Target and reality of adjuvant endocrine therapy in postmenopausal patients with invasive breast cancer (original) (raw)
Related papers
Adherence to Adjuvant Endocrine Therapy in Breast Cancer Patients
Current Oncology
Background: Adjuvant endocrine therapy (AET) reduces breast cancer recurrence and mortality of women with hormone-receptor-positive tumors, but poor adherence remains a significant problem. The aim of this study was to analyze AET side effects and their impact on adherence to treatment. Methods: A total of 373 breast cancer patients treated with AET filled out a specific questionnaire during their follow up visits at the Breast Unit of our Centre. Results: Side effects were reported by 81% of patients, 84% of those taking tamoxifen and 80% of those taking aromatase inhibitors (AIs). The most common side effect in the tamoxifen group was hot flashes (55.6%), while in the AI group it was arthralgia (60.6%). The addition of GnRH agonists to both tamoxifen and AI significantly worsened all menopausal symptoms. Overall, 12% of patients definitively discontinued AET due to side effects, 6.4% during the first 5 years and 24% during extended therapy. Patients who had previously received che...
Oncology Nursing Forum, 2014
Purpose/Objectives-To comprehensively assess the patient and illness or treatment factors that may predict nonadherence to adjuvant endocrine therapy and to explore whether an interaction occurs between these factors in women with breast cancer. Design-Repeated-measures design. Setting-The Outpatient Services of the Women's Cancer Program at the University of Pittsburgh Cancer Institute and participants' homes. Sample-91 women with early-stage breast cancer who received endocrine therapy.
European Journal of Cancer Care
Adherence to adjuvant endocrine therapy (AET) following breast cancer is known to be suboptimal despite its known efficacy in reducing recurrence and mortality. This study aims to investigate factors associated with non-adherence and inform the development of interventions to support women and promote adherence. A questionnaire survey to measure level of adherence, side effects experienced, beliefs about medicine, support received and socio-demographic details was sent to 292 women 2-4 years post breast cancer diagnosis. Differences between non-adherers and adherers to AET were explored, and factors associated with intentional and unintentional non-adherence are reported. Approximately one quarter of respondents, 46 (22%), were non-adherers, comprising 29 (14%) intentional non-adherers and 17 (8%) unintentional non-adherers. Factors significantly associated with intentional non-adherence were: the presence of side effects (p<0.03), greater concerns about AET (p<0.001), and a lower perceived necessity to take AET (p<0.001). Half of the sample (105/211) reported that side effects had a moderate or high impact on their quality of life. Factors associated with unintentional non-adherence were: younger age (<65), (p<0.001), post-secondary education (p=0.046), and paid employment (p=0.031). There are distinct differences between intentional non-adherence and unintentional non-adherence. Differentiation between the two types of non-adherence may help tailor support and advice interventions
Patient preference and adherence, 2018
Despite evidence of the efficacy of adjuvant endocrine therapy (AET) in reducing the risk of recurrence and mortality after treatment for primary breast cancer, adherence to AET is suboptimal. This study aimed to explore factors that influence adherence and nonadherence to AET following breast cancer to inform the development of supportive interventions. Interviews were conducted with 32 women who had been prescribed AET, 2-4 years following their diagnosis of breast cancer. Both adherers (n=19) and nonadherers (n=13) were recruited. The analysis was conducted using the Framework approach. Factors associated with adherence were as follows: managing side effects including information and advice on side effects and taking control of side effects, supportive relationships, and personal influences. Factors associated with nonadherence were as follows: burden of side effects, feeling unsupported, concerns about long-term AET use, regaining normality, including valuing the quality of life...
Cohort study of adherence to adjuvant endocrine therapy, breast cancer recurrence and mortality
British journal of cancer, 2013
Adjuvant endocrine therapy is recommended for women with oestrogen receptor-positive breast cancer, but many women do not take the medication as directed and they stop treatment before completing the standard 5-year duration. This retrospective cohort study conducted between 1993 and 2008 of all women with incident breast cancer, who are residing in the Tayside region of Scotland, examined adherence to prescribed adjuvant tamoxifen or aromatase inhibitors (AIs). Survival analysis examined the effect of adherence on all-cause mortality, breast cancer death and recurrence, using linked prescribing, cancer registry, clinical cancer audit, hospital discharge and death records. A total of 3361 women with breast cancer were followed for a median 4.47 years (interquartile range (IQR)=2.04-8.55). The median overall adherence was 90% (IQR=90-100%), but the annual adherence reduced after a longer period from diagnosis. Low adherence of <80% was associated with poorer survival (hazard ratio...
Non-Adherence to Adjuvant Hormonal Treatment in Early Breast Cancer
The benefit of hormonal adjuvant treatment is well established by clinical trials for the women with early breast cancer with hormonal receptors. Though, the information about adherence of the patients to this treatment are little known. We sought to estimate adherence and predictors of nonadherence in women starting hormonal adjuvant treatment in early breast cancer. Methods: Subjects were age 18 years or older initiating hormonal therapy(tamoxifen, letrozole, exemestane, anastrozol) for primary breast cancer , treated in Center of Medical Oncology from Iasi, Romania, in the period 2001-2009. The patients have completed a questionnaire about predictors of non-adherence to treatment and about their level of adherence to hormonal treatment. Results: Twenty-nine percent of patients missed taking hormonal therapy more than 2 months/ year. Predictors of non-adherence are: adverse events (flushes, arthralgia), extreme ages (particularly after 70 years ), psychological aspects. The percen...
Public Health Research & Practice
Objective: Although clinical trials recommend that women with hormonedependent primary breast cancer remain on endocrine therapy for at least 5 years, up to 60% discontinue treatment early. We determined whether these women had consulted with clinicians or had investigations for cancer recurrence or metastasis around the time they discontinued endocrine therapy, and whether clinical contact continued after discontinuation. Methods: We performed case-control and cohort studies of women from the 45 and Up Study who were diagnosed with invasive primary breast cancer between January 2003 and December 2008, and who had ≥12 months of anastrozole, exemestane, letrozole or tamoxifen subsequently dispensed. Results: Women who consulted general practitioners and surgeons/oncologists, and women who had breast ultrasound/mammogram were just as likely to discontinue endocrine therapy within 30 days as those who did not consult these clinicians or have this investigation. In the 6 months after early discontinuation, women who discontinued endocrine therapy were less likely to consult general practitioners (adjusted risk ratio [RR adj ] 0.80; 95% confidence interval [CI] 0.75, 0.86) and surgeons/oncologists (RR adj 0.62; 95% CI 0.54, 0.72) than those who remained on therapy. Conclusions: For most women, endocrine therapy discontinuation did not appear to follow consultation with doctors managing their breast cancer treatment or investigations for recurrence or metastasis. However, women who discontinued endocrine therapy were less likely to consult their general practitioner or surgeon/oncologist in the 6 months following discontinuation than those who remained on therapy. Of the clinician groups studied, general practitioners are best placed to engage and support women to continue pharmacotherapy. However, mechanisms are needed to prompt clinicians to do this at every visit.
Modifiable risk factors for adherence to adjuvant endocrine therapy among breast cancer patients
Patient Education and Counseling, 2014
Objective: Breast cancer incidence and mortality are declining due to improvements in early detection and treatment. One advance in treatment is the development of adjuvant endocrine therapy (AET) for women with hormone receptor positive breast cancer. Despite strong evidence linking AET to better health outcomes, AET adherence continues to be suboptimal. This study tests the hypothesis that patient beliefs about medication mediate the relationship between frequency of physician communication and AET adherence. Methods: This cross-sectional study utilizes data from patient self-report and medical chart abstraction (N = 200). Survey measures included frequency of physician communication, patient beliefs about medicine, AET adherence, and demographic characteristics. Results: Necessity beliefs mediated the relationship between frequency of physician communication and medication adherence (necessity beliefs b = .18, p < .05; physician communication b = .13, p > .05).
Adherence to oral administration of endocrine treatment for the patient with breast cancer: a review
REVIEWS IN ONCOLOGY, 2014
The adjuvant treatment with oral hormonal therapy improves clinical results of breast cancer, but women find difficulty in adhering to the 5-yearregime. The imperfect adherence to the therapeutic treatment has an impact on the clinical benefit; it can induce resistance to the treatment, disease progression and also death. The percentages of adherence to such treatments fluctuate between 15 and 50% and they are influenced by many factors (for example the appearance of side effects, elaborate dosage, the lack of confidence in the treatment, the price, the absence of relationship between doctor and patient). This article critically discusses the barriers to adherence to the endocrine oral therapy and the interventions able to improve it.
Journal of cancer survivorship : research and practice, 2018
Endocrine therapy reduces the risk of breast cancer recurrences and mortality in hormone receptor-positive (HR+) breast cancer survivors. However, non-adherence to treatment remains a significant problem. The aim of this study was to review current literature and ongoing trials to identify interventions employed to improve adherence to adjuvant endocrine therapy (AET) in breast cancer survivors. We searched PubMed and the National Library of Medicine registry of clinical trials using the terms "breast cancer" and "adherence" or "compliance" and "intervention" and "medication" or "endocrine therapy" or "hormone therapy" to identify published studies as well as ongoing clinical trials. Three hundred and sixty-three studies were identified; five studies met the inclusion criteria. Most studies enrolled postmenopausal women diagnosed with early stage HR+ breast cancer. Providing educational materials was the most comm...