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Almallah WR, Bakas T, Shaughnessy E, Morrison CF. Factors and Beliefs Affecting Women Diagnosed With Breast Cancer to Initiate Cancer Treatment: A Systematic Review. West J Nurs Res 2024; 46:623-634. [PMID: 39076138 DOI: 10.1177/01939459241262653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/31/2024]
Abstract
BACKGROUND Initiating treatment within the optimal time is critical for women with breast cancer. A delay in cancer treatment initiation can result in increased morbidity and mortality and decreased overall survival. OBJECTIVE This systematic review aims to investigate the literature for the factors and beliefs affecting women diagnosed with breast cancer with regard to initiating cancer treatment. METHODS The PubMed, CINAHL, and PsycINFO databases were searched using the terms of breast cancer, initiating or seeking treatment, and beliefs. The Johns Hopkins Evidence-Based Practice Research Evidence Appraisal Tool was used to evaluate the included articles. RESULTS Sixteen articles were included in this review. The addressed factors were classified as (1) patient-related factors, (2) disease-related factors, (3) provider-related factors, and (4) system-related factors. The identified beliefs were cultural beliefs and perceived barriers to initiating treatment. CONCLUSION Although the literature reported multiple factors and beliefs that impact the time of initiating treatment among women with breast cancer, more research is needed to fully understand the beliefs influencing treatment initiation. It is essential to address and screen the factors and beliefs identified for women diagnosed with breast cancer to enhance treatment initiation early and prevent any possible delay. Interventions can be developed to overcome the factors and beliefs that may lead to late treatment initiation. Advocacy for new policies should be in action to reduce the disparities associated with treatment initiation among women with breast cancer.
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Affiliation(s)
- Walaa R Almallah
- University of Cincinnati College of Nursing, Cincinnati, OH, USA
- College of Nursing, Jordan University of Science & Technology, Irbid, Jordan
| | - Tamilyn Bakas
- University of Cincinnati College of Nursing, Cincinnati, OH, USA
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O'Neil DS, Blanchard CL, Joffe M, Antoni M, Ream M, Mmoledi KC, Mkwanazi N, Shandukani V, Ruff P. Associations between HIV infection status, psychosocial factors, and adjuvant endocrine therapy adherence among South African women with early-stage breast cancer. RESEARCH SQUARE 2024:rs.3.rs-4559587. [PMID: 38978566 PMCID: PMC11230477 DOI: 10.21203/rs.3.rs-4559587/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/10/2024]
Abstract
Purpose We aimed to evaluate for associations between HIV status, psychosocial factors, and adjuvant endocrine therapy (AET) adherence in South African (SA) women with estrogen receptor positive (ER+) breast cancer (BC). Methods We enrolled South African women with early-stage ER + BC in remission and prescribed tamoxifen or an aromatase inhibitor to the prospective observational study. We performed AET pill counts at enrollment, 12 weeks, and 24 weeks, and calculated adherence ratios of pills consumed between visits to days between visits. Women completed questionnaires on social support, attitude towards medication, health literacy, self-efficacy, mental health, and AET toxicity. We collected household wealth data. We used hierarchical linear (HLM) and structural equation modelling (SEM) to compare adherence ratios between women with and without HIV while adjusting for psychosocial factors. Results We collected adherence data from 239 women, 63 (26.4%) with co-morbid HIV. Comparing women with and without HIV, median AET adherence ratio was 0.88 vs 0.89, respectively (HLM p = 0.31). In our SEM model for the full cohort, mental health, healthcare savvy, and side effect burden latent variables were not significantly associated with adherence. In the subgroup of women living with HIV, lower SES quintile (β 0.04, SE 0.02, p = 0.08) and poorer mental health (β -0.02, SE 0.01, p = 0.10) showed trends toward association with adherence. Conclusions HIV status is not predictive of AET adherence among SA women with ER + BC, though decreasing SES status and increasing mental health symptoms are marginally associated with adherence in women with BC and HIV.
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Gomaa S, Lopez A, Slamon R, Smith R, Lapitan E, Nightingale G, Miller SM, Wen KY. The lived experience of patients with breast cancer on adjuvant endocrine therapy: side effects and coping strategies during the first year of medication initiation. Support Care Cancer 2023; 31:719. [PMID: 38008817 DOI: 10.1007/s00520-023-08170-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 11/07/2023] [Indexed: 11/28/2023]
Abstract
PURPOSE Adjuvant endocrine therapy (AET) is pivotal for hormone receptor-positive breast cancer patients, significantly enhancing survival rates. Yet, adherence to AET remains challenging due to side effects. This study delves into the lived experience of breast cancer survivors concerning AET-induced side effects and examines differences in symptom profiles between Tamoxifen and aromatase inhibitors (AIs). METHODS We interviewed 35 breast cancer survivors on AET, conducting qualitative iterative analysis using grounded theory. A codebook was developed to aid data coding and interpretation. NVIVO software facilitated comprehensive transcript analysis. RESULTS Survivors reported a spectrum of side effects like hot flashes, sexual issues, joint pain, stiffness, mood swings, and fertility concerns. Symptom profiles differed based on AET type. Tamoxifen users experienced more frequent sexual side effects and mood swings, while AIs were linked to joint pain, stiffness, and bone health worries. Those on AET for over 6 months expressed heightened concerns about side effects. CONCLUSION Tailored patient education, aligned with AET type, empowers survivors to manage side effects using self-regulatory strategies. Acknowledging distinct symptom profiles enables informed decisions, improving adherence and quality of life. IMPLICATIONS This study underscores tailored survivorship support, equipping patients with tools to manage side effects, enhancing adherence, and long-term outcomes. The findings inform the integration of comprehensive survivorship programs, emphasizing individualized strategies for managing side effects and promoting better adherence and improved quality of life.
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Affiliation(s)
- Sameh Gomaa
- Department of Medical Oncology, Thomas Jefferson University, Philadelphia, PA, USA
| | - AnaMaria Lopez
- Department of Medical Oncology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Rachel Slamon
- Department of Medical Oncology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Rita Smith
- Department of Medical Oncology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Emmanuel Lapitan
- Cancer Prevention and Control, Fox Chase Cancer Center/Temple University Health System, Philadelphia, PA, USA
| | - Ginah Nightingale
- Department of Pharmacy Practice, Thomas Jefferson University, Philadelphia, PA, USA
| | - Suzanne M Miller
- Cancer Prevention and Control, Fox Chase Cancer Center/Temple University Health System, Philadelphia, PA, USA
| | - Kuang-Yi Wen
- Department of Medical Oncology, Thomas Jefferson University, Philadelphia, PA, USA.
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Kumar T, Dutta RR, Thakre S, Singh A, Velagala VR, Shinde RK. Resistance to Resilience: Understanding Post-surgical Hormone Therapy in Breast Cancer Care. Cureus 2023; 15:e47869. [PMID: 38021507 PMCID: PMC10681032 DOI: 10.7759/cureus.47869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 10/28/2023] [Indexed: 12/01/2023] Open
Abstract
Breast cancer is one of the most common types of cancer affecting women worldwide. Over the years, breast cancer has become a major public health concern, and its incidence is rising globally. The treatment of breast cancer does not stop with surgical intervention, but adjuvant therapies are administered to improve patient outcomes post-surgery based on the type of breast cancer diagnosed. This review focuses on the value of hormone therapy (HT) in improving the prognosis of breast cancer patients and why adhering to adjuvant treatment post-surgery is difficult for patients. HT aims to reduce the chances of breast cancer recurrence after surgical treatment. Even though HT is life-saving, patients tend to not adhere to the therapy due to various factors such as side effects, age-related issues, and socioeconomic status. Most patients stop adhering to the therapy as the duration can be as long as 5-10 years, and the quality of life is greatly impacted due to the side effects of the treatment. This review examines the possible factors leading to non-adherence to HT and tries to propose possible interventions that might improve patient compliance with the treatment. This article not only focuses on the impact of side effects of HT on patients' quality of life but also tries to understand the problems faced by breast cancer patients in adhering to HT.
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Affiliation(s)
- Tanishq Kumar
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Rajoshee R Dutta
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Swedaj Thakre
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Arihant Singh
- General Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Vivek R Velagala
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Raju K Shinde
- General Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Kim J, Kim MS, Rajan SS, Du XL, Franzini L, Kim TG, Giordano SH, Morgan RO. Geographic Variations and the Associated Factors in Adherence to and Persistence with Adjuvant Hormonal Therapy for the Privately Insured women Aged 18–64 with Breast Cancer in Texas. Curr Oncol 2023; 30:3800-3816. [PMID: 37185401 PMCID: PMC10136640 DOI: 10.3390/curroncol30040288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 03/17/2023] [Accepted: 03/27/2023] [Indexed: 04/01/2023] Open
Abstract
The purpose of this study is to examine the geographical patterns of adjuvant hormonal therapy adherence and persistence and the associated factors in insured Texan women aged 18–64 with early breast cancer. A retrospective cohort study was conducted using 5-year claims data for the population insured by the Blue Cross Blue Shield of Texas (BCBSTX). Women diagnosed with early breast cancer who were taking tamoxifen or aromatase inhibitors (AIs) for adjuvant hormonal therapy with at least one prescription claim were identified. Adherence to adjuvant hormonal therapy and persistence with adjuvant hormonal therapy were calculated as outcome measures. Women without a gap between two consecutively dispensed prescriptions of at least 90 days were considered to be persistently taking the medications. Patient-level multivariate logistic regression models with repeated regional-level adjustments and a Cox proportional hazards model with mixed effects were used to determine the geographical variations and patient-, provider-, and area-level factors that were associated with adjuvant hormonal therapy adherence and persistence. Of the 938 women in the cohort, 627 (66.8%) initiated adjuvant hormonal therapy. Most of the smaller HRRs have significantly higher or lower rates of treatment adherence and persistence rates relative to the median regions. The use of AHT varies substantially from one geographical area to another, especially for adherence, with an approximately two-fold difference between the lowest and highest areas, and area-level factors were found to be significantly associated with the compliance of AHT. There are geographical variations in AHT adherence and persistence in Texas. Patient-level and area-level factors have significant associations explaining these patterns.
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Kuhn EP, Pirruccello J, Boothe JT, Li Z, Tosteson TD, Stahl JE, Schwartz GN, Chamberlin MD. Preventing metastatic recurrence in low-risk ER/PR + breast cancer patients-a retrospective clinical study exploring the evolving challenge of persistence with adjuvant endocrine therapy. Breast Cancer Res Treat 2023; 198:31-41. [PMID: 36592233 PMCID: PMC9883310 DOI: 10.1007/s10549-022-06849-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 11/30/2022] [Indexed: 01/03/2023]
Abstract
PURPOSE In the genomic era, more women with low-risk breast cancer will forego chemotherapy and rely on adjuvant endocrine therapy (AET) to prevent metastatic recurrence. However, some of these patients will unfortunately relapse. We sought to understand this outcome. Preliminary work suggested that early discontinuation of AET, also known as non-persistence, may play an important role. A retrospective analysis exploring factors related to our breast cancer patients' non-persistence with AET was performed. METHODS Women who underwent Oncotype-DX® testing between 2011 and 2014 with minimum 5 years follow-up were included. 'Low risk' was defined as Oncotype score < 26. Outcomes of recurrence and persistence were determined by chart review. Patient, tumor and treatment factors were collected, and persistent versus non-persistent groups compared using multivariable ANOVA and Fisher Chi square exact test. RESULTS We identified six cases of distant recurrence among low-risk patients with a median follow-up of 7.7 years. Among them, five of six patients (83%) were non-persistent with AET. The non-persistence rate in our cohort regardless of recurrence was 57/228 (25%). Non-persistent patients reported more severe side effects compared with persistent patients (p = 0.002) and were more likely to be offered a switch in endocrine therapy, rather than symptom-relief (p = 0.006). In contrast, persistent patients were 10.3 times more likely to have been offered symptom-alleviating medications compared with non-persistent patients (p < 0.001). A subset analysis revealed that patients who persisted with therapy had a higher Oncotype-DX® score than patients who discontinued early (p = 0.028). CONCLUSION Metastatic recurrence in low-risk breast cancer patients may be primarily due to non-persistence with endocrine therapy. Further work is needed to optimize care for patients who struggle with side effects. To our knowledge, these are the first published data suggesting that Oncotype-DX® score may influence persistence with AET.
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Affiliation(s)
- Elaine P Kuhn
- Department of Internal Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.
- Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.
| | - Jonathan Pirruccello
- Department of Internal Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - James T Boothe
- Department of Internal Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Zhongze Li
- Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
- Department of Biomedical Data Sciences, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Tor D Tosteson
- Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
- Department of Biomedical Data Sciences, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - James E Stahl
- Department of Internal Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Gary N Schwartz
- Department of Internal Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
- Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Mary D Chamberlin
- Department of Internal Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
- Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
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Rosenberg SM, Zheng Y, Gelber S, Ruddy KJ, Poorvu P, Sella T, Tamimi RM, Wassermann J, Schapira L, Borges VF, Come S, Peppercorn J, Sepucha KR, Partridge AH. Adjuvant endocrine therapy non-initiation and non-persistence in young women with early-stage breast cancer. Breast Cancer Res Treat 2023; 197:547-558. [PMID: 36436128 PMCID: PMC10233447 DOI: 10.1007/s10549-022-06810-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 11/09/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE Characterizing oral adjuvant endocrine therapy (ET) non-initiation and non-persistence in young women with breast cancer can inform strategies to improve overall adherence in this population. METHODS We identified 693 women with hormone receptor-positive, stage I-III breast cancer enrolled in a cohort of women diagnosed with breast cancer at age ≤ 40 years. Women were classified as non-initiators if they did not report taking ET in the 18 months after diagnosis. Women who initiated but did not report taking ET subsequently (through 5-year post-diagnosis) were categorized as non-persistent. We assessed ET decision-making and used logistic regression to identify factors associated with non-initiation/non-persistence and to evaluate the association between non-persistence and recurrence. RESULTS By 18 months, 9% had not initiated ET. Black women had higher odds and women with a college degree had lower odds of non-initiation. Among 607 women who initiated, 20% were non-persistent. Younger age, being married/partnered, and reporting more weight problems were associated with higher odds of non-persistence; receipt of chemotherapy and greater hot flash and vaginal symptom burden were associated with lower odds of non-persistence. Adjusting for age and clinical characteristics, non-persistence was associated with lower odds of recurrence. Women who initiated were more likely to report shared decision-making than non-initiators (57% vs. 38%, p = 0.049), while women who were non-persistent were less likely to indicate high confidence with the decision than women who were persistent (40% vs. 63%, p < 0.001). CONCLUSION Interventions to improve ET decision-making may facilitate initiation and address barriers to adherence in young breast cancer survivors. TRIAL REGISTRATION www. CLINICALTRIALS gov , NCT01468246.
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Affiliation(s)
- Shoshana M Rosenberg
- Department of Population Health Sciences, Weill Cornell Medicine, 402 E 67St LA-0005, New York, NY, 10065, USA.
- Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.
- Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
| | - Yue Zheng
- Data Science, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Shari Gelber
- Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA
| | | | - Philip Poorvu
- Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Tal Sella
- Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Rulla M Tamimi
- Department of Population Health Sciences, Weill Cornell Medicine, 402 E 67St LA-0005, New York, NY, 10065, USA
| | - Johanna Wassermann
- Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA
- Department of Medical Oncology, Sorbonne Université, IUC, Pitié-Salpêtrière University Hospital, Paris, AP-HP, France
| | - Lidia Schapira
- Department of Medicine, Division of Medical Oncology, Stanford University, Stanford, CA, USA
| | - Virginia F Borges
- Medical Oncology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Steven Come
- Harvard Medical School, Boston, MA, USA
- Medical Oncology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Jeffrey Peppercorn
- Harvard Medical School, Boston, MA, USA
- Department of Medicine, Division of Medical Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Karen R Sepucha
- Harvard Medical School, Boston, MA, USA
- Department of Medicine, Division of Medical Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Ann H Partridge
- Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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En‐nasery ‐ de Heer S, Tromp VNMF, Westerman MJ, Konings I, Beckeringh JJ, Boons CLM, Timmers L, Hugtenburg JG. Patient experiences and views on pharmaceutical care during adjuvant endocrine therapy for breast cancer: A qualitative study. Eur J Cancer Care (Engl) 2022; 31:e13749. [PMID: 36300863 PMCID: PMC9786726 DOI: 10.1111/ecc.13749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 09/24/2022] [Accepted: 10/09/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVE The use of adjuvant endocrine therapy (AET) after primary treatment of hormone receptor-positive breast cancer reduces the risk of recurrence and mortality. However, non-adherence is still common. Limited consideration has been given to how users deal with AET and the role of pharmaceutical care. Therefore, this study aims to obtain insight into the needs and wishes of women using AET regarding pharmaceutical care and eHealth. METHODS This is a qualitative explorative study comprising semi-structured interviews (n = 16) and a focus group (n = 5) among women who use or used AET after primary early-stage breast cancer (EBC) treatment using a thematic analysis approach. RESULTS Three themes emerged from the interviews and focus group: (1) experiences with AET use, (2) experiences with provided information and (3) needs and wishes regarding pharmaceutical care. Most women were highly motivated to use AET and indicated to have received useful information on AET. However, many expressed a strong need for more elaborate tailored and timely provided information on AET. They acknowledged the accessibility of pharmacists but reported that currently, pharmacists are hardly involved in AET care. Several women considered eHealth useful to obtain counselling and reliable information. CONCLUSION Women need more comprehensive information and follow-up in primary setting after initial cancer treatments. A more elaborate role for the pharmacy and eHealth/mHealth, especially with regard to counselling on side effects and side effect management, could potentially improve pharmaceutical care.
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Affiliation(s)
- Selma En‐nasery ‐ de Heer
- Department of Clinical Pharmacology and PharmacyAmsterdam UMC, Location VUmcAmsterdamThe Netherlands,Amsterdam Public Health Research InstituteAmsterdam UMC, Location VUmcAmsterdamThe Netherlands
| | - Vashti N. M. F. Tromp
- Department of Clinical Pharmacology and PharmacyAmsterdam UMC, Location VUmcAmsterdamThe Netherlands,Amsterdam Public Health Research InstituteAmsterdam UMC, Location VUmcAmsterdamThe Netherlands
| | - Marjan J. Westerman
- Department of Epidemiology and Data ScienceAmsterdam UMC, Location VUmcAmsterdamThe Netherlands
| | - Inge Konings
- Department of Medical Oncology, Cancer Center AmsterdamAmsterdam UMC, Location VUmcAmsterdamThe Netherlands
| | | | - Christel L. M. Boons
- Department of Clinical Pharmacology and PharmacyAmsterdam UMC, Location VUmcAmsterdamThe Netherlands,Amsterdam Public Health Research InstituteAmsterdam UMC, Location VUmcAmsterdamThe Netherlands
| | - Lonneke Timmers
- Department of Clinical Pharmacology and PharmacyAmsterdam UMC, Location VUmcAmsterdamThe Netherlands
| | - Jacqueline G. Hugtenburg
- Department of Clinical Pharmacology and PharmacyAmsterdam UMC, Location VUmcAmsterdamThe Netherlands,Amsterdam Public Health Research InstituteAmsterdam UMC, Location VUmcAmsterdamThe Netherlands
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Freedman RA, Ko NY, Lederman RI, Gagnon H, Fikre T, Gundersen DA, Revette AC, Odai-Afotey A, Kantor O, Hershman DL, Crew KD, Keating NL. Breast cancer knowledge and understanding treatment rationales among diverse breast cancer survivors. Breast Cancer Res Treat 2022; 196:623-633. [PMID: 36220997 PMCID: PMC9552717 DOI: 10.1007/s10549-022-06752-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 09/18/2022] [Indexed: 12/02/2022]
Abstract
Purpose The degree to which breast cancer survivors know about their tumors and understand treatment rationales is not well understood. We sought to identify information gaps within a diverse sample and explore whether knowledge about breast cancer and treatment may impact care. Methods We conducted a one-time, interviewer-administered survey of women who were diagnosed with breast cancer during 2013–2017 and received care at one of three centers in Boston, MA, and New York, NY. We examined knowledge of breast cancer and treatment rationales, information preferences, and treatment receipt. Results During 2018–2020, we interviewed 313 women (American Association for Public Opinion Research Cooperation Rates 58.4–76.5% across centers) who were 56.9% White, 23.6% Black, 14.1% Hispanic, and 5.4% other. Among the 296 included in analyses, we observed high variability in knowledge of breast cancer and treatment rationales, with a substantial number demonstrating limited knowledge despite feeling highly informed; > 25% actively avoided information. Black and Hispanic (vs. White) women consistently knew less about their cancers. Lack of understanding of treatment rationales for chemotherapy, radiation, and hormonal therapy was common but not consistently different by race and ethnicity. Understanding treatment rationale (but not cancer knowledge) was associated with treatment initiation, but small sample sizes limited in-depth examination. Conclusions Our study highlights the need for enhanced informational support for breast cancer survivors, who are challenged with complex information during the decision-making process and beyond. More research is needed to understand how to further educate and empower diverse populations of patients with breast cancer. Supplementary Information The online version contains supplementary material available at 10.1007/s10549-022-06752-8.
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Affiliation(s)
- Rachel A Freedman
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA. .,Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA.
| | - Naomi Y Ko
- Section of Hematology and Medical Oncology, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Ruth I Lederman
- Survey and Qualitative Methods Core, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Haley Gagnon
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Tsion Fikre
- Section of Hematology and Medical Oncology, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Daniel A Gundersen
- Survey and Qualitative Methods Core, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Anna C Revette
- Survey and Qualitative Methods Core, Dana-Farber Cancer Institute, Boston, MA, USA
| | | | - Olga Kantor
- Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA.,Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Dawn L Hershman
- Department of Medicine and Epidemiology, Columbia University Irving Medical Center, Herbert Irving Comprehensive Cancer Center, New York, NY, USA
| | - Katherine D Crew
- Department of Medicine and Epidemiology, Columbia University Irving Medical Center, Herbert Irving Comprehensive Cancer Center, New York, NY, USA
| | - Nancy L Keating
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.,Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
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Doshi SD, Lichtenstein MRL, Beauchemin MP, Raghunathan R, Lee S, Law C, Accordino MK, Elkin EB, Wright JD, Hershman DL. Factors Associated With Patients Not Receiving Oral Anticancer Drugs. JAMA Netw Open 2022; 5:e2236380. [PMID: 36227596 PMCID: PMC9561978 DOI: 10.1001/jamanetworkopen.2022.36380] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Oral anticancer drugs (OACDs) are increasingly prescribed for cancer treatment and require significant coordination of care. Retrospective studies suggest that 10% to 20% of OACD prescriptions are never received by the patients, but the reasons behind this are poorly understood. OBJECTIVES To estimate the rate of failure to receive OACD prescriptions among patients with cancer and to examine the underlying reasons for this failure. DESIGN, SETTING, AND PARTICIPANTS A prospective cohort study was conducted among patients with cancer who were prescribed a new OACD from January 1, 2018, to December 31, 2019, at an urban academic medical center. Data analysis was conducted between 2021 and 2022. MAIN OUTCOMES AND MEASURES Patient demographic, clinical, and insurance data and OACD delivery dates were collected. The reasons for a failure to receive a prescribed OACD within 3 months were confirmed by manual review of medical records and were classified into 7 categories: clinical deterioration, financial access, clinician-directed change in decision-making, patient-directed change in decision-making, transfer of care, loss to follow-up, and unknown or other. A multivariable random-effects model was developed to identify factors associated with failure to receive a prescribed OACD. RESULTS The cohort included 1024 patients (538 men [53%]; mean [SD] age, 66.2 [13.9] years; 463 non-Hispanic White patients [45%], 140 non-Hispanic Black patients [14%], and 300 Hispanic patients [29%]), representing 1197 new OACD prescriptions. Of the 1197 prescriptions, 158 (13%) were categorized as having not been received by the patient. The most common reason for the failure to receive a prescribed OACD was due to patient and clinician decision-making (73 of 158 [46%]), and 20 cases (13%) in which prescriptions were not received were associated with financial access issues. In multivariable analysis, patients with a nonmetastatic solid malignant neoplasm were significantly less likely to not receive their OACDs than those with a hematologic malignant neoplasm (odds ratio, 0.57 [95% CI, 0.33-1.00]; P = .048). CONCLUSIONS AND RELEVANCE This cohort study of patients prescribed a new OACD found that 13% of prescriptions were not received. The failure to receive a prescribed OACD was most frequently due to a change in clinical decision-making or patient choice. Ultimately, the reasons for the failure to receive a prescribed OACD were multifactorial and may have been appropriate in some cases.
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Affiliation(s)
- Sahil D. Doshi
- Division of Medical Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Morgan R. L. Lichtenstein
- Divison of Hematology/Oncology, Department of Medicine, Columbia University Irving Medical Center, New York, New York
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, New York
| | - Melissa P. Beauchemin
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, New York
- School of Nursing, Columbia University Irving Medical Center, New York, New York
| | - Rohit Raghunathan
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, New York
| | - Shing Lee
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, New York
| | - Cynthia Law
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, New York
| | - Melissa K. Accordino
- Divison of Hematology/Oncology, Department of Medicine, Columbia University Irving Medical Center, New York, New York
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, New York
| | - Elena B. Elkin
- Mailman School of Public Health, Columbia University Irving Medical Center, New York, New York
| | - Jason D. Wright
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, New York
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York
| | - Dawn L. Hershman
- Divison of Hematology/Oncology, Department of Medicine, Columbia University Irving Medical Center, New York, New York
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, New York
- Mailman School of Public Health, Columbia University Irving Medical Center, New York, New York
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11
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Rogers CC, Pope S, Whitfield F, Cohn WF, Valdez RS. The lived experience during the peri-diagnostic period of breast cancer: A scoping review. PATIENT EDUCATION AND COUNSELING 2022; 105:547-585. [PMID: 34210570 DOI: 10.1016/j.pec.2021.06.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 06/13/2021] [Accepted: 06/14/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES The aim of this scoping review is to provide an overview of the existing research that investigates the lived experience during the peri-diagnostic period of breast cancer. METHODS Nine databases were searched for relevant literature between January 2007 and April 2019. Data were extracted and categorized using deductive and inductive approaches. RESULTS A majority of the 66 studies included used qualitative methods to retrospectively explore the treatment decision making process of female breast cancer patients. Patients experienced uncertainty, emotional distress, and a need for more information from providers and relied on social support and family guidance during this period. CONCLUSIONS The results of this review show that the burdens experienced during the peri-diagnostic period parallel those in later periods of cancer care. However, these burdens are prompted by different circumstances. More research is needed to explore the lived experience during this period through the use of mixed-methods and by recruiting a diverse sample with regards to role in the breast cancer experience, age, gender, race, and ethnicity. PRACTICE IMPLICATIONS Interventions positioned at earlier points in the breast cancer experience should provide informational support, which could be delivered through shared decision making models. Additional support could be facilitated by patient navigation programs and health information technology.
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Affiliation(s)
- Courtney C Rogers
- Department of Engineering Systems and Environment, University of Virginia, Charlottesville, VA, United States; Department of Public Health Sciences, University of Virginia, Charlottesville, VA, United States
| | - Shannon Pope
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, United States
| | - Francesca Whitfield
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, United States
| | - Wendy F Cohn
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, United States
| | - Rupa S Valdez
- Department of Engineering Systems and Environment, University of Virginia, Charlottesville, VA, United States; Department of Public Health Sciences, University of Virginia, Charlottesville, VA, United States.
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12
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Five-Year Adjuvant Endocrine Therapy Adherence Trajectories Among Women With Breast Cancer: A Nationwide French Study Using Administrative Data. Clin Breast Cancer 2021; 21:e415-e426. [PMID: 33745868 DOI: 10.1016/j.clbc.2021.01.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 12/18/2020] [Accepted: 01/10/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND Adjuvant endocrine therapy (AET) improves long-term survival of breast cancer patients, yet many women are nonadherent or discontinue this treatment. In this study we aimed to describe AET adherence trajectories over 5 years after treatment initiation and to identify factors associated with these trajectories, in a nationwide French cohort of breast cancer survivors. PATIENTS AND METHODS Every woman diagnosed with a first nonmetastatic breast cancer in 2011 in France who initiated AET in the 12 months after surgery was included from the French cancer cohort. We identified all reimbursements for AET from national health administrative data sets and modeled AET adherence trajectories over 5 years, using group-based trajectory modeling on the basis of the monthly proportion of days covered by AET. Associated factors were identified using multinomial logistic regressions. RESULTS We included 33,260 women. A 6-trajectory model was selected: 1, immediate discontinuation (6.6%); 2, continuous suboptimal adherence (4.3%); 3, progressive nonadherence then discontinuation (6.3%); 4, early nonadherence then discontinuation (5.7%); 5, continuous optimal adherence (68.8%); and 6, late nonadherence then discontinuation (8.3%). The main factors associated with nonadherence trajectories were extreme age (younger than 50 and older than 70 years) and switching AET. CONCLUSION Approximately 70% of women had optimal adherence over all 5 years. The original nationwide approach enabled us to identify the "continuous suboptimal adherence trajectory" never previously described.
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13
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Montagna E, Zagami P, Masiero M, Mazzocco K, Pravettoni G, Munzone E. Assessing Predictors of Tamoxifen Nonadherence in Patients with Early Breast Cancer. Patient Prefer Adherence 2021; 15:2051-2061. [PMID: 34552323 PMCID: PMC8450184 DOI: 10.2147/ppa.s285768] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 07/31/2021] [Indexed: 12/11/2022] Open
Abstract
Adjuvant endocrine therapy (AET) is generally proposed to all patients with hormone receptor-positive breast cancer to reduce the risk of recurrence and death. Adherence to therapy is crucial. However, non-adherence to AET is common, with estimates of up to 50% of patients not successfully completing a five-year course of treatment, and it is significantly associated with lower survival rates and a higher risk of recurrence. Currently, no gold standard is available to assess adherence. Several studies, most of them retrospective in nature, have used both direct and indirect methods to monitor the adherence to therapy in breast cancer. The indirect method is more widely used, and it is based on pharmacy prescription refills and patient administered questionnaires. On the other hand, direct methods such as a measurement of the level of the drug or its metabolites in blood or urine are much more precise, but more expensive and not routinely implemented. In this review, we analyzed the results of the major studies focused on the adherence to tamoxifen in breast cancer patients. We identified several factors associated with poor adherence, such as the side effects of therapy, the lack of shared decision-making between the physician and patient, the context in which the discussion takes place, and whether the patients are enrolled in a clinical trial. Moreover, we discussed possible methods to improve adherence to adjuvant therapy in breast cancer.
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Affiliation(s)
- Emilia Montagna
- Division of Medical Senology, IEO European Institute of Oncology IRCCS, Milan, Italy
- Correspondence: Emilia Montagna Division of Medical Senology, European Institute of Oncology, IRCCS, Via Ripamonti 435, Milan, 20141, ItalyTel +39 02 57489439Fax +39 02 574829212 Email
| | - Paola Zagami
- Division of Medical Senology, IEO European Institute of Oncology IRCCS, Milan, Italy
- Division of Early Drug Development for Innovative Therapies, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Marianna Masiero
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
- Applied Research Division for Cognitive and Psychological Science, IEO European Institute of Oncology IRCCS, Milan, 20141, Italy
| | - Ketti Mazzocco
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
- Applied Research Division for Cognitive and Psychological Science, IEO European Institute of Oncology IRCCS, Milan, 20141, Italy
| | - Gabriella Pravettoni
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
- Applied Research Division for Cognitive and Psychological Science, IEO European Institute of Oncology IRCCS, Milan, 20141, Italy
| | - Elisabetta Munzone
- Division of Medical Senology, IEO European Institute of Oncology IRCCS, Milan, Italy
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14
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Felder TM, Heiney SP, Hebert JR, Friedman DB, Elk R, Franco R, Gansauer L, Christensen B, Ford ME. Improving Adherence to Adjuvant Hormonal Therapy Among Disadvantaged Women Diagnosed with Breast Cancer in South Carolina: Proposal for a Multimethod Study. JMIR Res Protoc 2020; 9:e17742. [PMID: 32880374 PMCID: PMC7499167 DOI: 10.2196/17742] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 06/15/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Current clinical guidelines recommend that hormone receptor-positive breast cancer survivors take adjuvant hormonal therapy (AHT) for 5 to 10 years, following the end of definitive treatment. However, fewer than half of patients adhere to the guidelines, and suboptimal adherence to AHT is associated with an increased risk of breast cancer mortality. Research has extensively documented sociodemographic and disease-specific factors associated with adherence to AHT, but very little evidence exists on behavioral factors (eg, knowledge, patient-provider communication) that can be modified and targeted by interventions. OBJECTIVE The goal of this study is to develop and test a theory-based, multilevel intervention to improve adherence to AHT among breast cancer survivors from racially and socioeconomically disadvantaged backgrounds (eg, Medicaid-insured). The specific aims are to (1) explore multilevel (eg, patient, health care system) factors that influence adherence to AHT; (2) develop a theory-based, multilevel intervention to improve adherence to AHT; and (3) pilot test and evaluate the intervention developed in Aim 2. METHODS For Aim 1, we will recruit breast cancer survivors and health care professionals to participate in semistructured interviews to gain their perspectives about barriers and facilitators to AHT use. We will conduct a directed content analysis of the Aim 1 qualitative interview data. For Aim 2, we will integrate Aim 1 findings and current literature into the design of a multilevel intervention using an Intervention Mapping approach. For Aim 3, we will recruit Medicaid-insured breast cancer survivors to assess the feasibility of the pilot intervention. RESULTS From May 2016 to July 2018, we completed interviews with 19 breast cancer survivors and 23 health care professionals in South Carolina. We will conduct a directed content analysis of the qualitative interview data. Results from this analysis will be used, in combination with current literature, to design (Aim 2) and pilot test a theory-based multilevel intervention (Aim 3) in Summer 2021. Results of the pilot are expected for Fall 2021. CONCLUSIONS This study will provide a deeper understanding of how to improve adherence to AHT, using a novel and multilevel approach, among socioeconomically disadvantaged breast cancer survivors who often experience disproportionate breast cancer mortality. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/17742.
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Affiliation(s)
- Tisha M Felder
- College of Nursing, University of South Carolina, Columbia, SC, United States
- Cancer Prevention & Control Program, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Sue P Heiney
- College of Nursing, University of South Carolina, Columbia, SC, United States
| | - James R Hebert
- Cancer Prevention & Control Program, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Daniela B Friedman
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
- Office for the Study of Aging, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Ronit Elk
- Center for Palliative and Supportive Care, Division of Geriatrics, Gerontology, and Palliative Care, University of Alabama-Birmingham School of Medicine, Birmingham, AL, United States
| | - Regina Franco
- Center for Integrative Oncology & Survivorship, Cancer Institute, Prisma Health, Greenville, SC, United States
| | - Lucy Gansauer
- Gibbs Cancer Center & Research Institute, Spartanburg Regional Healthcare System, Spartanburg, SC, United States
| | - Barbara Christensen
- Gibbs Cancer Center & Research Institute, Spartanburg Regional Healthcare System, Spartanburg, SC, United States
| | - Marvella E Ford
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, United States
- Population Sciences and Cancer Disparities, Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, United States
- Office of Community Outreach and Engagement, Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, United States
- SmartState Endowed Chair, Cancer Disparities Research, Medical University of South Carolina and South Carolina State University, Charleston, SC, United States
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15
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Endocrine treatment and incidence of relapse in women with oestrogen receptor-positive breast cancer in Europe: a population-based study. Breast Cancer Res Treat 2020; 183:439-450. [PMID: 32651753 DOI: 10.1007/s10549-020-05761-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 06/17/2020] [Indexed: 01/01/2023]
Abstract
PURPOSE Endocrine therapy (ET) is the mainstream adjuvant treatment for ER-positive breast cancer (BC). We analysed 9293 ER-positive BC patients diagnosed in nine European countries in 2009-2013 to investigate how comorbidities at diagnosis, age, stage and subtype affected ET use over time, and relapse. METHODS Adjusted odds ratios (ORs) and 95% confidence intervals (95%CIs) of receiving ET were estimated according to Charlson comorbidity, age, stage and subtype using logistic regression. The 2-year cumulative incidence and adjusted sub-hazard ratios (SHRs) of relapse were estimated using competing risk analysis, with all-cause death as the competing event. The z-test was used to assess differences in the proportion of patients receiving ET in 1996-1998 and 2009-2013. RESULTS Ninety percent of the patients started adjuvant ET, range 96% (Belgium, Estonia, Slovenia, Spain)-75% (Switzerland). ORs of starting ET were lower for women aged > 75 years, with severe comorbidities, or luminal B HER2-positive cancer. The factors independently increasing the risk of relapse were: not receiving ET (SHR 2.26, 95%CI 1.02-5.03); severe comorbidity (SHR 1.94, 95%CI 1.06-3.55); luminal B, either HER2 negative (SHR 3.06, 95%CI 1.61-5.79) or positive (SHR 3.10, 95%CI 1.36-7.07); stage II (SHR 3.20, 95%CI 1.56-6.57) or stage III (SHR 7.41, 95%CI 3.48-15.73). ET use increased significantly but differently across countries from 51-85% in 1996-1998 to 86-96% in 2009-2013. CONCLUSIONS ER-positive BC patients in Europe are increasingly prescribed ET but between-country disparities persist. Older women and women with severe comorbidity less frequently receive ET. ET omission and severe comorbidity independently predict early disease relapse.
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16
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Krok-Schoen JL, Naughton MJ, Young GS, Moon J, Poi M, Melin SA, Wood ME, Hopkins JO, Paskett ED, Post DM. Increasing Adherence to Adjuvant Hormone Therapy Among Patients With Breast Cancer: A Smart Phone App-Based Pilot Study. Cancer Control 2020; 26:1073274819883287. [PMID: 31736324 PMCID: PMC6862779 DOI: 10.1177/1073274819883287] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
PURPOSE This study tested the feasibility and efficacy of using a text-based intervention to increase initiation, decrease discontinuation, and improve adherence as prescribed to adjuvant hormone therapy (AHT) among hyphenate post-menopausal breast cancer survivors. METHODS The 3-month intervention consisted of daily text message reminders to take medication, coupled with a dynamic (eg, feedback on progress) tailored intervention using weekly interactive surveys delivered by a smartphone app. Five clinic sites within the Alliance for Clinical Trials in Oncology participated. Hormone levels were measured prior to AHT initiation and at study exit. RESULTS Of the 39 patients recruited to the pilot study, 27 (69.2%) completed all study requirements (completed both the baseline and the exit surveys, both blood draws, and did not miss more than 2 weekly surveys). Significant improvements were observed pre- to postintervention for self-reported medication adherence (P = .015), mental health functioning (P = .007), and perceived stress (P = .04). Significant decreases in estradiol, estrogen, and estrone hormone levels were observed from baseline to study exit (P < .001), indicating the accuracy of self-reported AHT adherence. Participants (91.9%) and physicians (100%) agreed that participant participation in the intervention was beneficial. CONCLUSIONS The results of this pilot study established the general feasibility and efficacy of an app-based intervention to support patient AHT adherence. Larger controlled, randomized trials are needed to examine the effectiveness of the app-based intervention in improving AHT and quality of life among breast cancer survivors.
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Affiliation(s)
- Jessica L Krok-Schoen
- School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University, Columbus, OH, USA.,Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
| | - Michelle J Naughton
- Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA.,Division of Cancer Prevention and Control, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Gregory S Young
- Center for Biostatistics, The Ohio State University, Columbus, OH, USA
| | - Jennifer Moon
- Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
| | | | - Susan A Melin
- Department of Hematology and Oncology, Wake Forest University Baptist Medical Center, Winston-Salem, NC, USA
| | - Marie E Wood
- Division of Hematology and Oncology, University of Vermont Medical Center, Burlington, VT, USA
| | - Judith O Hopkins
- Novant Health Oncology Specialists, Kernersville Medical Pkwy, Kernersville, NC, USA
| | - Electra D Paskett
- Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA.,Division of Cancer Prevention and Control, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA.,Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH, USA
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17
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de Mendoza AH, Cabling M, Dilawari A, Turner JW, Fernández N, Henderson A, Zhu Q, Gómez S, Sheppard VB. Providers' Perspectives on Adherence to Hormonal Therapy in Breast Cancer Survivors. Is there a Role for the Digital Health Feedback System? HEALTH AND TECHNOLOGY 2019; 9:175-184. [PMID: 31448187 DOI: 10.1007/s12553-018-0267-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Objective Despite the benefits of hormonal therapy (HT) adherence remains suboptimal in ER positive breast cancer patients. Medication adherence is challenging to assess and tends to be overestimated. The Digital Health Feedback System (DHFS) consists of an ingestible sensor attached to a pill that sends intake date and time to a smart phone or computer. Patients can share this information with health care providers and other persons. The DHFS can also send reminders. This mixed methods study examined providers' perceptions of HT medication adherence. The potential role of the DHFS in enhancing medication tracking and adherence was also explored. Methods We conducted semi-structured interviews with key informants (N=10). Questions examined perceptions about adherence barriers and facilitators, challenges tracking adherence, and views on the DHFS. Findings informed the development of a survey that was administered online (N=19). Results Providers emphasized the importance of fostering open and trustful communication around adherence. The most mentioned challenges to assessing adherence were the patient not disclosing discontinuation immediately (78.9%) and over-reporting adherence (57.9%). The perceived potential benefits of DHFS were the ability to track adherence better (94.7%) and reminders to take the medication (68.4%). Safety to ingest a sensor was as a major perceived barrier (8 4.2%). Conclusion Interventions that target providers and doctor-patient communication are warranted to enhance adherence and reduce communication delays around HT discontinuation. Practice Implications DHFS has the potential to enhance HT adherence by directly targeting barriers. Future studies should also examine the feasibility of adopting the DHFS with cancer patients.
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Affiliation(s)
| | | | | | | | | | | | - Qi Zhu
- Georgetown University Medical Center
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18
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Wheeler SB, Spencer J, Pinheiro LC, Murphy CC, Earp JA, Carey L, Olshan A, Tse CK, Bell ME, Weinberger M, Reeder-Hayes KE. Endocrine Therapy Nonadherence and Discontinuation in Black and White Women. J Natl Cancer Inst 2019; 111:498-508. [PMID: 30239824 PMCID: PMC6510227 DOI: 10.1093/jnci/djy136] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2017] [Revised: 06/08/2018] [Accepted: 07/10/2018] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Differential use of endocrine therapy (ET) by race may contribute to breast cancer outcome disparities, but racial differences in ET behaviors are poorly understood. METHODS Women aged 20-74 years with a first primary, stage I-III, hormone receptor-positive (HR+) breast cancer were included. At 2 years postdiagnosis, we assessed nonadherence, defined as not taking ET every day or missing more than two pills in the past 14 days, discontinuation, and a composite measure of underuse, defined as either missing pills or discontinuing completely. Using logistic regression, we evaluated the relationship between race and nonadherence, discontinuation, and overall underuse in unadjusted, clinically adjusted, and socioeconomically adjusted models. RESULTS A total of 1280 women were included; 43.2% self-identified as black. Compared to white women, black women more often reported nonadherence (13.7% vs 5.2%) but not discontinuation (10.0% vs 10.7%). Black women also more often reported the following: hot flashes, night sweats, breast sensitivity, and joint pain; believing that their recurrence risk would not change if they stopped ET; forgetting to take ET; and cost-related barriers. In multivariable analysis, black race remained statistically significantly associated with nonadherence after adjusting for clinical characteristics (adjusted odds ratio = 2.72, 95% confidence interval = 1.75 to 4.24) and after adding socioeconomic to clinical characteristics (adjusted odds ratio = 2.44, 95% confidence interval = 1.50 to 3.97) but was not independently associated with discontinuation after adjustment. Low recurrence risk perception and lack of a shared decision making were strongly predictive of ET underuse across races. CONCLUSIONS Our results highlight important racial differences in ET-adherence behaviors, perceptions of benefits/harms, and shared decision making that may be targeted with culturally tailored interventions.
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Affiliation(s)
- Stephanie B Wheeler
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Jennifer Spencer
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Laura C Pinheiro
- Division of General Internal Medicine, Weill Cornell Medical College, New York, NY
| | - Caitlin C Murphy
- Division of Epidemiology, Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX
| | - Jo Anne Earp
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Lisa Carey
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Division of Hematology and Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Andrew Olshan
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Chiu Kit Tse
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Mary E Bell
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Morris Weinberger
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Katherine E Reeder-Hayes
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Division of Hematology and Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC
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de Ligt KM, van Egdom LS, Koppert LB, Siesling S, van Til JA. Opportunities for personalised follow-up care among patients with breast cancer: A scoping review to identify preference-sensitive decisions. Eur J Cancer Care (Engl) 2019; 28:e13092. [PMID: 31074162 PMCID: PMC9285605 DOI: 10.1111/ecc.13092] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 03/21/2019] [Accepted: 04/20/2019] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Current follow-up arrangements for breast cancer do not optimally meet the needs of individual patients. We therefore reviewed the evidence on preferences and patient involvement in decisions about breast cancer follow-up to explore the potential for personalised care. METHODS Studies published between 2008 and 2017 were extracted from MEDLINE, PsycINFO and EMBASE. We then identified decision categories related to content and form of follow-up. Criteria for preference sensitiveness and patient involvement were compiled and applied to determine the extent to which decisions were sensitive to patient preferences and patients were involved. RESULTS Forty-one studies were included in the full-text analysis. Four decision categories were identified: "surveillance for recurrent/secondary breast cancer; consultations for physical and psychosocial effects; recurrence-risk reduction by anti-hormonal treatment; and improving quality of life after breast cancer." There was little evidence that physicians treated decisions about anti-hormonal treatment, menopausal symptoms, and follow-up consultations as sensitive to patient preferences. Decisions about breast reconstruction were considered as very sensitive to patient preferences, and patients were usually involved. CONCLUSION Patients are currently not involved in all decisions that affect them during follow-up, indicating a need for improvements. Personalised follow-up care could improve resource allocation and the value of care for patients.
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Affiliation(s)
- Kelly M. de Ligt
- Department of ResearchNetherlands Comprehensive Cancer Organisation (IKNL)UtrechtThe Netherlands
- Department of Health Technology and Services Research, Technical Medical CentreUniversity of TwenteEnschedeThe Netherlands
| | - Laurentine S.E. van Egdom
- Department of Surgical OncologyErasmus MC Cancer Institute, University Medical Centre RotterdamRotterdamThe Netherlands
| | - Linetta B. Koppert
- Department of Surgical OncologyErasmus MC Cancer Institute, University Medical Centre RotterdamRotterdamThe Netherlands
| | - Sabine Siesling
- Department of ResearchNetherlands Comprehensive Cancer Organisation (IKNL)UtrechtThe Netherlands
- Department of Health Technology and Services Research, Technical Medical CentreUniversity of TwenteEnschedeThe Netherlands
| | - Janine A. van Til
- Department of Health Technology and Services Research, Technical Medical CentreUniversity of TwenteEnschedeThe Netherlands
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Association between financial burden and adjuvant hormonal therapy adherence and persistent use for privately insured women aged 18-64 years in BCBS of Texas. Breast Cancer Res Treat 2018; 169:573-586. [PMID: 29423900 DOI: 10.1007/s10549-018-4704-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 02/01/2018] [Indexed: 10/18/2022]
Abstract
PURPOSE The objective of this study is to understand an impact of financial burden on the adjuvant hormonal therapy (AHT) adherence and persistence for insured women aged 18-64 with early breast cancer in Texas. METHODS We conducted a retrospective cohort study using claims data for population insured by Blue Cross Blue Shield of Texas from the year 2008 to 2013. Outcomes include adherence to adjuvant hormonal therapy, which was measured by medication possession ratio and persistence on AHT, which is the duration of time from initiation to discontinuation of therapy. Multivariate logistic regression models with repeated regional-level adjustments were used to explore the odds of AHT adherence. Cox proportional hazards model was conducted to assess time to the first 90+-day gap for persistence and a Kaplan-Meier curve were used to estimate probabilities to calculate the percentages of women who experienced 90+-day gaps in AHT. RESULTS Of the 938 women in the cohort, 627 (66.8%) initiated the treatment. By year 1, 66.9% of women were adherent to the therapy, and by year 5, only 29% of those were adherent. The percentage of women with no gap in therapy greater than 90 days was 80.8%. Both higher out-of-pocket costs spent on all prescription drugs except AHT and AHT-specific out-of-pocket costs were negatively associated with adherence to AHT as well as continuing AHT as recommended. CONCLUSIONS Financial burdens including both non-AHT medication and AHT-specific out-of-pocket costs were significantly associated with adherence and persistence to the therapy.
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21
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Sheppard VB, de Mendoza AH, He J, Jennings Y, Edmonds MC, Oppong BA, Tadesse MG. Initiation of Adjuvant Endocrine Therapy in Black and White Women With Breast Cancer. Clin Breast Cancer 2017; 18:337-346.e1. [PMID: 29422259 DOI: 10.1016/j.clbc.2017.12.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 10/20/2017] [Accepted: 12/01/2017] [Indexed: 01/18/2023]
Abstract
BACKGROUND Adjuvant endocrine therapy reduces risk of recurrence and mortality in women with hormone receptor-positive breast cancer, yet many women never initiate it. We examined the influence of race, sociocultural factors, and process-of-care factors on initiation of adjuvant endocrine therapy in a racially diverse sample. PATIENTS AND METHODS Eligible women were originally recruited for the Narrowing the Gaps in Adjuvant Therapy Study (2006-2011). Sociocultural and process-of-care factors were collected via telephone surveys before adjuvant therapy. Clinical factors were abstracted from charts. Penalized LASSO (least absolute shrinkage and selection operator) logistic regression model was used to identify variables associated with initiation. RESULTS Of the 270 women, 55.6% were black and the rest were white. Most women (74.8%) initiated therapy. A significant interaction (P = .008) was found between race and age. Black women aged ≤ 50 years had the lowest initiation (59.7%) compared to black women > 50 years (87.1%), white women ≤ 50 years (73.7%), or white women > 50 years (72.0%). Multivariate analysis found that younger black women exhibited a marginally higher risk of noninitiation compared to older black women. Additionally, ratings of financial access, presence of comorbidities, and levels of communication were all associated with endocrine therapy initiation. CONCLUSION Black women ≤ 50 years of age and women with financial constraints may be important subgroups for interventions. Patient-provider communication appears to be an important leverage point to foster therapy uptake.
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Affiliation(s)
- Vanessa B Sheppard
- Department of Health Behavior and Policy, School of Medicine, Virginia Commonwealth University, Richmond, VA.
| | | | - Jun He
- Department of Health Behavior and Policy, School of Medicine, Virginia Commonwealth University, Richmond, VA
| | - Yvonne Jennings
- Department of Health Behavior and Policy, School of Medicine, Virginia Commonwealth University, Richmond, VA
| | - Megan C Edmonds
- Department of Health Behavior and Policy, School of Medicine, Virginia Commonwealth University, Richmond, VA
| | - Bridget A Oppong
- Georgetown University Medical Center, Georgetown University, Washington, DC
| | - Mahlet G Tadesse
- Department of Mathematics and Statistics, Georgetown University, Washington, DC
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22
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Impact of persistence on survival of patients with breast cancer treated with endocrine therapy in Northeast China: a prospective study. Oncotarget 2017; 8:102499-102510. [PMID: 29254265 PMCID: PMC5731975 DOI: 10.18632/oncotarget.18454] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 05/22/2017] [Indexed: 11/25/2022] Open
Abstract
The purpose of this prospective study is to investigate the impact of endocrine treatment persistence on the survival of patients with estrogen receptor-positive breast cancer treated with endocrine therapy and identify the risk factors influencing the treatment persistence. We enrolled 1085 patients from Northeast China who were diagnosed as stage I–III, estrogen receptor-positive breast cancer between January 2007 and December 2010. The prognostic factors for disease-free survival (DFS) and overall survival (OS) of patients were identified using univariate and multivariate Cox proportional hazards regression models. Multiple logistic regression analysis was done to determine the possible risk factors for non-endocrine treatment and treatment discontinuation. Among the patients enrolled, 598 (55.1%) underwent 5 years of endocrine therapy, 278 (25.6%) less than 5 years, and 209 (19.3%) non-endocrine therapy. OS rates in the continuation, discontinuation, and non-endocrine treatment groups were 97.8%, 92.6% and 74.3%, and DFS 97.5%, 86.2% and 69.9%, respectively. After adjusting for pathological and socioeconomic factors, non-endocrine therapy and discontinuation were independent predictors for DFS and OS. Elderly patients (≥ 65 years), those living in suburban and rural areas, locally advanced patients, and receiving no radiotherapy and/or chemotherapy were more likely to receive non-endocrine therapy and discontinue endocrine treatment. In conclusion, the prospective study demonstrate that the persistence of endocrine treatment is low in estrogen receptor-positive breast cancer patients in Northeast China. Non-endocrine treatment and early discontinuation serve as independent prognostic factors for both DFS and OS of breast cancer patients treated with endocrine therapy.
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23
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Mougalian SS, Epstein LN, Jhaveri AP, Han G, Abu-Khalaf M, Hofstatter EW, DiGiovanna MP, Silber AL, Adelson K, Pusztai L, Gross CP. Bidirectional Text Messaging to Monitor Endocrine Therapy Adherence and Patient-Reported Outcomes in Breast Cancer. JCO Clin Cancer Inform 2017; 1:1-10. [DOI: 10.1200/cci.17.00015] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Introduction Up to 40% of patients with breast cancer may not adhere to adjuvant endocrine therapy. Therapy-related adverse effects (AEs) are important contributors to nonadherence. We developed a bidirectional text-message application, BETA-Text, that simultaneously tracks adherence, records symptoms, and alerts the clinical team. Patients and Methods We piloted our intervention in 100 patients. The intervention consisted of text messages to which patients responded for 3 months: daily, evaluating adherence; weekly, evaluating medication-related AEs; and monthly, regarding barriers to adherence. Concerning responses prompted a telephone call from a clinic nurse. The primary objective was to assess patient acceptance of this intervention using self-reported surveys. To compare participants with the general population at our institution, we assessed 100 consecutively treated patients as historical controls using medical record review. Results We approached 141 consecutive patients, 100 (71%) of whom agreed to participate and 89 of whom completed the intervention. A majority of patients reported that the intervention was easy to use (98%) and helpful in taking their medication (96%). Four patients discontinued therapy before 3 months, and 93% of patients who continued therapy took ≥ 80% of their medication. The frequency of AEs reported by participants via text was higher than that reported in clinical trials: hot flashes (72%), arthralgias (53%), and vaginal symptoms (35%). Approximately 39% of patients reported one or more severe AE that prompted an alert to the provider team to call the patient. Conclusion A daily bidirectional text-messaging system can monitor adherence and identify AEs and other barriers to adherence in real time without inconveniencing patients. AEs of endocrine therapy, as detected using this texting approach, are more prevalent than reported in clinical trials.
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Affiliation(s)
- Sarah S. Mougalian
- Sarah S. Mougalian, Lianne N. Epstein, Erin W. Hofstatter, Michael P. DiGiovanna, Andrea L.M. Silber, Kerin Adelson, Lajos Pusztai, and Cary P. Gross, Yale Cancer Center, Yale University; Sarah S. Mougalian, Kerin Adelson, and Cary P. Gross, Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, Yale University, New Haven, CT; Ami P. Jhaveri, Lancaster General Health, Penn Medicine, Lancaster; Maysa Abu-Khalaf, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
| | - Lianne N. Epstein
- Sarah S. Mougalian, Lianne N. Epstein, Erin W. Hofstatter, Michael P. DiGiovanna, Andrea L.M. Silber, Kerin Adelson, Lajos Pusztai, and Cary P. Gross, Yale Cancer Center, Yale University; Sarah S. Mougalian, Kerin Adelson, and Cary P. Gross, Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, Yale University, New Haven, CT; Ami P. Jhaveri, Lancaster General Health, Penn Medicine, Lancaster; Maysa Abu-Khalaf, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
| | - Ami P. Jhaveri
- Sarah S. Mougalian, Lianne N. Epstein, Erin W. Hofstatter, Michael P. DiGiovanna, Andrea L.M. Silber, Kerin Adelson, Lajos Pusztai, and Cary P. Gross, Yale Cancer Center, Yale University; Sarah S. Mougalian, Kerin Adelson, and Cary P. Gross, Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, Yale University, New Haven, CT; Ami P. Jhaveri, Lancaster General Health, Penn Medicine, Lancaster; Maysa Abu-Khalaf, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
| | - Gang Han
- Sarah S. Mougalian, Lianne N. Epstein, Erin W. Hofstatter, Michael P. DiGiovanna, Andrea L.M. Silber, Kerin Adelson, Lajos Pusztai, and Cary P. Gross, Yale Cancer Center, Yale University; Sarah S. Mougalian, Kerin Adelson, and Cary P. Gross, Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, Yale University, New Haven, CT; Ami P. Jhaveri, Lancaster General Health, Penn Medicine, Lancaster; Maysa Abu-Khalaf, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
| | - Maysa Abu-Khalaf
- Sarah S. Mougalian, Lianne N. Epstein, Erin W. Hofstatter, Michael P. DiGiovanna, Andrea L.M. Silber, Kerin Adelson, Lajos Pusztai, and Cary P. Gross, Yale Cancer Center, Yale University; Sarah S. Mougalian, Kerin Adelson, and Cary P. Gross, Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, Yale University, New Haven, CT; Ami P. Jhaveri, Lancaster General Health, Penn Medicine, Lancaster; Maysa Abu-Khalaf, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
| | - Erin W. Hofstatter
- Sarah S. Mougalian, Lianne N. Epstein, Erin W. Hofstatter, Michael P. DiGiovanna, Andrea L.M. Silber, Kerin Adelson, Lajos Pusztai, and Cary P. Gross, Yale Cancer Center, Yale University; Sarah S. Mougalian, Kerin Adelson, and Cary P. Gross, Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, Yale University, New Haven, CT; Ami P. Jhaveri, Lancaster General Health, Penn Medicine, Lancaster; Maysa Abu-Khalaf, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
| | - Michael P. DiGiovanna
- Sarah S. Mougalian, Lianne N. Epstein, Erin W. Hofstatter, Michael P. DiGiovanna, Andrea L.M. Silber, Kerin Adelson, Lajos Pusztai, and Cary P. Gross, Yale Cancer Center, Yale University; Sarah S. Mougalian, Kerin Adelson, and Cary P. Gross, Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, Yale University, New Haven, CT; Ami P. Jhaveri, Lancaster General Health, Penn Medicine, Lancaster; Maysa Abu-Khalaf, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
| | - Andrea L.M. Silber
- Sarah S. Mougalian, Lianne N. Epstein, Erin W. Hofstatter, Michael P. DiGiovanna, Andrea L.M. Silber, Kerin Adelson, Lajos Pusztai, and Cary P. Gross, Yale Cancer Center, Yale University; Sarah S. Mougalian, Kerin Adelson, and Cary P. Gross, Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, Yale University, New Haven, CT; Ami P. Jhaveri, Lancaster General Health, Penn Medicine, Lancaster; Maysa Abu-Khalaf, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
| | - Kerin Adelson
- Sarah S. Mougalian, Lianne N. Epstein, Erin W. Hofstatter, Michael P. DiGiovanna, Andrea L.M. Silber, Kerin Adelson, Lajos Pusztai, and Cary P. Gross, Yale Cancer Center, Yale University; Sarah S. Mougalian, Kerin Adelson, and Cary P. Gross, Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, Yale University, New Haven, CT; Ami P. Jhaveri, Lancaster General Health, Penn Medicine, Lancaster; Maysa Abu-Khalaf, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
| | - Lajos Pusztai
- Sarah S. Mougalian, Lianne N. Epstein, Erin W. Hofstatter, Michael P. DiGiovanna, Andrea L.M. Silber, Kerin Adelson, Lajos Pusztai, and Cary P. Gross, Yale Cancer Center, Yale University; Sarah S. Mougalian, Kerin Adelson, and Cary P. Gross, Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, Yale University, New Haven, CT; Ami P. Jhaveri, Lancaster General Health, Penn Medicine, Lancaster; Maysa Abu-Khalaf, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
| | - Cary P. Gross
- Sarah S. Mougalian, Lianne N. Epstein, Erin W. Hofstatter, Michael P. DiGiovanna, Andrea L.M. Silber, Kerin Adelson, Lajos Pusztai, and Cary P. Gross, Yale Cancer Center, Yale University; Sarah S. Mougalian, Kerin Adelson, and Cary P. Gross, Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, Yale University, New Haven, CT; Ami P. Jhaveri, Lancaster General Health, Penn Medicine, Lancaster; Maysa Abu-Khalaf, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
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24
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Dean LT, Moss SL, McCarthy AM, Armstrong K. Healthcare System Distrust, Physician Trust, and Patient Discordance with Adjuvant Breast Cancer Treatment Recommendations. Cancer Epidemiol Biomarkers Prev 2017; 26:1745-1752. [PMID: 28971987 DOI: 10.1158/1055-9965.epi-17-0479] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 08/07/2017] [Accepted: 09/18/2017] [Indexed: 12/19/2022] Open
Abstract
Background: Adjuvant therapy after breast cancer surgery decreases recurrence and increases survival, yet not all women receive and complete it. Previous research has suggested that distrust in medical institutions plays a role in who initiates adjuvant treatment, but has not assessed treatment completion, nor the potential mediating role of physician distrust.Methods: Women listed in Pennsylvania and Florida cancer registries, who were under the age of 65 when diagnosed with localized invasive breast cancer between 2005 and 2007, were surveyed by mail in 2007 to 2009. Survey participants self-reported demographics, cancer stage and treatments, treatment discordance (as defined by not following their surgeon or oncologist treatment recommendation), healthcare system distrust, and physician trust. Age and cancer stage were verified against cancer registry records. Logistic regression assessed the relationship between highest and lowest tertiles of healthcare system distrust and the dichotomous outcome of treatment discordance, controlling for demographics and clinical treatment factors, and testing for mediation by physician trust.Results: Of the 2,754 participants, 30.2% (n = 832) reported not pursing at least one recommended treatment. The mean age was 52. Patients in the highest tertile of healthcare system distrust were 22% more likely to report treatment discordance than the lowest tertile; physician trust did not mediate the association between healthcare system distrust and treatment discordance.Conclusions: Healthcare system distrust is positively associated with treatment discordance, defined as failure to initiate or complete physician-recommended adjuvant treatment after breast cancer.Impact: Interventions should test whether or not resolving institutional distrust reduces treatment discordance. Cancer Epidemiol Biomarkers Prev; 26(12); 1745-52. ©2017 AACR.
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Affiliation(s)
- Lorraine T Dean
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland. .,Department of Health Policy & Management, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Shadiya L Moss
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Anne Marie McCarthy
- Massachusetts General Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Katrina Armstrong
- Massachusetts General Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
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25
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Daly B, Olopade OI, Hou N, Yao K, Winchester DJ, Huo D. Evaluation of the Quality of Adjuvant Endocrine Therapy Delivery for Breast Cancer Care in the United States. JAMA Oncol 2017; 3:928-935. [PMID: 28152150 DOI: 10.1001/jamaoncol.2016.6380] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Importance Randomized trials in breast cancer have demonstrated the clinical benefits of adjuvant endocrine therapy (AET) in preventing recurrence and death. The examination of concordance with AET guidelines at a national level as a measure of quality of care is important. Objective To investigate temporal trends and factors related to receipt of AET for breast cancer. Design, Setting, and Participants This retrospective cohort study included 981 729 women with breast cancer in the National Cancer Database from January 1, 2004, to December 31, 2013. Women with stages I to III breast cancer who received all or part of their treatment at the reporting institution were included in the analysis. Main Outcomes and Measures Temporal changes in AET receipt (estimating the annual percentage change) and AET practice patterns (using logistic regression) and the effect of AET guideline concordance on survival of women with hormone receptor-positive (HR+) breast cancer (using the multivariable Cox proportional hazards model). Results Of the 981 729 eligible patients (mean [SD] age, 60.8 [13.3] years), 818 435 had HR+ and 163 294 had HR-negative (HR-) cancer. Among the patients with HR+ cancer, receipt of AET increased over time, from 69.8% in 2004 to 82.4% in 2013. Among patients with HR- cancer, receipt decreased from 5.2% in 2004 to 3.4% in 2013. Hospital-level adherence (≥80% of patients with HR+ cancer received AET) increased from 40.2% in 2004 to 69.2% in 2013. Receipt of AET varied significantly by age (lower in patients ≥80 years), race (lower in African American and Hispanic participants), geographic location (lower in West South Central, Mountain, and Pacific census regions), and receptor status (lower in patients with estrogen receptor-negative and progesterone receptor-positive cancer). Surgery and radiotherapy were the factors most significantly associated with appropriate AET receipt (only 45.0% in patients who received lumpectomy without radiotherapy). Receipt of AET was associated with a 29% relative risk reduction in mortality. Based on this effectiveness estimate, if all patients with HR+ cancer received AET, approximately 14 630 lives would have been saved over 10 years. Conclusions and Relevance From 2004 to 2013, underuse and misuse of AET have decreased for patients with breast cancer, but optimal use has not been achieved, and significant variation in care remains. The involvement of surgery and radiotherapy were among the most significant factors associated with optimal use, which underscores the benefits of team-based care to support guideline-concordant therapy.
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Affiliation(s)
- Bobby Daly
- Thoracic Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Olufunmilayo I Olopade
- Center for Clinical Cancer Genetics, Department of Medicine, University of Chicago, Chicago, Illinois
| | - Ningqi Hou
- Department of Public Health Sciences, University of Chicago, Chicago, Illinois
| | - Katharine Yao
- Department of Surgery, NorthShore University HealthSystem, Evanston, Illinois
| | - David J Winchester
- Department of Surgery, NorthShore University HealthSystem, Evanston, Illinois
| | - Dezheng Huo
- Department of Public Health Sciences, University of Chicago, Chicago, Illinois
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26
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O’Neill SC, Isaacs C, Lynce F, Graham DMA, Chao C, Sheppard VB, Zhou Y, Liu C, Selvam N, Schwartz MD, Potosky AL. Endocrine therapy initiation, discontinuation and adherence and breast imaging among 21-gene recurrence score assay-eligible women under age 65. Breast Cancer Res 2017; 19:45. [PMID: 28359319 PMCID: PMC5374604 DOI: 10.1186/s13058-017-0837-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 03/15/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Aside from chemotherapy utilization, limited data are available on the relationship between gene expression profiling (GEP) testing and breast cancer care. We assessed the relationship between GEP testing and additional variables and the outcomes of endocrine therapy initiation, discontinuation and adherence, and breast imaging exams in women under age 65 years. METHODS Data from five state cancer registries were linked with claims data and GEP results. We assessed variables associated with survivorship care outcomes in an incident cohort of 5014 commercially insured women under age 65 years, newly diagnosed with stage I or II hormone-receptor-positive, human epidermal growth factor receptor 2 (HER2) non-positive breast cancer from 2006 to 2010. RESULTS Among tested women, those with high Oncotype DX® Breast Recurrence Score® (RS) were significantly less likely to initiate endocrine therapy than women with low RS tumors (OR 0.40 (95% CI 0.20 to 0.81); P = 0.01). Among all test-eligible women, receipt of Oncotype DX testing was associated with a greater likelihood of endocrine therapy initiation (OR 2.48 (95% CI 2.03 to 3.04); P <0.0001). The odds of initiation were also significantly higher for tested vs. untested women among women who did not initiate chemotherapy within six months of diagnosis (OR 3.25 (95% CI 2.53 to 4.16)), with no effect in women who received chemotherapy. Discontinuation and adherence and breast imaging exams were unrelated to tested status or RS. CONCLUSIONS Lower endocrine therapy initiation rates among women with high RS tumors and among untested women not receiving chemotherapy are concerning, given its established efficacy. Additional research is needed to suggest mechanisms to close this gap.
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Affiliation(s)
- Suzanne C. O’Neill
- Georgetown Lombardi Comprehensive Cancer Center, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC, 20007 USA
| | - Claudine Isaacs
- Georgetown Lombardi Comprehensive Cancer Center, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC, 20007 USA
| | - Filipa Lynce
- Georgetown Lombardi Comprehensive Cancer Center, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC, 20007 USA
| | | | | | | | - Yingjun Zhou
- Georgetown Lombardi Comprehensive Cancer Center, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC, 20007 USA
| | | | | | - Marc D. Schwartz
- Georgetown Lombardi Comprehensive Cancer Center, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC, 20007 USA
| | - Arnold L. Potosky
- Georgetown Lombardi Comprehensive Cancer Center, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC, 20007 USA
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27
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Murphy CC, Tiro JA, Jean GW, Balasubramian BA, Alvarez CA. High Initiation of Adjuvant Hormonal Therapy Among Uninsured Stages I-III Breast Cancer Patients Treated in a Safety-Net Healthcare System. J Womens Health (Larchmt) 2017; 26:655-661. [PMID: 28296574 DOI: 10.1089/jwh.2016.6099] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE Despite benefits of adjuvant hormonal therapy (AHT), many eligible breast cancer patients do not complete therapy as recommended. Patterns of AHT use have not been well studied among uninsured breast cancer patients who fall into coverage gaps or are ineligible for public insurance programs. METHODS We identified 291 patients newly diagnosed with stages I-III hormone receptor-positive breast cancer from January 2008 to December 2012. All patients were treated at a safety-net healthcare system and enrolled in an income-based medical assistance program that fills AHT prescriptions at low cost. We extracted and linked cancer registry, pharmacy claims, and medical record data to assess AHT initiation (defined as a new AHT prescription ≤18 months since diagnosis) and sociodemographic and healthcare utilization variables. Log-binomial regression was used to identify correlates of initiation. RESULTS Overall, 239 (82%) patients initiated AHT. Tamoxifen (42%) and anastrozole (55%) were most commonly prescribed. The mean copay was $4.90 for tamoxifen and $6.00 for anastrozole. Although crude analyses revealed small, statistically significant prevalence ratios for race/ethnicity (Hispanic vs. white, other vs. white), year of diagnosis (2008 vs. 2012), primary care visit before diagnosis (any vs. none), and smoking status (current vs. never), there were no significant correlates of initiation in the adjusted model. CONCLUSION Safety-net healthcare systems providing access to AHT (i.e., through reduced copays) could improve the number of eligible patients initiating therapy. Continuity and integration of care in these settings may reduce disparities frequently observed in uninsured, low-income breast cancer populations.
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Affiliation(s)
- Caitlin C Murphy
- 1 Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center , Dallas, Texas
| | - Jasmin A Tiro
- 1 Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center , Dallas, Texas
| | - Gary W Jean
- 2 School of Pharmacy, Texas Tech University Health Sciences Center , Dallas, Texas.,3 Parkland Health & Hospital System , Dallas, Texas
| | - Bijal A Balasubramian
- 4 University of Texas School of Public Health-Dallas Regional Campus , Dallas, Texas
| | - Carlos A Alvarez
- 2 School of Pharmacy, Texas Tech University Health Sciences Center , Dallas, Texas.,3 Parkland Health & Hospital System , Dallas, Texas
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28
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Pinheiro LC, Wheeler SB, Reeder-Hayes KE, Samuel CA, Olshan AF, Reeve BB. Investigating Associations Between Health-Related Quality of Life and Endocrine Therapy Underuse in Women With Early-Stage Breast Cancer. J Oncol Pract 2017; 13:e463-e473. [PMID: 28291383 DOI: 10.1200/jop.2016.018630] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Endocrine therapy (ET) underuse puts women at increased risk for breast cancer (BC) recurrence. Our objective was to determine if health-related quality of life (HRQOL) subgroups were associated with underuse. METHODS Data came from the third phase of the Carolina Breast Cancer Study. We included 1,599 women with hormone receptor-positive BC age 20 to 74 years. HRQOL was measured, on average, 5 months postdiagnosis. Subgroups were derived using latent profile (LP) analysis. Underuse was defined as not initiating or adhering to ET by 36 months postdiagnosis. Multivariable logistic regression models estimated adjusted odds ratios (ORs) between HRQOL LPs and underuse. The best HRQOL LP was the reference. Chemotherapy- and race-stratified models were estimated, separately. RESULTS Initiation analyses included 953 women who had not begun ET by their 5-month survey. Of these, 154 never initiated ET. Adherence analyses included 1,114 ET initiators, of whom 211 were nonadherent. HRQOL was not significantly associated with noninitiation, except among nonchemotherapy users, with membership in the poorest LP associated with increased odds of noninitiation (adjusted OR, 5.5; 95% CI, 1.7 to 17.4). Membership in the poorest LPs was associated with nonadherence (LP1: adjusted OR, 2.2; 95% CI, 1.2 to 4.0 and LP2: adjusted OR,1.9; 95% CI, 1.1 to 3.6). Membership in the poorest LP was associated with nonadherence among nonchemotherapy users (adjusted OR, 2.1; 95% CI, 1.2 to 5.1). CONCLUSION Our results suggest women with poor HRQOL during active treatment may be at increased risk for ET underuse. Focusing on HRQOL, a modifiable factor, may improve targeting of future interventions early in the BC continuum to improve ET initiation and adherence and prevent BC recurrence.
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Affiliation(s)
- Laura C Pinheiro
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Stephanie B Wheeler
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Katherine E Reeder-Hayes
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Cleo A Samuel
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Andrew F Olshan
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Bryce B Reeve
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
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29
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Bhattacharya P, Abderrahman B, Jordan VC. Opportunities and challenges of long term anti-estrogenic adjuvant therapy: treatment forever or intermittently? Expert Rev Anticancer Ther 2017; 17:297-310. [PMID: 28281842 DOI: 10.1080/14737140.2017.1297233] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Extended adjuvant (5-10 years) therapy targeted to the estrogen receptor (ER) has significantly decreased mortality from breast cancer (BC). Areas covered: Translational research advanced clinical testing of extended adjuvant therapy with tamoxifen or aromatase inhibitors (AIs). Short term therapy or non-compliance increase recurrence, but surprisingly recurrence and death does not increase dramatically after 5 years of adjuvant therapy stops. Expert commentary: Compliance ensures optimal benefit from extended antihormone adjuvant therapy.Retarding acquired resistance using CDK4/6 or mTOR inhibitors is discussed. Preventing acquired resistance from mutations of ER could be achieved with Selective ER Downregulators (SERDs), eg fulvestrant. Fulvestrant is a depot injectable so oral SERDs are sought for extended use. In reality, a 'super SERD' which destroys ER but improves women's health like a Selective ER Modulator (SERM), would aid compliance to prevent recurrence and death. Estrogen-induced apoptosis occurs in 30% of BC with antihormone resistance. The 'one in three' rule that dictates that one in three unselected patients respond to either hormonal or antihormonal therapy in BC occurs with estrogen or antiestrogen therapy and must be improved. The goal is to maintain patients for their natural lives by blocking cancer cell survival through precision medicine using short cycles of estrogen apoptotic salvage therapy, and further extended antihormone maintenance.
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Affiliation(s)
- Poulomi Bhattacharya
- a Department of Breast Medical Oncology , The University of Texas MD Anderson Cancer Center , Houston , TX , USA
| | - Balkees Abderrahman
- a Department of Breast Medical Oncology , The University of Texas MD Anderson Cancer Center , Houston , TX , USA
| | - V Craig Jordan
- a Department of Breast Medical Oncology , The University of Texas MD Anderson Cancer Center , Houston , TX , USA
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30
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Salgado TM, Davis EJ, Farris KB, Fawaz S, Batra P, Henry NL. Identifying socio-demographic and clinical characteristics associated with medication beliefs about aromatase inhibitors among postmenopausal women with breast cancer. Breast Cancer Res Treat 2017; 163:311-319. [DOI: 10.1007/s10549-017-4177-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 02/25/2017] [Indexed: 01/19/2023]
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Fisch MJ, Chung AE, Accordino MK. Using Technology to Improve Cancer Care: Social Media, Wearables, and Electronic Health Records. Am Soc Clin Oncol Educ Book 2017; 35:200-8. [PMID: 27249700 DOI: 10.1200/edbk_156682] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Digital engagement has become pervasive in the delivery of cancer care. Internet- and cellular phone-based tools and systems are allowing large groups of people to engage with each other and share information. Health systems and individual health professionals are adapting to this revolution in consumer and patient behavior by developing ways to incorporate the benefits of technology for the purpose of improving the quality of medical care. One example is the use of social media platforms by oncologists to foster interaction with each other and to participate with the lay public in dialogue about science, medicine, and cancer care. In addition, consumer devices and sensors (wearables) have provided a new, growing dimension of digital engagement and another layer of patient-generated health data to foster better care and research. Finally, electronic health records have become the new standard for oncology care delivery, bringing new opportunities to measure quality in real time and follow practice patterns, as well as new challenges as providers and patients seek ways to integrate this technology along with other forms of digital engagement to produce more satisfaction in the process of care along with measurably better outcomes.
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Affiliation(s)
- Michael J Fisch
- From AIM Specialty Health, Chicago, IL; Outcomes Research Program, Lineberger Comprehensive Cancer Center, University of North Carolina School of Medicine, Chapel Hill, NC; Department of Medicine, Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY
| | - Arlene E Chung
- From AIM Specialty Health, Chicago, IL; Outcomes Research Program, Lineberger Comprehensive Cancer Center, University of North Carolina School of Medicine, Chapel Hill, NC; Department of Medicine, Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY
| | - Melissa K Accordino
- From AIM Specialty Health, Chicago, IL; Outcomes Research Program, Lineberger Comprehensive Cancer Center, University of North Carolina School of Medicine, Chapel Hill, NC; Department of Medicine, Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY
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Sheppard VB, Cavalli LR, Dash C, Kanaan YM, Dilawari AA, Horton S, Makambi KH. Correlates of Triple Negative Breast Cancer and Chemotherapy Patterns in Black and White Women With Breast Cancer. Clin Breast Cancer 2017; 17:232-238. [PMID: 28189497 DOI: 10.1016/j.clbc.2016.12.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 12/15/2016] [Accepted: 12/16/2016] [Indexed: 12/31/2022]
Abstract
BACKGROUND Triple negative breast cancer (TNBC) tumors are estrogen receptor-negative, progesterone receptor-negative, and human epidermal growth factor-negative. TNBC is responsive to chemotherapy, but chemotherapy might be underused in some patient subgroups. The goal of the present study was to characterize the patterns of chemotherapy use (uptake and completion) in TNBC patients. PATIENTS AND METHODS Women with primary invasive, nonmetastatic breast cancer were recruited in Washington, DC, and Detroit. Data were collected using a standardized telephone survey that captured sociocultural and health care process factors. Clinical data were abstracted from the medical records. We used χ2 tests to access the association between the receipt of chemotherapy use (initiation and completion) and categorical variables, and t tests were used for continuous variables. Logistic regression models were used to evaluate the factors associated with chemotherapy uptake. RESULTS Women with TNBC (16% of sample) were more likely to be black than white (68% vs. 32%; P < .05). Among women with TNBC, 60% underwent chemotherapy. Chemotherapy uptake was greater for black than for white women (48.3% vs. 11.7%; P = .01) and in women without (vs. with) healthcare discrimination (35% vs. 25%; P = .04). In multivariable models, only race was associated with the receipt of chemotherapy. Black women were more likely to receive chemotherapy than were white women. The odds ratio of receiving chemotherapy by race was 4.1 (95% confidence interval, 1.3-13.1). Each 1-year increase in age was associated with a lower likelihood of chemotherapy completion (odds ratio, 0.9; 95% confidence interval, 0.826-0.981; P = .02). Women with at least some college were less likely to complete chemotherapy than were those with other education levels (P = .02). CONCLUSION A substantial number of TNBC patients failed to receive and/or complete chemotherapy. Differences in chemotherapy uptake by race and sociocultural factors diminished in multivariable models but age and stage remained significant. Suboptimal treatment among women with TNBC could contribute to adverse outcomes. Future investigations are necessary to assess whether the noninitiation and/or noncompletion of chemotherapy is clinically warranted.
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Affiliation(s)
| | | | | | - Yasmine M Kanaan
- Department of Microbiology, Howard University College of Medicine, Washington, DC
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Affiliation(s)
- Dawn L Hershman
- Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY
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Accordino MK, Hershman DL. Disparities and challenges in adherence to oral antineoplastic agents. Am Soc Clin Oncol Educ Book 2016:271-6. [PMID: 23714520 DOI: 10.14694/edbook_am.2013.33.271] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The issue of medication noncompliance is becoming increasingly important in oncology as more cancer therapies are delivered orally. Medication adherence is difficult to assess and there is no gold standard of measurement. The act of measuring adherence can affect outcomes. Medication noncompliance is common, and is estimated to be 50% in treatment of chronic diseases. Studies have shown that women initiate adjuvant hormonal therapy for breast cancer 64% to 88% of the time when prescribed. Of those who initiate therapy, 50% to 80% are adherent for the prescribed duration, depending on the study. Patients noncompliant with adjuvant hormonal therapy for breast cancer have worse overall survival than their counterparts. Suboptimal treatment responses in chronic myeloid leukemia (CML) are also associated with medication noncompliance. Poor adherence can also affect clinical trial results, leading to inaccuracies of treatment efficacy. Barriers to compliance can occur on the individual, cultural, or system level. Examples of specific barriers are side effects, cost and access to medication, and individual health beliefs. Specific populations, including racial minorities, elderly patients, and very young patients, may be at higher risk for medication noncompliance. Strategies to improve compliance are multifactorial and include improvement of patient education, reduction of treatment side effects, interventions to alter behavior, and changes in public policy to improve financial barriers to treatment. Technology has been an effective tool in improving compliance in noncancer-related illness, and ongoing studies are evaluating its role in the oncology population.
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Affiliation(s)
- Melissa K Accordino
- From the Department of Medicine and Epidemiology, Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY
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Hershman DL, Kushi LH, Hillyer GC, Coromilas E, Buono D, Lamerato L, Bovbjerg DH, Mandelblatt JS, Tsai WY, Zhong X, Jacobson JS, Wright JD, Neugut AI. Psychosocial factors related to non-persistence with adjuvant endocrine therapy among women with breast cancer: the Breast Cancer Quality of Care Study (BQUAL). Breast Cancer Res Treat 2016; 157:133-43. [PMID: 27086286 DOI: 10.1007/s10549-016-3788-x] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 04/05/2016] [Indexed: 11/25/2022]
Abstract
Non-adherence to adjuvant endocrine therapy (ET) for breast cancer (BC) is common. Our goal was to determine the associations between psychosocial factors and ET non-persistence. We recruited women with BC receiving care in an integrated healthcare system between 2006 and 2010. Using a subset of patients treated with ET, we investigated factors related to ET non-persistence (discontinuation) based on pharmacy records (≥90 days gap). Serial interviews were conducted at baseline and every 6 months. The Functional Assessment of Cancer Therapy (FACT), Medical Outcomes Survey, Treatment Satisfaction Questionnaire (TSQM), Impact of Events Scale (IES), Interpersonal Processes of Care measure, and Decision-making beliefs and concerns were measured. Multivariate models assessed factors associated with non-persistence. Of the 523 women in our final cohort who initiated ET and had a subsequent evaluation, 94 (18 %) were non-persistent over a 2-year follow-up. The cohort was primarily white (74.4 %), stage 1 (60.6 %), and on an aromatase inhibitor (68.1 %). Women in the highest income category had a lower odds of being non-persistent (OR 0.43, 95 % CI 0.23-0.81). Quality of life and attitudes toward ET at baseline were associated with non-persistence. At follow-up, the FACT, TSQM, and IES were associated with non-persistence (p < 0.001). Most women continued ET. Women who reported a better attitude toward ET, better quality of life, and more treatment satisfaction, were less likely to be non-persistent and those who reported intrusive/avoidant thoughts were more likely to be non-persistent. Interventions to enhance the psychosocial well-being of patients should be evaluated to increase adherence.
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Affiliation(s)
- Dawn L Hershman
- Department of Medicine, Columbia University, 161 Ft Washington, Room 1068, New York, NY, 10032, USA.
- Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons, Columbia University, New York, NY, USA.
- Department of Epidemiology, Columbia University, New York, NY, USA.
| | - Lawrence H Kushi
- Division of Research, Kaiser-Permanente of Northern California, Oakland, CA, USA
| | - Grace Clarke Hillyer
- Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Department of Epidemiology, Columbia University, New York, NY, USA
| | - Ellie Coromilas
- Department of Medicine, Columbia University, 161 Ft Washington, Room 1068, New York, NY, 10032, USA
| | - Donna Buono
- Department of Epidemiology, Columbia University, New York, NY, USA
| | - Lois Lamerato
- Department of Public Health Sciences, Henry Ford Health System, Detroit, MI, USA
| | - Dana H Bovbjerg
- Departments of Psychiatry, Psychology and Behavioral and Community Health Sciences, University of Pittsburgh, Pittsburgh, PA, USA
- University of Pittsburgh Cancer Institute, Pittsburgh, PA, USA
| | - Jeanne S Mandelblatt
- Department of Oncology and Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
| | - Wei-Yann Tsai
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Xiaobo Zhong
- Department of Epidemiology, Columbia University, New York, NY, USA
| | - Judith S Jacobson
- Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Department of Epidemiology, Columbia University, New York, NY, USA
| | - Jason D Wright
- Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Department of Obstetrics and Gynecology, Columbia University, 161 Ft Washington, Room 1068, New York, NY, 10032, USA
| | - Alfred I Neugut
- Department of Medicine, Columbia University, 161 Ft Washington, Room 1068, New York, NY, 10032, USA
- Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Department of Epidemiology, Columbia University, New York, NY, USA
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Age-related differences in persistence in women with breast cancer treated with tamoxifen or aromatase inhibitors in Germany. J Geriatr Oncol 2016; 7:169-75. [PMID: 27091510 DOI: 10.1016/j.jgo.2016.03.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Revised: 02/18/2016] [Accepted: 03/16/2016] [Indexed: 11/22/2022]
Abstract
AIMS To study age-related persistence in postmenopausal women with endocrine-responsive breast cancer treated with tamoxifen (TAM) and aromatase inhibitors (AI). METHODS Data on 29,245 patients diagnosed with metastatic or non-metastatic breast cancer (BC) and initially treated with TAM or AI between 2004 and 2013 were included. The primary outcome measure was the age-dependent rate of discontinuation of endocrine treatment within 5years after initiation. Discontinuation of therapy was defined as a period of at least 90days without treatment. A multivariate Cox regression model was created to determine the influence of age on the risk of discontinuation. Health insurance type (private/statutory), type of care (gynecological/general), region (West/East Germany), concomitant diagnoses (depression, osteoporosis, and diabetes), and Charlson Comorbidity Score were included as covariates. RESULTS The mean ages of the women in the <70 and ≥70 groups were 55.9 (SD: 9.7) and 77.4 (SD: 5.4) years, respectively. Within 5years after treatment initiation, 88.8% of women <70 of age and 82% of women ≥70 years of age had terminated treatment (p-value<0.001). Patients aged ≥70 exhibited a lower risk of treatment discontinuation than patients aged <70 (HR=0.75, 95% CI: 0.66-0.85). Furthermore, gynecological practices, disease management programs, and high Charlson scores increased persistence. CONCLUSIONS Overall, the present study indicates that persistence rates are low in both women with BC aged <70 and those aged ≥70 years. We also found that younger women with BC are at a higher risk of treatment discontinuation than older women.
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Behavioral Interventions to Enhance Adherence to Hormone Therapy in Breast Cancer Survivors: A Systematic Literature Review. Clin Breast Cancer 2016; 16:247-255.e3. [PMID: 27133733 DOI: 10.1016/j.clbc.2016.03.006] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 03/22/2016] [Indexed: 01/08/2023]
Abstract
Adjuvant hormone therapy contributes to reductions in recurrence and mortality for women with hormone receptor-positive breast cancer. However, adherence to hormone therapy is suboptimal. This is the first systematic literature review examining interventions aimed at improving hormone therapy adherence. Researchers followed the PRISMA guidelines. PubMed-Medline, CINAHL, PsychInfo, Ovid-Medline, and EMBASE were searched for behavioral interventions that aimed to enhance adherence to adjuvant hormone therapy in breast cancer survivors. A total of 376 articles were screened for eligibility. Five articles met the study criteria. All interventions presented adherence outcomes after 1-year follow-up. None significantly enhanced adherence compared to the usual care in the primary analysis (odds ratios ranged from 1.03 to 2.06 for adherence and from 1.11 to 1.18 for persistence). All studies targeted patients, and only 3 studies included postmenopausal breast cancer patients. Three tested the same intervention consisting of educational materials. Only one was conducted in the United States. Only one reported participants' ethnicity. Overall, it was unclear whether the studies contained bias. The use of different terminology and operationalization of adherence made comparisons challenging. Interventions to improve adherence to adjuvant hormone therapy in US breast cancer populations that include survivors who are ethnically diverse, premenopausal, and receiving tamoxifen therapy are necessary to inform future interventions. Adoption of consistent adherence definitions/measurements will provide a clearer framework to consolidate aggregate findings. Given the limited efficacy of tested interventions, it is important to engage oncologists and researchers to develop approaches that target different components associated with hormone therapy adherence, such as doctor-patient communication or social support.
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Jacob L, Hadji P, Kostev K. Age-related differences in persistence with bisphosphonates in women with metastatic breast cancer. J Bone Oncol 2016; 5:63-6. [PMID: 27335773 PMCID: PMC4908184 DOI: 10.1016/j.jbo.2016.02.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 02/17/2016] [Accepted: 02/17/2016] [Indexed: 12/18/2022] Open
Abstract
Aims To investigate age-related persistence with bisphosphonates (BIS) in women with breast cancer (BC) and bone metastases. Methods We included a dataset of 1541 patients diagnosed with BC and bone metastases and initially treated with BIS between 1994 and 2013. The primary outcome measure was the age-related rate of BIS discontinuation within 12 months after treatment initiation. Therapy discontinuation was defined as a period of at least 90 days without treatment. A multivariate Cox regression model was created to determine the influence of age on the risk of discontinuation. Health insurance coverage (private/statutory), type of care (gynecological/general), region (West/East Germany), depression, chemotherapy, hormone therapy, pain medication, antidepressants, and the number of co-medications were included as covariates. Results The mean ages in the group of women <70 and that of women ≥70 years of age were 55.7 (SD: 9.8) and 76.7 (SD: 5.1) years respectively. Within 12 months after treatment initiation, 44.3% of women <70 and 34.8% of women ≥70 had terminated treatment (p-value<0.001). Patients aged ≥70 were at a lower risk of treatment discontinuation than patients <70 (HR=0.78, 95% CI: 0.67–0.91). Furthermore, treatment in gynecological practices, chemotherapy, hormone therapy, pain medication, and number of co-medications decreased the risk of discontinuation. By contrast, residing in West Germany and private health insurance coverage increased discontinuation risk. Conclusions Women with metastatic BC aged ≥70 are at a lower risk of BIS treatment discontinuation than younger women.
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Affiliation(s)
- L Jacob
- Department of Biology, École Normale Supérieure de Lyon, Lyon, France
| | - P Hadji
- Nordwest Hospital Frankfurt, Germany
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Roberts MC, Wheeler SB, Reeder-Hayes K. Racial/Ethnic and socioeconomic disparities in endocrine therapy adherence in breast cancer: a systematic review. Am J Public Health 2015; 105 Suppl 3:e4-e15. [PMID: 25905855 DOI: 10.2105/ajph.2014.302490] [Citation(s) in RCA: 104] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
We examined the current literature to understand factors that influence endocrine therapy (ET) adherence among racial/ethnic and socioeconomic subpopulations of breast cancer patients. We searched PubMed and PsycINFO databases for studies from January 1, 1978, to June 20, 2014, and January 1, 1991, to June 20, 2014, respectively, and hand-searched articles from relevant literature reviews. We abstracted and synthesized results within a social ecological framework. Fourteen articles met all inclusion criteria. The majority of included articles reported significant underuse of ET among minority and low-income women. Modifiable intrapersonal, interpersonal, and community-level factors are associated with ET use, and these factors vary across subgroups. Both race/ethnicity and socioeconomic status are associated with ET use in most settings. Variation in factors associated with ET use across subgroups indicates the need for more nuanced research and targeted interventions among breast cancer patients.
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Affiliation(s)
- Megan C Roberts
- Megan C. Roberts, Stephanie B. Wheeler, and Katherine Reeder-Hayes are with the Lineberger Comprehensive Cancer Center, University of North Carolina (UNC), Chapel Hill. Megan C. Roberts and Stephanie B. Wheeler are also with the Department of Health Policy and Management, Gillings School of Global Public Health, UNC, Chapel Hill. Katherine Reeder-Hayes is also with the Division of Hematology/Oncology, School of Medicine, UNC, Chapel Hill
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Ochayon L, Tunin R, Yoselis A, Kadmon I. Symptoms of hormonal therapy and social support: Is there a connection? Comparison of symptom severity, symptom interference and social support among breast cancer patients receiving and not receiving adjuvant hormonal treatment. Eur J Oncol Nurs 2014; 19:260-7. [PMID: 25529935 DOI: 10.1016/j.ejon.2014.11.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Revised: 10/23/2014] [Accepted: 11/16/2014] [Indexed: 01/11/2023]
Abstract
BACKGROUND Although there has been a significant reduction in mortality, breast cancer is the most frequent cancer among women worldwide. This decline in mortality has created a significant survivor population that must manage the post curative treatment phase, in order to have an increased quality of life and well-being. This study examined the relationship between symptom interference and severity with the perception of social support in the lives of women receiving or not receiving, hormonal therapy after initial treatment. METHODS AND SAMPLE Participants completed symptom severity and interference questionnaires, (MDASI and BCPT), a social support survey (MSPSS) and demographic and comorbidity questionnaires. RESULTS Of the 210 women participants, higher symptom severity correlated with unemployment, living alone or being religious. Participants who were currently taking hormonal treatment (n = 84), reported a significant negative correlation between symptom severity, measured by MDASI, and social support (p = 0.006). Consequently, as symptom severity increased, perceived social support decreased. In the BCPT assessment, decreased cognitive functioning (p < 0.05), pain (p < 0.05), bladder dysfunction (p = 0.001), and reduced self-image (p < 0.01) were significantly negatively correlated with social support for those participants currently taking hormonal therapy. Participants who had not previously received hormonal therapy (n = 64), cognitive dysfunction and bladder dysfunction were negatively correlated with social support. Women with preexisting heart or pulmonary dysfunction and arthritis reported statistically significant higher levels of symptom severity and decreased perceptions of social support. CONCLUSIONS Identifying socio-demographic variables and comorbidities that affect hormonal therapy symptom burden is essential for offering adequate support for breast cancer survivors.
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Affiliation(s)
- Lea Ochayon
- Radiotherapy Unit and Oncology Clinic, Hadassah Medical Organization, Jerusalem, Israel.
| | - Rina Tunin
- Henrietta Szold Hadassah Hebrew University School of Nursing, Jerusalem, Israel; Hadassah Medical Organization, Jerusalem, Israel
| | | | - Ilana Kadmon
- Henrietta Szold Hadassah Hebrew University School of Nursing, Jerusalem, Israel; Hadassah Medical Organization, Jerusalem, Israel
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Hershman DL, Tsui J, Meyer J, Glied S, Hillyer GC, Wright JD, Neugut AI. The change from brand-name to generic aromatase inhibitors and hormone therapy adherence for early-stage breast cancer. J Natl Cancer Inst 2014; 106:dju319. [PMID: 25349080 DOI: 10.1093/jnci/dju319] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Nonadherence to hormonal therapy is common and is associated with increased copayment amount. We investigated the change in adherence after the introduction of generic aromatase inhibitors (AIs) in 2010. METHODS Using deidentified pharmacy and claims data from OptumInsight, we identified women older than 50 years on brand-name AIs (BAIs) and/or generic AIs (GAIs) for early breast cancer between January 1, 2007 and December 31, 2012. Clinical, demographic, and financial variables were evaluated. Adherence was defined as a medication possession ratio (MPR) 80% or greater. RESULTS We identified 5511 women, 2815 (51.1%) on BAI, 1411 (25.6%) on GAI, and 1285 (23.3%) who switched from BAI to GAI. The median 30-day copayment was higher for BAI ($33.3) than for GAI ($9.04). In a multivariable Cox-proportional hazard analysis, women who took GAI were less likely to discontinue therapy (hazard ratio [HR] = 0.69, 95% confidence interval [CI] = 0.57 to 0.84) compared with BAI. Discontinuation was positively associated with a higher monthly copayment of $15 to $30 (HR = 1.21, 95% CI = 1.01 to 1.44) and more than $30 (HR = 1.49, 95% CI = 1.23 to 1.80) compared with less than $15. In a multivariable logistic regression analysis, adherence (medication possession ratio ≥ 80%) was positively associated with GAI use (odds ratio = 1.53, 95% CI = 1.22 to 1.91) compared with BAI and inversely associated with increased monthly copayment. In addition, adherence was associated with a high annual income of more than $100k/year (odds ratio = 1.58, 95% CI = 1.17 to 2.11). CONCLUSIONS Higher prescription copayment amount was associated with nonadherence and discontinuation of AIs. After controlling for copayment, discontinuation was higher and adherence was lower with Brand AIs. Because nonadherence is associated with worse survival, efforts should be directed towards reducing out-of-pocket costs for these life-saving medications.
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Affiliation(s)
- Dawn L Hershman
- Department of Medicine, Gynecology and the Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons (DLH, JW, AIN) and Department of Epidemiology (DLH, JT, GCH, JW, AIN), Mailman School of Public Health, Columbia University, New York, NY; Wagner School of Public Service, New York University, New York, NY (SG); Optum, Eden Prairie, MN (JM).
| | - Jennifer Tsui
- Department of Medicine, Gynecology and the Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons (DLH, JW, AIN) and Department of Epidemiology (DLH, JT, GCH, JW, AIN), Mailman School of Public Health, Columbia University, New York, NY; Wagner School of Public Service, New York University, New York, NY (SG); Optum, Eden Prairie, MN (JM)
| | - Jay Meyer
- Department of Medicine, Gynecology and the Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons (DLH, JW, AIN) and Department of Epidemiology (DLH, JT, GCH, JW, AIN), Mailman School of Public Health, Columbia University, New York, NY; Wagner School of Public Service, New York University, New York, NY (SG); Optum, Eden Prairie, MN (JM)
| | - Sherry Glied
- Department of Medicine, Gynecology and the Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons (DLH, JW, AIN) and Department of Epidemiology (DLH, JT, GCH, JW, AIN), Mailman School of Public Health, Columbia University, New York, NY; Wagner School of Public Service, New York University, New York, NY (SG); Optum, Eden Prairie, MN (JM)
| | - Grace Clarke Hillyer
- Department of Medicine, Gynecology and the Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons (DLH, JW, AIN) and Department of Epidemiology (DLH, JT, GCH, JW, AIN), Mailman School of Public Health, Columbia University, New York, NY; Wagner School of Public Service, New York University, New York, NY (SG); Optum, Eden Prairie, MN (JM)
| | - Jason D Wright
- Department of Medicine, Gynecology and the Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons (DLH, JW, AIN) and Department of Epidemiology (DLH, JT, GCH, JW, AIN), Mailman School of Public Health, Columbia University, New York, NY; Wagner School of Public Service, New York University, New York, NY (SG); Optum, Eden Prairie, MN (JM)
| | - Alfred I Neugut
- Department of Medicine, Gynecology and the Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons (DLH, JW, AIN) and Department of Epidemiology (DLH, JT, GCH, JW, AIN), Mailman School of Public Health, Columbia University, New York, NY; Wagner School of Public Service, New York University, New York, NY (SG); Optum, Eden Prairie, MN (JM)
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Vanderpool RC, Swanberg JE, Chambers MD. A Narrative Review of the Confluence of Breast Cancer and Low-wage Employment and Its Impact on Receipt of Guideline-recommended Treatment. Glob Adv Health Med 2014; 2:75-85. [PMID: 24416698 PMCID: PMC3833560 DOI: 10.7453/gahmj.2013.046] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Breast cancer is the leading cause of cancer among women in the United States, costing the healthcare system, employers, and society billions of dollars each year. Despite improvements in screening and treatment, significant breast cancer treatment and survivorship disparities exist among various groups of women. One variable that has not been explored extensively as a possible contributor to breast cancer treatment disparities is employment. This is concerning, given the changing economic and employment trends in the United States favoring low-wage employment. Currently, one-quarter to one-third of all US workers are considered to be working poor, and women are disproportionally represented in this group. Characteristics of low-wage work-limited paid time off, minimal health benefits, schedule inflexibility, and economic insecurity-may become even more significant in the event of a breast cancer diagnosis. To date, there has been limited research into how job conditions inherent to low-wage work may influence working poor survivors' receipt of guideline-recommended breast cancer treatment. Therefore, the purpose of this narrative review was to critically examine the current literature to further our understanding of how employment context may impact treatment decisions and adherence-and therefore receipt of guideline-recommended care-among newly diagnosed, working poor breast cancer survivors. After undertaking a comprehensive review, we failed to identify any published literature that explicitly addressed low-wage employment and receipt of guideline-recommended breast cancer treatment. Four articles reported circumstances where women delayed, missed, or quit treatments due to work interference, or alternatively, developed strategies that allowed them to continue to work and obtain their breast cancer treatment concurrent with medical and economic challenges. An additional five articles, while focused on other cancer and employment outcomes, described the need for increased patient-provider communication about the influence of work on treatment decisions and the development of alternative treatment plans. Due to the paucity of research in this area, future policy, practice, and research efforts should focus on the employment context of working poor breast cancer survivors as a potential contributor to cancer disparities. Engagement of women, employers, oncology providers, healthcare systems, and interdisciplinary researchers is warranted to improve cancer outcomes among this disparate population of working women.
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Affiliation(s)
- Robin C Vanderpool
- University of Kentucky College of Public Health, Department of Health Behavior, Lexington, United States
| | | | - Mara D Chambers
- University of Kentucky College of Medicine, Markey Cancer Center, Comprehensive Breast Care Center, Lexington, United States
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Sheppard VB, Faul LA, Luta G, Clapp JD, Yung RL, Wang JHY, Kimmick G, Isaacs C, Tallarico M, Barry WT, Pitcher BN, Hudis C, Winer EP, Cohen HJ, Muss HB, Hurria A, Mandelblatt JS. Frailty and adherence to adjuvant hormonal therapy in older women with breast cancer: CALGB protocol 369901. J Clin Oncol 2014; 32:2318-27. [PMID: 24934786 DOI: 10.1200/jco.2013.51.7367] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
PURPOSE Most patients with breast cancer age ≥ 65 years (ie, older patients) are eligible for adjuvant hormonal therapy, but use is not universal. We examined the influence of frailty on hormonal therapy noninitiation and discontinuation. PATIENTS AND METHODS A prospective cohort of 1,288 older women diagnosed with invasive, nonmetastatic breast cancer recruited from 78 sites from 2004 to 2011 were included (1,062 had estrogen receptor-positive tumors). Interviews were conducted at baseline, 6 months, and annually for up to 7 years to collect sociodemographic, health care, and psychosocial data. Hormonal initiation was defined from records and discontinuation from self-report. Baseline frailty was measured using a previously validated 35-item scale and grouped as prefrail or frail versus robust. Logistic regression and proportional hazards models were used to assess factors associated with noninitiation and discontinuation, respectively. RESULTS Most women (76.4%) were robust. Noninitiation of hormonal therapy was low (14%), but in prefrail or frail (v robust) women the odds of noninitiation were 1.63 times as high (95% CI, 1.11 to 2.40; P = .013) after covariate adjustment. Nonwhites (v whites) had higher odds of noninitiation (odds ratio, 1.71; 95% CI, 1.04 to 2.80; P = .033) after covariate adjustment. Among initiators, the 5-year continuation probability was 48.5%. After adjustment, the risk of discontinuation was higher with increasing age (P = .005) and lower for stage ≥ IIB (v stage I) disease (P = .003). CONCLUSION Frailty is associated with noninitiation of hormonal therapy, but it does not seem to be a major predictor of early discontinuation in older patients.
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Affiliation(s)
- Vanessa B Sheppard
- Vanessa B. Sheppard, Leigh Anne Faul, George Luta, Jonathan D. Clapp, Judy Huei-yu Wang, Claudine Isaacs, Michelle Tallarico, and Jeanne S. Mandelblatt, Georgetown University Medical Center and Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC; Rachel L. Yung and Eric P. Winer, Dana-Farber Cancer Institute, Boston, MA; Gretchen Kimmick, William T. Barry, Brandelyn N. Pitcher, and Harvey J. Cohen, Duke University Medical Center; William T. Barry and Brandelyn N. Pitcher, Cancer and Leukemia Group B Statistical Center, Durham; Hyman B. Muss, University of North Carolina Chapel Hill, Chapel Hill, NC; Clifford Hudis, Memorial Sloan-Kettering Cancer Center, New York, NY; and Arti Hurria, City of Hope, Los Angeles, CA.
| | - Leigh Anne Faul
- Vanessa B. Sheppard, Leigh Anne Faul, George Luta, Jonathan D. Clapp, Judy Huei-yu Wang, Claudine Isaacs, Michelle Tallarico, and Jeanne S. Mandelblatt, Georgetown University Medical Center and Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC; Rachel L. Yung and Eric P. Winer, Dana-Farber Cancer Institute, Boston, MA; Gretchen Kimmick, William T. Barry, Brandelyn N. Pitcher, and Harvey J. Cohen, Duke University Medical Center; William T. Barry and Brandelyn N. Pitcher, Cancer and Leukemia Group B Statistical Center, Durham; Hyman B. Muss, University of North Carolina Chapel Hill, Chapel Hill, NC; Clifford Hudis, Memorial Sloan-Kettering Cancer Center, New York, NY; and Arti Hurria, City of Hope, Los Angeles, CA
| | - George Luta
- Vanessa B. Sheppard, Leigh Anne Faul, George Luta, Jonathan D. Clapp, Judy Huei-yu Wang, Claudine Isaacs, Michelle Tallarico, and Jeanne S. Mandelblatt, Georgetown University Medical Center and Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC; Rachel L. Yung and Eric P. Winer, Dana-Farber Cancer Institute, Boston, MA; Gretchen Kimmick, William T. Barry, Brandelyn N. Pitcher, and Harvey J. Cohen, Duke University Medical Center; William T. Barry and Brandelyn N. Pitcher, Cancer and Leukemia Group B Statistical Center, Durham; Hyman B. Muss, University of North Carolina Chapel Hill, Chapel Hill, NC; Clifford Hudis, Memorial Sloan-Kettering Cancer Center, New York, NY; and Arti Hurria, City of Hope, Los Angeles, CA
| | - Jonathan D Clapp
- Vanessa B. Sheppard, Leigh Anne Faul, George Luta, Jonathan D. Clapp, Judy Huei-yu Wang, Claudine Isaacs, Michelle Tallarico, and Jeanne S. Mandelblatt, Georgetown University Medical Center and Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC; Rachel L. Yung and Eric P. Winer, Dana-Farber Cancer Institute, Boston, MA; Gretchen Kimmick, William T. Barry, Brandelyn N. Pitcher, and Harvey J. Cohen, Duke University Medical Center; William T. Barry and Brandelyn N. Pitcher, Cancer and Leukemia Group B Statistical Center, Durham; Hyman B. Muss, University of North Carolina Chapel Hill, Chapel Hill, NC; Clifford Hudis, Memorial Sloan-Kettering Cancer Center, New York, NY; and Arti Hurria, City of Hope, Los Angeles, CA
| | - Rachel L Yung
- Vanessa B. Sheppard, Leigh Anne Faul, George Luta, Jonathan D. Clapp, Judy Huei-yu Wang, Claudine Isaacs, Michelle Tallarico, and Jeanne S. Mandelblatt, Georgetown University Medical Center and Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC; Rachel L. Yung and Eric P. Winer, Dana-Farber Cancer Institute, Boston, MA; Gretchen Kimmick, William T. Barry, Brandelyn N. Pitcher, and Harvey J. Cohen, Duke University Medical Center; William T. Barry and Brandelyn N. Pitcher, Cancer and Leukemia Group B Statistical Center, Durham; Hyman B. Muss, University of North Carolina Chapel Hill, Chapel Hill, NC; Clifford Hudis, Memorial Sloan-Kettering Cancer Center, New York, NY; and Arti Hurria, City of Hope, Los Angeles, CA
| | - Judy Huei-Yu Wang
- Vanessa B. Sheppard, Leigh Anne Faul, George Luta, Jonathan D. Clapp, Judy Huei-yu Wang, Claudine Isaacs, Michelle Tallarico, and Jeanne S. Mandelblatt, Georgetown University Medical Center and Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC; Rachel L. Yung and Eric P. Winer, Dana-Farber Cancer Institute, Boston, MA; Gretchen Kimmick, William T. Barry, Brandelyn N. Pitcher, and Harvey J. Cohen, Duke University Medical Center; William T. Barry and Brandelyn N. Pitcher, Cancer and Leukemia Group B Statistical Center, Durham; Hyman B. Muss, University of North Carolina Chapel Hill, Chapel Hill, NC; Clifford Hudis, Memorial Sloan-Kettering Cancer Center, New York, NY; and Arti Hurria, City of Hope, Los Angeles, CA
| | - Gretchen Kimmick
- Vanessa B. Sheppard, Leigh Anne Faul, George Luta, Jonathan D. Clapp, Judy Huei-yu Wang, Claudine Isaacs, Michelle Tallarico, and Jeanne S. Mandelblatt, Georgetown University Medical Center and Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC; Rachel L. Yung and Eric P. Winer, Dana-Farber Cancer Institute, Boston, MA; Gretchen Kimmick, William T. Barry, Brandelyn N. Pitcher, and Harvey J. Cohen, Duke University Medical Center; William T. Barry and Brandelyn N. Pitcher, Cancer and Leukemia Group B Statistical Center, Durham; Hyman B. Muss, University of North Carolina Chapel Hill, Chapel Hill, NC; Clifford Hudis, Memorial Sloan-Kettering Cancer Center, New York, NY; and Arti Hurria, City of Hope, Los Angeles, CA
| | - Claudine Isaacs
- Vanessa B. Sheppard, Leigh Anne Faul, George Luta, Jonathan D. Clapp, Judy Huei-yu Wang, Claudine Isaacs, Michelle Tallarico, and Jeanne S. Mandelblatt, Georgetown University Medical Center and Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC; Rachel L. Yung and Eric P. Winer, Dana-Farber Cancer Institute, Boston, MA; Gretchen Kimmick, William T. Barry, Brandelyn N. Pitcher, and Harvey J. Cohen, Duke University Medical Center; William T. Barry and Brandelyn N. Pitcher, Cancer and Leukemia Group B Statistical Center, Durham; Hyman B. Muss, University of North Carolina Chapel Hill, Chapel Hill, NC; Clifford Hudis, Memorial Sloan-Kettering Cancer Center, New York, NY; and Arti Hurria, City of Hope, Los Angeles, CA
| | - Michelle Tallarico
- Vanessa B. Sheppard, Leigh Anne Faul, George Luta, Jonathan D. Clapp, Judy Huei-yu Wang, Claudine Isaacs, Michelle Tallarico, and Jeanne S. Mandelblatt, Georgetown University Medical Center and Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC; Rachel L. Yung and Eric P. Winer, Dana-Farber Cancer Institute, Boston, MA; Gretchen Kimmick, William T. Barry, Brandelyn N. Pitcher, and Harvey J. Cohen, Duke University Medical Center; William T. Barry and Brandelyn N. Pitcher, Cancer and Leukemia Group B Statistical Center, Durham; Hyman B. Muss, University of North Carolina Chapel Hill, Chapel Hill, NC; Clifford Hudis, Memorial Sloan-Kettering Cancer Center, New York, NY; and Arti Hurria, City of Hope, Los Angeles, CA
| | - William T Barry
- Vanessa B. Sheppard, Leigh Anne Faul, George Luta, Jonathan D. Clapp, Judy Huei-yu Wang, Claudine Isaacs, Michelle Tallarico, and Jeanne S. Mandelblatt, Georgetown University Medical Center and Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC; Rachel L. Yung and Eric P. Winer, Dana-Farber Cancer Institute, Boston, MA; Gretchen Kimmick, William T. Barry, Brandelyn N. Pitcher, and Harvey J. Cohen, Duke University Medical Center; William T. Barry and Brandelyn N. Pitcher, Cancer and Leukemia Group B Statistical Center, Durham; Hyman B. Muss, University of North Carolina Chapel Hill, Chapel Hill, NC; Clifford Hudis, Memorial Sloan-Kettering Cancer Center, New York, NY; and Arti Hurria, City of Hope, Los Angeles, CA
| | - Brandelyn N Pitcher
- Vanessa B. Sheppard, Leigh Anne Faul, George Luta, Jonathan D. Clapp, Judy Huei-yu Wang, Claudine Isaacs, Michelle Tallarico, and Jeanne S. Mandelblatt, Georgetown University Medical Center and Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC; Rachel L. Yung and Eric P. Winer, Dana-Farber Cancer Institute, Boston, MA; Gretchen Kimmick, William T. Barry, Brandelyn N. Pitcher, and Harvey J. Cohen, Duke University Medical Center; William T. Barry and Brandelyn N. Pitcher, Cancer and Leukemia Group B Statistical Center, Durham; Hyman B. Muss, University of North Carolina Chapel Hill, Chapel Hill, NC; Clifford Hudis, Memorial Sloan-Kettering Cancer Center, New York, NY; and Arti Hurria, City of Hope, Los Angeles, CA
| | - Clifford Hudis
- Vanessa B. Sheppard, Leigh Anne Faul, George Luta, Jonathan D. Clapp, Judy Huei-yu Wang, Claudine Isaacs, Michelle Tallarico, and Jeanne S. Mandelblatt, Georgetown University Medical Center and Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC; Rachel L. Yung and Eric P. Winer, Dana-Farber Cancer Institute, Boston, MA; Gretchen Kimmick, William T. Barry, Brandelyn N. Pitcher, and Harvey J. Cohen, Duke University Medical Center; William T. Barry and Brandelyn N. Pitcher, Cancer and Leukemia Group B Statistical Center, Durham; Hyman B. Muss, University of North Carolina Chapel Hill, Chapel Hill, NC; Clifford Hudis, Memorial Sloan-Kettering Cancer Center, New York, NY; and Arti Hurria, City of Hope, Los Angeles, CA
| | - Eric P Winer
- Vanessa B. Sheppard, Leigh Anne Faul, George Luta, Jonathan D. Clapp, Judy Huei-yu Wang, Claudine Isaacs, Michelle Tallarico, and Jeanne S. Mandelblatt, Georgetown University Medical Center and Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC; Rachel L. Yung and Eric P. Winer, Dana-Farber Cancer Institute, Boston, MA; Gretchen Kimmick, William T. Barry, Brandelyn N. Pitcher, and Harvey J. Cohen, Duke University Medical Center; William T. Barry and Brandelyn N. Pitcher, Cancer and Leukemia Group B Statistical Center, Durham; Hyman B. Muss, University of North Carolina Chapel Hill, Chapel Hill, NC; Clifford Hudis, Memorial Sloan-Kettering Cancer Center, New York, NY; and Arti Hurria, City of Hope, Los Angeles, CA
| | - Harvey J Cohen
- Vanessa B. Sheppard, Leigh Anne Faul, George Luta, Jonathan D. Clapp, Judy Huei-yu Wang, Claudine Isaacs, Michelle Tallarico, and Jeanne S. Mandelblatt, Georgetown University Medical Center and Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC; Rachel L. Yung and Eric P. Winer, Dana-Farber Cancer Institute, Boston, MA; Gretchen Kimmick, William T. Barry, Brandelyn N. Pitcher, and Harvey J. Cohen, Duke University Medical Center; William T. Barry and Brandelyn N. Pitcher, Cancer and Leukemia Group B Statistical Center, Durham; Hyman B. Muss, University of North Carolina Chapel Hill, Chapel Hill, NC; Clifford Hudis, Memorial Sloan-Kettering Cancer Center, New York, NY; and Arti Hurria, City of Hope, Los Angeles, CA
| | - Hyman B Muss
- Vanessa B. Sheppard, Leigh Anne Faul, George Luta, Jonathan D. Clapp, Judy Huei-yu Wang, Claudine Isaacs, Michelle Tallarico, and Jeanne S. Mandelblatt, Georgetown University Medical Center and Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC; Rachel L. Yung and Eric P. Winer, Dana-Farber Cancer Institute, Boston, MA; Gretchen Kimmick, William T. Barry, Brandelyn N. Pitcher, and Harvey J. Cohen, Duke University Medical Center; William T. Barry and Brandelyn N. Pitcher, Cancer and Leukemia Group B Statistical Center, Durham; Hyman B. Muss, University of North Carolina Chapel Hill, Chapel Hill, NC; Clifford Hudis, Memorial Sloan-Kettering Cancer Center, New York, NY; and Arti Hurria, City of Hope, Los Angeles, CA
| | - Arti Hurria
- Vanessa B. Sheppard, Leigh Anne Faul, George Luta, Jonathan D. Clapp, Judy Huei-yu Wang, Claudine Isaacs, Michelle Tallarico, and Jeanne S. Mandelblatt, Georgetown University Medical Center and Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC; Rachel L. Yung and Eric P. Winer, Dana-Farber Cancer Institute, Boston, MA; Gretchen Kimmick, William T. Barry, Brandelyn N. Pitcher, and Harvey J. Cohen, Duke University Medical Center; William T. Barry and Brandelyn N. Pitcher, Cancer and Leukemia Group B Statistical Center, Durham; Hyman B. Muss, University of North Carolina Chapel Hill, Chapel Hill, NC; Clifford Hudis, Memorial Sloan-Kettering Cancer Center, New York, NY; and Arti Hurria, City of Hope, Los Angeles, CA
| | - Jeanne S Mandelblatt
- Vanessa B. Sheppard, Leigh Anne Faul, George Luta, Jonathan D. Clapp, Judy Huei-yu Wang, Claudine Isaacs, Michelle Tallarico, and Jeanne S. Mandelblatt, Georgetown University Medical Center and Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC; Rachel L. Yung and Eric P. Winer, Dana-Farber Cancer Institute, Boston, MA; Gretchen Kimmick, William T. Barry, Brandelyn N. Pitcher, and Harvey J. Cohen, Duke University Medical Center; William T. Barry and Brandelyn N. Pitcher, Cancer and Leukemia Group B Statistical Center, Durham; Hyman B. Muss, University of North Carolina Chapel Hill, Chapel Hill, NC; Clifford Hudis, Memorial Sloan-Kettering Cancer Center, New York, NY; and Arti Hurria, City of Hope, Los Angeles, CA
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Non-initiation and early discontinuation of adjuvant trastuzumab in women with localized HER2-positive breast cancer. Breast Cancer 2014; 21:780-5. [PMID: 24902664 DOI: 10.1007/s12282-014-0543-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Accepted: 05/09/2014] [Indexed: 10/25/2022]
Abstract
One year of trastuzumab therapy is recommended for women with HER2-positive breast cancer ≥ 1.0 cm in size to increase survival and is considered for women with tumors 0.5-0.9 cm in size. We analyzed compliance with trastuzumab among women with HER2-positive breast cancer in a prospective cohort study. Of 1145 recruited patients with breast cancer, 152 were HER2-positive (13.2 %), of whom 126 had tumors ≥ 1.0 cm; 110/126 (87.3 %) of these initiated trastuzumab. Non-receipt was associated with older age, better prognosis tumors, and with non-receipt of adjuvant chemotherapy. Of the 110 who initiated treatment, 18 (15 %) did not complete treatment, 15 (83 %) of them because of cardiotoxicity. Of 20 women with tumors 0.5-0.9 cm, 5 (25 %) initiated trastuzumab. Compliance with trastuzumab was very high among those with HER2-positive breast cancer, as was the completion of the recommended therapy.
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von Blanckenburg P, Schuricht F, Albert US, Rief W, Nestoriuc Y. Optimizing expectations to prevent side effects and enhance quality of life in breast cancer patients undergoing endocrine therapy: study protocol of a randomized controlled trial. BMC Cancer 2013; 13:426. [PMID: 24047450 PMCID: PMC3848828 DOI: 10.1186/1471-2407-13-426] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Accepted: 09/12/2013] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Adjuvant endocrine therapy can improve disease-free survival and time before recurrence in breast cancer patients. However, it is associated with considerable side effects that negatively affect patients' quality of life and cause non-adherence. The recently demonstrated effect of individual expectations on side-effect development (nocebo effect) suggests that psychological factors play a role in the prevention of side effects. The aim of this study is to evaluate cognitive-behavioral side-effect prevention training (SEPT) for breast cancer patients. This article describes the study protocol and applied research methods. METHODS/DESIGN In a randomized controlled trial, 184 female breast cancer patients are assigned to receive either SEPT, standard medical care or a manualized supportive therapy at the start of adjuvant endocrine treatment. SEPT consists of three sessions of cognitive-behavioral training including psychoeducation to provide a realistic view of endocrine therapy, imagination-training to integrate positive aspects of medication into daily life, and side-effect management to enhance expectations about coping ability. Side effects three months after the start of endocrine therapy serve as primary outcomes. Secondary outcomes include quality of life, coping ability and patients' medication adherence. Patients' expectations (i.e., expectations about side effects, coping ability, treatment and illness) are analyzed as mediators. DISCUSSION The optimization of expectations might be a potential pathway in health care to improve patients' quality of life during long-term medication intake. The results will provide implications for a possible integration of evidence-based prevention training into clinical practice. TRIAL REGISTRATION ClinicalTrials.gov, (NCT01741883).
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Bickell NA, Geduld AN, Joseph KA, Sparano JA, Kemeny MM, Oluwole S, Menes T, Srinivasan A, Franco R, Fei K, Leventhal H. Do community-based patient assistance programs affect the treatment and well-being of patients with breast cancer? J Oncol Pract 2013; 10:48-54. [PMID: 24023271 DOI: 10.1200/jop.2013.000920] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
PURPOSE Patients with breast cancer who need adjuvant treatments often fail to receive them. High-quality, community-based patient-assistance programs are an underused, inexpensive resource to help patients with cancer obtain needed therapy. We sought to determine whether connecting women to patient-assistance programs would reduce underuse of adjuvant therapies. METHODS We conducted a randomized trial of 374 women (190 assigned intervention [INT], 184 to usual care [UC]) with early-stage breast cancer who underwent surgery between October 2006 and August 2009. After initial needs assessment, individualized action plans were created to connect INT patients with targeted patient-assistance programs; UC patients received an informational pamphlet. Main outcome measures were receiving adjuvant treatment and obtaining help. RESULTS High rates of INT and UC patients received treatment: 87% INT versus 91% UC women who underwent lumpectomy received radiotherapy (P = .39); 93% INT versus 86% UC women with estrogen receptor (ER) -negative tumors ≥ 1 cm received chemotherapy (P = .42); 92% INT versus 93% UC women with ER-positive tumors ≥ 1 cm received hormonal therapy (P = .80). Many women reported needs: 63% had informational; 55%, psychosocial; and 53%, practical needs. High rates of INT patients with needs connected with a program within 2 weeks (92%). At 6 months, INT and UC women used patient-assistance programs at similar rates (75% v 76%; P = .54). Women with informational or psychosocial needs were more likely to receive help (relative risk [RR], 1.77; 95% CI, 1.51 to 1.90 and RR, 1.37; 95% CI, 1.06 to 1.61, respectively). CONCLUSION INT and UC patients received high rates of adjuvant treatment regardless of trial assignment. Patients with breast cancer who connect to relevant patient assistance programs receive useful informational and psychosocial but not practical help.
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Affiliation(s)
- Nina A Bickell
- Mount Sinai School of Medicine; Columbia University Medical Center; Bellevue Hospital Center; Harlem Hospital Center; Metropolitan Hospital Center; Montefiore Medical Center; Queens Hospital Center, New York; Elmhurst Hospital Center, Elmhurst, NY; Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; and Rutgers, the State University of New Jersey, New Brunswick, NJ
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47
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[The importance of individual beliefs about cancer treatments for therapeutic decisions]. Bull Cancer 2013; 100:999-1005. [PMID: 23883592 DOI: 10.1684/bdc.2013.1784] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Interest for representations about cancer treatments and their side effects is increasing because their central role has been proved in how patients cope with illness and symptoms and how they react emotionally. Through a synthesis of the literature, this paper has two objectives: firstly, to clarify the current state of knowledge in this field, and secondly to point out the manner that bringing out these individual representations during oncological consultations contributes to preventing difficulties and treatment discontinuation and facilitates medical decision processing.
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48
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Current World Literature. Curr Opin Obstet Gynecol 2013; 25:81-9. [DOI: 10.1097/gco.0b013e32835cc6b6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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49
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Shelton RC, Clarke Hillyer G, Hershman DL, Leoce N, Bovbjerg DH, Mandelblatt JS, Kushi LH, Lamerato L, Nathanson SD, Ambrosone CB, Neugut AI. Interpersonal influences and attitudes about adjuvant therapy treatment decisions among non-metastatic breast cancer patients: an examination of differences by age and race/ethnicity in the BQUAL study. Breast Cancer Res Treat 2012; 137:817-28. [PMID: 23263696 DOI: 10.1007/s10549-012-2370-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2012] [Accepted: 12/03/2012] [Indexed: 10/27/2022]
Abstract
Patients are increasingly involved in cancer treatment decisions and yet little research has explored factors that may affect patient attitudes and beliefs about their therapeutic choices. This paper examines psychosocial factors (e.g., attitudes, social support), provider-related factors (e.g., communication, trust), and treatment considerations in a prospective study of a sample of non-metastatic breast cancer patients eligible for chemotherapy and/or hormonal therapy (BQUAL cohort). The data come from a multisite cohort study of white, black, Hispanic, and Asian non-metastatic breast cancer patients recruited in New York City, Northern California, and Detroit, Michigan. Baseline surveys were conducted over the telephone between 2006 and 2010 among a total of 1,145 women. Most participants were white (69 %), had more than a high school education (76 %), and were diagnosed with stage I disease (51 %). The majority of women reported discussing chemotherapy and hormonal therapy with their doctor (90 and 83 %, respectively); these discussions primarily took place with medical oncologists. Nearly a quarter of women reported that the treatment decision was difficult, and the majority were accompanied to the doctor (76 %) and involved a friend or family member in making the decision (54 %). Positive considerations (e.g., beliefs about treatment reducing risk of recurrence) were important in making treatment decisions. Participants preferred a shared decision-making style, but results suggested that there is room for improvement in terms of actual patient's involvement in making the decision and provider communication, particularly among black patients. Patients 65 years and older reported fewer provider discussions of chemotherapy, poorer patient-provider communication, higher rates of being assisted by family members in making the decision, and more negative attitudes and beliefs toward treatment.
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Affiliation(s)
- Rachel C Shelton
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA,
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Neugut AI, Hillyer GC, Kushi LH, Lamerato L, Leoce N, Nathanson SD, Ambrosone CB, Bovbjerg DH, Mandelblatt JS, Magai C, Tsai WY, Jacobson JS, Hershman DL. Noninitiation of adjuvant chemotherapy in women with localized breast cancer: the breast cancer quality of care study. J Clin Oncol 2012; 30:3800-9. [PMID: 23008305 DOI: 10.1200/jco.2012.43.8168] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE For some women, adjuvant chemotherapy for nonmetastatic breast cancer decreases recurrences and increases survival; however, patient-physician decisions regarding chemotherapy receipt can be influenced by medical and nonmedical factors. PATIENTS AND METHODS We used a prospective cohort design and multivariate modeling to investigate factors related to noninitiation of chemotherapy among women with newly diagnosed breast cancer recruited from three US sites. We interviewed patients at baseline and during treatment on sociodemographic, tumor, and treatment decision-making factors. Patients were categorized according to National Comprehensive Cancer Network guidelines as those for whom chemotherapy was definitely indicated, clinically discretionary, or discretionary based on age greater than 70 years. RESULTS Of 1,145 patients recruited, chemotherapy was clinically indicated for 392 patients, clinically discretionary for 459 patients, discretionary because of age for 169 patients, and not indicated for 93 patients; data were insufficient for 32 patients. Chemotherapy rates were 90% for those in whom chemotherapy was clinically indicated, 36% for those in whom it was discretionary because of clinical factors, and 19% for those in whom it was discretionary based on age greater than 70 years. Nonreceipt of chemotherapy was associated with older age, more negative beliefs about treatment efficacy, less positive beliefs about chemotherapy, and more concern about adverse effects. In the two discretionary groups, clinical predictors of worse outcome (greater tumor size, positive nodes, worse grade, and estrogen receptor- and progesterone receptor-negative status) were associated with increased chemotherapy initiation. CONCLUSION Utilization of adjuvant chemotherapy was most common among patients who, based on clinical criteria, would most likely benefit from it, patients with more positive than negative beliefs regarding treatment efficacy, and patients with few concerns about adverse effects.
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Affiliation(s)
- Alfred I Neugut
- Division of Medical Oncology, Columbia University Medical Center, 722 W 168th St, Room 725, New York, NY 10032, USA.
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