.1177/1078155214559114 CrossRefPubMedGoogle Scholar
  46. 46.
    Hurtado-de-Mendoza A, Cabling ML, Lobo T et al (2016) Behavioral interventions to enhance adherence to hormone therapy in breast cancer survivors: a systematic literature review. Clin Breast Cancer 16(247–255):e3.  https://doi.org/10.1016/j.clbc.2016.03.006 Google Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Charlotte Pourcelot
    • 1
  • Emeline Orillard
    • 2
  • Gilles Nallet
    • 3
    • 4
  • Camille Dirand
    • 1
  • François Billion-Rey
    • 5
  • Garance Barbier
    • 1
  • Sarah Chouk
    • 1
  • Samuel Limat
    • 1
    • 6
  • Philippe Montcuquet
    • 2
  • Julie Henriques
    • 6
    • 7
  • Sophie Paget-Bailly
    • 6
    • 7
  • Amélie Anota
    • 6
    • 7
  • Loïc Chaigneau
    • 2
  • Virginie Nerich
    • 1
    • 6
  1. 1.Department of PharmacyBesançon University HospitalBesançon CedexFrance
  2. 2.Department of Medical OncologyBesançon University HospitalBesançon CedexFrance
  3. 3.Federative Regional Institute for Cancer of Franche-ComtéBesançon CedexFrance
  4. 4.ONCOLIE Network of CancerBesançon CedexFrance
  5. 5.Department of PharmacyLons-le-Saunier HospitalLons Le SaunierFrance
  6. 6.University of Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, Interactions hôte-greffon-tumeur – Ingénierie Cellulaire et GéniqueBesançon CedexFrance
  7. 7.Besançon University Hospital, Methodological and Quality of Life in Cancerology UnitUniversity of Bourgogne Franche-ComtéBesançonFrance

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