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Wang A, Quint E, Kukeev I, Agassi R, Belochitski O, Barski G, Vaynshtein J. Application of Intraoperative Radiotherapy in Early-Stage Breast Cancer Patients in a Clinical Setting. Int J Breast Cancer 2024; 2024:5551907. [PMID: 38919804 PMCID: PMC11199062 DOI: 10.1155/2024/5551907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 05/25/2024] [Accepted: 05/31/2024] [Indexed: 06/27/2024] Open
Abstract
Background: Intraoperative radiation therapy (IORT) has gained popularity in recent years as an alternative to external beam whole breast radiation therapy (WBRT) for early-stage breast cancer. Here, we report 43-month recurrence and survival outcomes in a multiethnic cohort treated with IORT in a clinical context. Method: Two hundred and eleven patients with low-risk features were treated with IORT for early-stage breast cancer from 2014 to 2021. Selection criteria were based on Group Europeen de Curietherapie-European Society for Therapeutic Radiology and Oncology (GEC-ESTRO) guidelines: preferably unifocal intraductal carcinoma (IDC), aged > 50, tumor size ≤ 2.0 cm, and without lymph node involvement. All patients received 20 Gy of radiation dose during the lumpectomy. Information on patient and tumor characteristics was collected. Results: The mean age of this cohort was 67.5 years; 95.2% of patients are Jewish, and the rest are Bedouins (4.7%). Most tumors were intraductal carcinoma (97.2%) and stage 1 (94.8%). The mean follow-up time was 43.4 months. Bedouins had larger tumor sizes (mean 1.21 vs. 1.13 cm) and were younger at diagnosis than Jewish patients (mean 65.4 vs. 67.6 years), although the differences are not significant. The overall recurrence rate was 1.4%. One case of local recurrence (0.5%) and two cases of metastasis (0.9%) were observed during the study period. One patient died from metastasis. Conclusion: Our findings suggest that IORT in selected low-risk patients can achieve an excellent prognosis with low rates of recurrence and metastasis.
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Affiliation(s)
- Ao Wang
- Medical School for International HealthBen-Gurion University of the Negev, Be'er Sheva 8410501, Israel
| | - Elchanan Quint
- Department of General Surgery BSoroka University Medical Center, Be'er Sheva 8410101, Israel
| | - Ivan Kukeev
- Department of General Surgery BSoroka University Medical Center, Be'er Sheva 8410101, Israel
| | - Ravit Agassi
- Center Surgical Oncology of BreastSoroka University Medical Center, Be'er Sheva 8410101, Israel
| | - Olga Belochitski
- Radiation Oncology UnitSoroka University Medical Center, Be'er Sheva, Israel
| | - Gay Barski
- Department of General Surgery BSoroka University Medical Center, Be'er Sheva 8410101, Israel
| | - Julie Vaynshtein
- Department of General Surgery BSoroka University Medical Center, Be'er Sheva 8410101, Israel
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Turcu-Stiolica A, Udristoiu I, Subtirelu MS, Gheorman V, Aldea M, Dumitrescu EA, Volovat SR, Median DM, Lungulescu CV. Digging in real-word electronic database for assessing CDK 4/6 inhibitors adherence in breast cancer patients from Romania. Front Pharmacol 2024; 15:1345482. [PMID: 38464732 PMCID: PMC10920324 DOI: 10.3389/fphar.2024.1345482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 02/12/2024] [Indexed: 03/12/2024] Open
Abstract
Introduction: It is imperative for patients to respect the prescribed treatments to achieve the anticipated clinical outcomes, including the outpatients receiving oral anti-cancer drugs such as selective cyclin-dependent kinase 4/6 inhibitors (CDK 4/6i). With the introduction of three CDK 4/6i drugs in the Romanian pharmaceutical market in 2018, our study aimed to evaluate medication adherence and the influencing factors among patients undergoing treatment with palbociclib, ribociclib, or abemaciclib for advanced or metastatic breast cancer. Methods: Medication adherence was assessed using the Proportion of Days Covered (PDC) method, and Spearman correlation analysis was conducted to explore the relationships between adherence, age, gender, and follow-up duration. Results: The study enrolled 330 breast cancer patients, with an average follow-up period of 14.6 ± 12.5 months for palbociclib, 10.6 ± 7.1 months for ribociclib, and 8.6 ± 6.4 months for abemaciclib-treated patients. A small proportion of patients demonstrated non-adherence: 12.8% for palbociclib, 14.6% for ribociclib, and 14.7% for abemaciclib. Among patients receiving palbociclib, there was no significant correlation between adherence, age (rho = 0.07, p = 0.35), or gender (rho = -0.144, p = 0.054). However, a significant correlation was found with the duration of follow-up (rho = -0.304, p < 0.0001). Similar results were observed for patients receiving ribociclib or abemaciclib. Most patients received combination therapy with letrozole (46%) and exemestane (13%) for palbociclib, letrozole (48%) and fulvestrant (19%) for ribociclib, and fulvestrant (39%) and letrozole (27%) for abemaciclib, Discussion: High adherence rates were observed among patients treated with CDK 4/6i drugs, with no significant differences noted among the three drugs in this class. However, the collected patient data was limited, lacking information on adverse reactions that could potentially lead to treatment discontinuation, as determined by the oncologist's decision not to prescribe. Consequently, a comprehensive understanding of all factors contributing to the low adherence levels is hindered.
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Affiliation(s)
- Adina Turcu-Stiolica
- Pharmacoeconomics Department, University of Medicine and Pharmacy of Craiova, Craiova, Romania
| | - Ion Udristoiu
- Psychiatry Department, University of Medicine and Pharmacy of Craiova, Craiova, Romania
| | | | - Victor Gheorman
- Psychiatry Department, University of Medicine and Pharmacy of Craiova, Craiova, Romania
| | - Madalina Aldea
- Psychiatry Department, University of Medicine and Pharmacy of Craiova, Craiova, Romania
| | | | - Simona Ruxandra Volovat
- Department of Medical Oncology, University of Medicine and Pharmacy Grigore T. Popa Iasi, Iasi, Romania
| | - Dragos Mircea Median
- Gynecologic Oncology Department, Filantropia Clinical Hospital Bucharest, Bucharest, Romania
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Ravani LV, Calomeni P, Wang M, Deng D, Speers C, Zaorsky NG, Shah C. Comparison of partial-breast irradiation and intraoperative radiation to whole-breast irradiation in early-stage breast cancer patients: a Kaplan-Meier-derived patient data meta-analysis. Breast Cancer Res Treat 2024; 203:1-12. [PMID: 37736843 DOI: 10.1007/s10549-023-07112-w] [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] [Received: 05/12/2023] [Accepted: 08/24/2023] [Indexed: 09/23/2023]
Abstract
PURPOSE Partial breast irradiation (PBI) and intraoperative radiation (IORT) represent alternatives to whole breast irradiation (WBI) following breast conserving surgery. However, data is mixed regarding outcomes. We therefore performed a pooled analysis of Kaplan-Meier-derived patient data from randomized trials to evaluate the hypothesis that PBI and IORT have comparable long-term rates of ipsilateral breast tumor recurrence as WBI. METHODS In February, 2023, PubMed, EMBASE and Cochrane Central were systematically searched for randomized phase 3 trials of early-stage breast cancer patients undergoing breast-conserving surgery with PBI or IORT as compared to WBI. Time-to-event outcomes of interest included ipsilateral breast tumor recurrence (IBTR), overall survival (OS) and distant disease-free survival (DDFS). Statistical analysis was performed with R Statistical Software. RESULTS Eleven randomized trials comprising 15,460 patients were included; 7,675 (49.6%) patients were treated with standard or moderately hypofractionated WBI, 5,413 (35%) with PBI and 2,372 (15.3%) with IORT. Median follow-up was 9 years. PBI demonstrated comparable IBTR risk compared with WBI (HR 1.20; 95% CI 0.95-1.52; p = 0.12) with no differences in OS (HR 1.02; 95% CI 0.90-1.16; p = 0.70) or DDFS (HR 1.15; 95% CI 0.81-1.64; p = 0.43). In contrast, patients treated with IORT had a higher IBTR risk (HR 1.46; 95% CI 1.23-1.72; p < 0.01) compared with WBI with no difference in OS (HR 0.98; 95% CI 0.84-1.14; p = 0.81) or DDFS (HR 0.91; 95% CI 0.76-1.09; p = 0.31). CONCLUSION For patients with early-stage breast cancer following breast-conserving surgery, PBI demonstrated no difference in IBTR as compared to WBI while IORT was inferior to WBI with respect to IBTR.
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Affiliation(s)
| | - Pedro Calomeni
- University of Sao Paulo Medical School, São Paulo, Brazil
| | - Ming Wang
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Daxuan Deng
- Department of Public Health Sciences, Penn State University College of Medicine, Hershey, PA, USA
| | - Corey Speers
- Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Nicholas G Zaorsky
- Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Chirag Shah
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
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Li ZHJ, MacDonald K, Preston K, Giuliani M, Leung B, Melosky B, Simmons C, Hamilton S, Tinker A, Ingledew PA. Evaluating the childcare needs of cancer patients undergoing radiation therapy. Support Care Cancer 2023; 31:463. [PMID: 37439947 DOI: 10.1007/s00520-023-07923-z] [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] [Received: 02/17/2023] [Accepted: 06/30/2023] [Indexed: 07/14/2023]
Abstract
PURPOSE About one-fifth of newly diagnosed cancer patients are parents to young children. These patients are at higher risk of psychosocial stress and inability to attend treatment due to having to balance their own healthcare needs with childcare duties. This study aims to explore the impact of childcare on cancer parents and elicit their perspectives on potential supports. The results could help inform the implementation of suitable childcare programs to remove this barrier in accessing care. METHODS Patients at a large Canadian cancer treatment center were screened by oncologists for having minor children at home. Secure electronic surveys were then distributed to consenting participants. Domains surveyed included patient demographics, childcare burden, impact on treatment, and preference for childcare supports. RESULTS The mean age of correspondents was 43.9 (range 33-54), 46 patients (92%) were female, and breast cancer was the most common primary tumor. The median number of children per correspondent was two, and their mean age was 8.4. Balancing childcare with cancer treatment had a significant impact on self-reported stress levels for most correspondents. Twenty (40%) participants had to reschedule and 7 (14%) participants missed at least one appointment due to childcare conflicts. During the COVID-19 pandemic, access to childcare resources decreased while childcare responsibilities increased. Three-quarters of correspondents reported that a flexible childcare would make it easier for them to adhere to appointment schedules. CONCLUSION Childcare is a significant psychosocial barrier for patients accessing cancer care. Our results indicate that most parents undergoing treatment may benefit from hospital-based childcare services.
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Affiliation(s)
- Zhang Hao Jim Li
- Department of Surgery, Division of Radiation Oncology, University of British Columbia, Vancouver, British Columbia, Canada
- BC Cancer, Vancouver, British Columbia, Canada
| | - Kenzie MacDonald
- Department of Surgery, Division of Radiation Oncology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Katherine Preston
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Meredith Giuliani
- Princess Margaret Cancer Centre, Radiation Medicine Program, Toronto, Ontario, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Bonnie Leung
- BC Cancer, Vancouver, British Columbia, Canada
- Division of Medical Oncology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Barbara Melosky
- BC Cancer, Vancouver, British Columbia, Canada
- Division of Medical Oncology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Christine Simmons
- BC Cancer, Vancouver, British Columbia, Canada
- Division of Medical Oncology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sarah Hamilton
- Department of Surgery, Division of Radiation Oncology, University of British Columbia, Vancouver, British Columbia, Canada
- BC Cancer, Vancouver, British Columbia, Canada
| | - Anna Tinker
- BC Cancer, Vancouver, British Columbia, Canada
- Division of Medical Oncology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Paris-Ann Ingledew
- Department of Surgery, Division of Radiation Oncology, University of British Columbia, Vancouver, British Columbia, Canada.
- BC Cancer, Vancouver, British Columbia, Canada.
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Shah C, Fleming-Hall E, Asha W. Update on Accelerated Whole Breast Irradiation. Clin Breast Cancer 2023; 23:237-240. [PMID: 36792457 DOI: 10.1016/j.clbc.2023.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 01/21/2023] [Accepted: 01/23/2023] [Indexed: 01/27/2023]
Abstract
Since the advent of breast conservation, adjuvant radiation therapy (RT) has been standard of care following breast conserving surgery (BCS). Radiation therapy following BCS has traditionally been whole breast irradiation (WBI); studies comparing breast conservation to mastectomy utilized standard fractionation WBI, which delivers treatment daily over 5 to 7 weeks (1.8-2 Gy/fraction) and was the standard for decades. More recently, multiple randomized trials have compared standard fractionation WBI to moderately hypofractionated WBI (2.66 Gy/fraction, 15-16 fractions), which allows for completion of treatment in 3 to 4 weeks. Results have demonstrated no difference in local control between these two approaches with comparable toxicity and cosmetic outcomes with long-term follow-up. As such, moderately hypofractionated WBI represents the standard of care approach for most patients with early-stage breast cancer following BCS at this time. In the past few years, ultra-hypofractionated WBI (5.2-5.7 Gy/fraction, 5 fractions) has emerged with promising outcomes; 5-year outcomes from the FAST-Forward randomized trial demonstrated noninferiority between ultra-hypofractionated WBI and moderately hypofractionated WBI. Moving forward, long-term outcomes from ultra-hypofractionated WBI studies are expected, as well as the potential for incorporating moderately hypofractionated regimens into patients requiring regional nodal irradiation following BCS. Finally, the advent of ultra-short regimens may allow clinicians to re-evaluate treatment de-intensification in early-stage breast cancer to consider radiation therapy alone following BCS in lieu of endocrine therapy.
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Affiliation(s)
- Chirag Shah
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH.
| | - Erica Fleming-Hall
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | - Wafa Asha
- Department of Radiation Oncology, King Hussein Cancer Center, Amman, Jordan
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Taparra K, Qu V, Lau B, Pollom E. A National Cancer Disparities Analysis of Predictors for Radiation Therapy Refusal by Race. Int J Radiat Oncol Biol Phys 2023; 116:96-102. [PMID: 36764491 DOI: 10.1016/j.ijrobp.2023.01.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 01/19/2023] [Accepted: 01/23/2023] [Indexed: 02/11/2023]
Abstract
PURPOSE Radiation therapy (RT) refusal by patients with cancer is infrequent but is significant because it portends poor outcomes. No prior study has evaluated all five federally defined racial categories with respects to RT refusal. Here we use a large nationally representative population with cancer to determine: 1) which race of patients refuse RT the most and 2) predictive factors for RT refusal by race. MATERIALS/METHODS A retrospective study included patients ≥18 years old with diagnostically confirmed cancer between 2004-2017, using the National Cancer Database. All patients included were offered RT for first course treatment. Multivariable logistic regression assessed RT refusal (adjusted odds ratio [aOR]) with 95% confidence intervals (95%CI). Analyses were adjusted for patient factors (age, rurality, income, education, and comorbidities) and cancer characteristics (stage, cancer type, facility type, year of diagnosis, and region). Median overall survival was calculated using the Kaplan-Meier method. RESULTS Of 11,609,044 patients, 2,759,753 patients were included and recommended for RT by the treating physician. Median follow-up was 50 months. RT was refused by 139,383 patients (5.0%), varying by race: 416 NHPI (7.2%), 489 AIAN (5.8%), 118,186 Non-Hispanic White (5.0%), 17,427 Black (4.8%), and 2,865 Asian (4.8%) patients. The rates of annual RT refusal were increasing, especially among NHPI patients. The populations with the highest likelihood of refusing RT were NHPI (aOR=1.53, 95%CI=1.36-1.71), AIAN (aOR=1.24, 95%CI=1.12-1.37), and Black (aOR=1.11, 95%CI=1.09-1.14) patients, compared to Non-Hispanic White patients. Older age and higher comorbidity burden predicted RT refusal across all races. Median overall survival was 81 months and 144 months for patients who refused RT and received RT, respectively. CONCLUSIONS Indigenous and Black patients are more likely to refuse RT, which may contribute to inferior cancer outcomes. Understanding NHPI and AIAN patient perspectives and perceptions may elucidate interventions to mitigate these disparities.
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Affiliation(s)
- Kekoa Taparra
- Department of Radiation Oncology, Stanford Medicine, Palo Alto, California.
| | - Vera Qu
- Department of Radiation Oncology, Stanford Medicine, Palo Alto, California
| | - Brianna Lau
- Department of Radiation Oncology, Stanford Medicine, Palo Alto, California
| | - Erqi Pollom
- Department of Radiation Oncology, Stanford Medicine, Palo Alto, California; Palo Alto Veterans Affairs Hospital, Palo Alto, California
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Smith SG, Green SMC, Ellison R, Foy R, Graham CD, Mason E, French DP, Hall LH, Wilkes H, McNaught E, Raine E, Walwyn R, Howdon D, Clark J, Rousseau N, Buxton J, Moore SJL, Parbutt C, Velikova G, Farrin A, Collinson M. Refining and optimising a behavioural intervention to support endocrine therapy adherence (ROSETA) in UK women with breast cancer: protocol for a pilot fractional factorial trial. BMJ Open 2023; 13:e069971. [PMID: 36737093 PMCID: PMC9900066 DOI: 10.1136/bmjopen-2022-069971] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Women with breast cancer who do not adhere to adjuvant endocrine therapy (AET) have increased risks of mortality and recurrence. There are multiple barriers to AET adherence, including medication side-effects, beliefs about medication, memory and psychological distress. We developed four intervention components, each targeting a different barrier. This pilot trial is part of the preparation phase of the Multiphase Optimisation Strategy, and aims to establish key trial parameters, establish intervention component adherence, establish availability and feasibility of outcome and process data, estimate variability in planned outcome measures and estimate cost of developing and delivering each intervention component. METHODS AND ANALYSIS The four intervention components are as follows: short message service text reminders (target: memory); a written information leaflet (target: medication beliefs); a guided self-help Acceptance and Commitment Therapy programme (target: psychological flexibility to reduce distress) and a self-management website (target: side-effect management). To evaluate the feasibility of recruitment, acceptability of the intervention components and the availability of outcome data, we will conduct a multisite, exploratory pilot trial using a 24-1 fractional factorial design, with a nested process evaluation. We will randomise 80 women with early-stage breast cancer who have been prescribed AET to one of eight experimental conditions. This will determine the combination of intervention components they receive, ranging from zero to four, with all conditions receiving usual care. Key outcomes of interest include medication adherence and quality of life. Progression to the optimisation phase will be based on predefined criteria for consent rates, patient adherence to intervention components and availability of medication adherence data. ETHICS AND DISSEMINATION The study was reviewed by the Wales Research Authority Research Ethics Committee 3 (21/WA/0322). Written informed consent will be obtained from all patients before randomisation. The results of this trial will be disseminated in a peer-reviewed journal. TRIAL REGISTRATION NUMBER ISRTCN10487576.
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Affiliation(s)
- Samuel G Smith
- Academic Unit of Primary Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Sophie M C Green
- Academic Unit of Primary Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Rachel Ellison
- Complex Interventions Division, Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Robbie Foy
- Academic Unit of Primary Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | | | - Ellen Mason
- Complex Interventions Division, Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - David P French
- School of Psychological Sciences, Division of Psychology and Mental Health, University of Manchester, Manchester, UK
| | - Louise H Hall
- Academic Unit of Primary Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Hollie Wilkes
- Complex Interventions Division, Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Emma McNaught
- Complex Interventions Division, Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Erin Raine
- Academic Unit of Primary Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Rebecca Walwyn
- Complex Interventions Division, Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Daniel Howdon
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Jane Clark
- Department of Clinical and Health Psychology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Nikki Rousseau
- Surgical, Diagnostic and Devices Division, Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Jacqueline Buxton
- Academic Unit of Primary Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Sally J L Moore
- Academic Unit of Primary Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Catherine Parbutt
- Medicines Management and Pharmacy Services, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Galina Velikova
- Leeds Institute of Medical Research, University of Leeds, Leeds, UK
| | - Amanda Farrin
- Complex Interventions Division, Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Michelle Collinson
- Complex Interventions Division, Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
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Shah C, Leonardi MC. Accelerated Partial Breast Irradiation: An Opportunity for Therapeutic De-escalation. Am J Clin Oncol 2023; 46:2-6. [PMID: 36255336 DOI: 10.1097/coc.0000000000000945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Partial breast irradiation (PBI) has been demonstrated to have comparable outcomes to whole breast irradiation based on multiple randomized trials with long-term follow-up. However, despite the strength of the data available, PBI remains underutilized despite being an appropriate option for many women diagnosed with early-stage breast cancer. This is significant, as PBI offers the potential to reduce toxicities and shorten treatment duration without impacting outcomes; in addition, for low-risk patients, PBI alone is being investigated as an alternative to endocrine therapy alone. Modern PBI can be delivered with multiple techniques, and advances in treatment planning have allowed for improved therapeutic ratios compared with earlier techniques; one such approach is utilizing stereotactic body radiation therapy approaches allowing for smaller target margins and therefore lower breast doses. Moving forward, studies are ongoing evaluating the use of radiation alone including PBI as compared with endocrine therapy alone, with prospective studies evaluating stereotactic body radiation therapy.
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Affiliation(s)
- Chirag Shah
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | - Maria C Leonardi
- Department of Radiotherapy, IEO European Institute of Oncology, IRCCS, Milano, Italy
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Gil-Guillen VF, Balsa A, Bernárdez B, Valdés y Llorca C, Márquez-Contreras E, de la Haba-Rodríguez J, Castellano JM, Gómez-Martínez J. Medication Non-Adherence in Rheumatology, Oncology and Cardiology: A Review of the Literature of Risk Factors and Potential Interventions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12036. [PMID: 36231341 PMCID: PMC9564665 DOI: 10.3390/ijerph191912036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 09/12/2022] [Accepted: 09/13/2022] [Indexed: 06/16/2023]
Abstract
Medication adherence is directly associated with health outcomes. Adherence has been reviewed extensively; however, most studies provide a narrow scope of the problem, covering a specific disease or treatment. This project's objective was to identify risk factors for non-adherence in the fields of rheumatology, oncology, and cardiology as well as potential interventions to improve adherence and their association with the risk factors. The project was developed in three phases and carried out by a Steering Committee made up of experts from the fields of rheumatology, oncology, cardiology, general medicine, and hospital and community pharmacy. In phase 1, a bibliographic review was performed, and the articles/reviews were classified according to the authors' level of confidence in the results and their clinical relevance. In phase 2, 20 risk factors for non-adherence were identified from these articles/reviews and agreed upon in Steering Committee meetings. In phase 3, potential interventions for improving adherence were also identified and agreed upon. The results obtained show that adherence is a dynamic concept that can change throughout the course of the disease, the treatments, and other factors. Educational interventions are the most studied ones and have the highest level of confidence in the authors' opinion. Information and education are essential to improve adherence in all patients.
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Affiliation(s)
- Vicente F. Gil-Guillen
- Department of Clinical Medicine, Miguel Hernandez University, 03550 San Juan, Spain
- Research Unit, Hospital General Universitario de Elda, 30600 Elda, Spain
| | - Alejandro Balsa
- Rheumatology Department, La Paz University Hospital, 28046 Madrid, Spain
- Institute for Health Research Hospital La Paz (IdiPaz), 28046 Madrid, Spain
| | - Beatriz Bernárdez
- Department of Oncologic Pharmacy, Santiago de Compostela University Hospital, 15706 Santiago de Compostela, Spain
- Medicine Department, Santiago de Compostela University, 15706 Santiago de Compostela, Spain
- Pharmacology Group, Health Research Institute of Santiago de Compostela (IDIS), 15782 Santiago de Compostela, Spain
- Adherence Group of the Sociedad Española de Farmacia Hospitalaria (ADHEFAR-SEFH), 28001 Madrid, Spain
| | - Carmen Valdés y Llorca
- Fuencarral Health Center, 28034 Madrid, Spain
- Observatorio de Adherencia al Tratamiento (OAT), 28231 Madrid, Spain
- Treatment Adherence Chair, San Juan de Alicante University, 03550 Alicante, Spain
| | | | | | - Jose M. Castellano
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), 28029 Madrid, Spain
- Centro Integral de Enfermedades Cardiovasculares, Monteprincipe University Hospital, 28660 Madrid, Spain
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Khanna NR, Kumar A, Kataki K, Sehra N, Laskar SG, Mummudi N, Gupta T, Tibdewal A, Pathak R, Wadasadawala T, Krishnatry R, Chopra S, Goda JS, Chatterjee A, Budrukkar A, Gurram L, Engineer R, Murthy V, Swain M, Laskar S, Sarin R, Agarwal JP. Compliance of Radiotherapy Treatment at a Tertiary Cancer Center in India—A Clinical Audit. Indian J Med Paediatr Oncol 2022. [DOI: 10.1055/s-0042-1742666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Abstract
Introduction Noncompliance to planned radiotherapy (RT) treatment is associated with inferior outcomes and also serves as an indicator of quality of care offered to the patients. Identification of the rate of noncompliance and its causative factors can help us develop an insight toward implementing mitigation measures thereby improving the quality of treatment.
Objective To ascertain the incidence of noncompliance and the factors affecting the same in patients offered RT appointments.
Materials and Methods We retrospectively reviewed the records of patients from January 1, 2019, to December 31, 2019, who were noncompliant (defaulted RT simulation or defaulted initiation of RT or defaulted planned RT during the course of RT but excluding planned/unplanned treatment breaks or early conclusions prescribed by the treating radiation oncologist) for the planned RT treatment.
Results Of the 8,607 appointments (7,699 external beam RT and 908 brachytherapy) given to the patients attending the radiation oncology outpatient department in the year 2019, a total of 197 (2.28%) patients were found to be noncomplaint. Ninety-seven patients defaulted RT simulation (49.2%), 53 defaulted RT starting (26.9%), and 47 defaulted while on RT (23.9%). Half of these had either head–neck (29.9%) or gynecological (20.8%) malignancies. Patients with breast cancers had the least noncompliance rates (0.02%). The cause for noncompliance was ascertained in 135 patients (68.5%). The common causes of noncompliance were the desire to continue treatment closer to home (21.5%) followed by logistic (17%), lack of confidence in the curative potential of the planned therapy (17%), and financial reasons (11.8%). Patients with head–neck and gynecological malignancies were more often with advanced staged disease and were planned multimodal treatment protocols. The majority of the 23 patients who defaulted palliative RT were planned for fractionated treatments (73.9%).
Conclusion The incidence of noncompliance in patients planned for RT in our institute can be considered optimum. Appropriate counseling of patients at the time of scheduling appointment, upfront identification of patients at high risk of noncompliance, and assisting patients with financial and logistic challenges are imperative to ensure adherence to planned treatment schedule.
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Affiliation(s)
- Nehal R. Khanna
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Anuj Kumar
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Kaushik Kataki
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Nishtha Sehra
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Sarbani Ghosh Laskar
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Naveen Mummudi
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Tejpal Gupta
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Anil Tibdewal
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Rima Pathak
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Tabassum Wadasadawala
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Rahul Krishnatry
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Supriya Chopra
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Jayant Sastri Goda
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Abhishek Chatterjee
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Ashwini Budrukkar
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Lavanya Gurram
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Reena Engineer
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Vedang Murthy
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Monali Swain
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Siddhartha Laskar
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Rajiv Sarin
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Jai Prakash Agarwal
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
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11
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Smith SG, Ellison R, Hall L, Clark J, Hartley S, Mason E, Metherell J, Olivier C, Napp V, Naik J, Buckley S, Hirst C, Hartup S, Neal RD, Velikova G, Farrin A, Collinson M, Graham CD. Acceptance and Commitment Therapy to support medication decision-making and quality of life in women with breast cancer: protocol for a pilot randomised controlled trial. Pilot Feasibility Stud 2022; 8:33. [PMID: 35135619 PMCID: PMC8822728 DOI: 10.1186/s40814-022-00985-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 01/19/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Adherence to adjuvant endocrine therapy is affected by medication side-effects and associated distress. Previous interventions focused on educating women to enhance adherence have proved minimally effective. We co-designed an Acceptance and Commitment Therapy (ACT) intervention to enhance medication decision-making and quality of life by targeting a broader range of factors, including side-effect management and psychological flexibility. This study aims to establish key trial parameters, assess the acceptability of the intervention and the extent to which it can be delivered with fidelity, and to demonstrate "proof of principle" regarding its efficacy on primary and process outcomes. METHODS The ACTION intervention includes an individual 1:1 ACT session followed by three group sessions involving 8-10 women and two practitioner psychologists. Participants are also provided with access to a website containing evidence-based methods for self-managing side-effects. The ACT sessions were adapted during the COVID-19 pandemic to be remotely delivered via video conferencing software. To evaluate the feasibility and acceptability of this intervention, a multi-site, exploratory, two-arm, individually randomised external pilot trial with a nested qualitative study will be undertaken. Eighty women with early stage breast cancer prescribed adjuvant endocrine therapy will be randomised (1:1) to receive treatment as usual or treatment as usual plus the ACTION intervention. The planned future primary outcome is medication adherence assessed by the ASK-12 measure. Progression to a phase III RCT will be based on criteria related to recruitment and follow-up rates, acceptability to patients, competency and fidelity of delivery, and proof of principle for change in medication adherence. DISCUSSION This external pilot trial will be used to ascertain the feasibility of undertaking a future phase III RCT to definitively evaluate an ACT-based intervention to support medication taking behaviour and quality of life in women with early stage breast cancer on adjuvant endocrine therapy. TRIAL REGISTRATION ISRCTN: 12027752. Registered 24 December 2020, https://doi.org/10.1186/ISRCTN12027752.
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Affiliation(s)
- Samuel G Smith
- Leeds Institute of Health Science, University of Leeds, Leeds, LS2 9JT, UK.
| | - Rachel Ellison
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, LS2 9JT, UK
| | - Louise Hall
- Leeds Institute of Health Science, University of Leeds, Leeds, LS2 9JT, UK
| | - Jane Clark
- Department of Clinical and Health Psychology, St James's University Hospital, Beckett Street, Leeds, LS9 7TF, UK
| | - Suzanne Hartley
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, LS2 9JT, UK
| | - Ellen Mason
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, LS2 9JT, UK
| | - Jamie Metherell
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, LS2 9JT, UK
| | - Catherine Olivier
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, LS2 9JT, UK
| | - Vicky Napp
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, LS2 9JT, UK
| | - Jay Naik
- Department of Oncology, Harrogate & District Foundation Trust, Park Road, Lancaster, HG2 7SX, UK
| | - Sarah Buckley
- Department of Clinical Research, Mid Yorkshire Hospitals NHS Trust, Aberford Road, Wakefield, WF1 4AL, UK
| | - Charlotte Hirst
- Department of Clinical Research, Mid Yorkshire Hospitals NHS Trust, Aberford Road, Wakefield, WF1 4AL, UK
| | - Sue Hartup
- St James's University Hospital, Beckett Street, Leeds, LS9 7TF, UK
| | - Richard D Neal
- Leeds Institute of Health Science, University of Leeds, Leeds, LS2 9JT, UK
| | - Galina Velikova
- St James's University Hospital, Beckett Street, Leeds, LS9 7TF, UK
| | - Amanda Farrin
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, LS2 9JT, UK
| | - Michelle Collinson
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, LS2 9JT, UK
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12
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Vicini F, Broughman J, Halima A, Mayo Z, Obi E, Al-Hilli Z, Arthur D, Wazer D, Shah C. Delivery of Adjuvant Radiation in 5 Days or Less After Lumpectomy for Breast Cancer: A Systematic Review. Int J Radiat Oncol Biol Phys 2021; 112:1090-1104. [PMID: 34921906 DOI: 10.1016/j.ijrobp.2021.11.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 11/21/2021] [Accepted: 11/29/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Recent data have been published supporting the application of ultra-short radiation therapy (RT) regimens for women with early stage breast cancer following breast conserving surgery (BCS). What has remained controversial is whether and how to apply accelerated whole breast irradiation (AWBI) or accelerated partial breast irradiation (APBI) approaches in these patients, as well as the consideration of intraoperative RT (IORT) for this population. METHODS We performed a systematic review of the literature searching for randomized and prospective data published evaluating ultra-short RT delivered in 5-days or less with APBI, AWBI, or IORT. RESULTS We identified two randomized studies applying AWBI (n=5,011 patients) with 5 to 10 year follow up, which supported the use of ultra-short course AWBI (5 fractions in one week) as compared to hypofractionated WBI. We identified six randomized trials evaluating APBI (as compared to WBI) in 5 days or less (n= 8,415) with numerous (n=55) prospective studies as well, with the data supporting short course APBI as compared to WBI. Finally, we identified two randomized trials evaluating IORT; however, both trials demonstrated elevated rates of recurrence with IORT as compared to WBI. CONCLUSIONS The current body of data available for ultra-short adjuvant RT regimens delivered in 5-days or less after BCS overwhelming support their utilization. While data for both exists, APBI regimens have, by far, greater numbers of patients and longer follow-up as compared to AWBI. Also, given increased rates of recurrence seen with IORT with long-term follow-up, this should not be considered a standard approach at this time.
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Affiliation(s)
| | - James Broughman
- Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Ahmed Halima
- Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Zachary Mayo
- Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Elizabeth Obi
- Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Zahraa Al-Hilli
- Department of General Surgery, Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Douglas Arthur
- Department of Radiation Oncology, Virginia Commonwealth University, Richmond, VA, USA
| | - David Wazer
- Department of Radiation Oncology, Virginia Commonwealth University, Richmond, VA, USA
| | - Chirag Shah
- Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA.
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13
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Lasala R, Santoleri F. Association between adherence to oral therapies in cancer patients and clinical outcome: A systematic review of the literature. Br J Clin Pharmacol 2021; 88:1999-2018. [PMID: 34784654 DOI: 10.1111/bcp.15147] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 11/02/2021] [Accepted: 11/03/2021] [Indexed: 01/23/2023] Open
Abstract
AIMS Adherence to therapy is a key factor in successful treatment. The aim of this systematic review is to assess the extent to which patients with better adherence to oral therapy have better clinical outcomes among cancer patients. METHODS All studies published in PubMed up to 20 October 2020, which considered the use of oral anticancer drugs for cancer patients and which correlated treatment adherence with a clinical outcome, were considered. RESULTS From the 42 studies considered in the systematic review, 14 were for oncological indications and 28 for haematological indications. There was considerable variance in calculation methods, outcomes considered, and in the definitions of adherence. However, it emerged that most studies reported a significant correlation between adherence to therapy and clinical outcome. CONCLUSION As adherence to therapy is a key factor in achieving a better clinical outcome, future studies with large samples, robust endpoints and the use of at least two methods of assessing adherence would be desirable in order to produce more robust evidence.
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14
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Okuyama A, Boku N, Higashi T. Real-world emetic risk of chemotherapy and the corresponding antiemetic therapy in Japan: A study based on a nationwide database. Cancer Rep (Hoboken) 2021; 5:e1482. [PMID: 34176233 PMCID: PMC8955058 DOI: 10.1002/cnr2.1482] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 06/01/2021] [Accepted: 06/04/2021] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Chemotherapy-induced nausea and vomiting (CINV) is a major concern of patients with cancer, leading to suboptimal treatment. AIM This study assessed the emetic risk associated with intravenous and oral chemotherapy and the prophylactic antiemetic drugs by cancer type in a real-world setting. METHODS AND RESULTS We used the health services utilisation data for patients with cancer diagnosed in 2016. Patients aged at least 20 years at the time of diagnosis and who started their first course of chemotherapy were included. The emetic risk of chemotherapy was determined according to the cancer type and was classified based on clinical practice guidelines. The prescription of antiemetic drugs was assessed. Overall, 172 133 patients were evaluated, of whom 121 103 (70.4%) received intravenous chemotherapy. High-emetic-risk chemotherapy (HEC) was prescribed in 46 458 (27.0%) patients. HEC was prescribed most for patients with oesophageal cancer (80.3%), followed by malignant lymphoma (60.2%) and breast cancer (53.8%). Moderate-emetic-risk chemotherapy (MEC) was prescribed in 60 528 (35.2%) patients and was mostly prescribed for small cell lung cancer (59.9%). Meanwhile, more than 50% of the chemotherapy prescribed for patients with gastric, colorectal, and pancreatic cancer was low-emetic-risk chemotherapy. HEC was accompanied by three-drug antiemetic prophylaxis in more than 90% of patients with small cell lung, non-small cell lung, breast, and oesophageal cancer, whereas only 13.5% of patients with malignant lymphoma were administered CHOP (cyclophosphamide, doxorubicin, vincristine sulphate, and prednisolone) with prophylaxis. CONCLUSION The risk of CINV differs with cancer type. HEC was less prescribed compared with MEC. Most patients received the recommended anti-emetic prophylaxis.
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Affiliation(s)
- Ayako Okuyama
- Center for Cancer Control and Information ServicesNational Cancer CenterChuo‐kuJapan
| | - Narikazu Boku
- Division of Gastrointestinal Medical OncologyNational Cancer Center HospitalChuo‐kuJapan
| | - Takahiro Higashi
- Center for Cancer Control and Information ServicesNational Cancer CenterChuo‐kuJapan
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15
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Ward MC, Vicini F, Al-Hilli Z, Chadha M, Abraham A, Recht A, Hayman J, Thaker N, Khan AJ, Keisch M, Shah C. Cost-Effectiveness Analysis of No Adjuvant Therapy Versus Partial Breast Irradiation Alone Versus Combined Treatment for Treatment of Low-Risk DCIS: A Microsimulation. JCO Oncol Pract 2021; 17:e1055-e1074. [PMID: 33970684 DOI: 10.1200/op.20.00992] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Adjuvant therapy in patients with ductal carcinoma in situ who undergo partial mastectomy remains controversial, particularly for low-risk patients (60 years or older, estrogen-positive, tumor extent < 2.5 cm, grade 1 or 2, and margins ≥ 3 mm). We performed a cost-effectiveness analysis comparing three strategies: no adjuvant treatment after surgery, a five-fraction course of accelerated partial breast irradiation using intensity-modulated radiation therapy (accelerated partial breast irradiation [APBI]-alone), or APBI plus an aromatase inhibitor for 5 years. MATERIALS AND METHODS Outcomes including local recurrence, distant metastases, and survival as well as toxicity data were modeled by a patient-level Markov microsimulation model, which were validated against trial data. Costs of treatment and possible adverse events were included from the societal perspective over a lifetime horizon, adjusted to 2019 US dollars and extracted from Medicare reimbursement data. Quality-adjusted life-years (QALYs) were calculated based on utilities extracted from the literature. RESULTS No adjuvant therapy was the least costly approach ($5,744), followed by APBI-alone ($11,070); combined therapy was costliest ($16,052). Adjuvant therapy resulted in slightly higher QALYs (no adjuvant, 11.320; APBI-alone, 11.343; and combination, 11.381). In the base case, no treatment was the cost-effective strategy, with an incremental cost-effectiveness ratio of $239,109/QALY for APBI-alone and $171,718/QALY for combined therapy. The incremental cost-effectiveness ratio for combined therapy compared with APBI-alone was $131,949. Probabilistic sensitivity analyses found that no therapy was cost effective (defined as $100,000/QALY of lower) in 63% of trials, APBI-alone in 19%, and the combination in 18%. CONCLUSION No adjuvant therapy represents the most cost-effective approach for postmenopausal women 60 years or older who receive partial mastectomy for low-risk ductal carcinoma in situ.
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Affiliation(s)
- Matthew C Ward
- Levine Cancer Institute, Atrium Health, Charlotte, NC.,Southeast Radiation Oncology Group, Charlotte, NC
| | | | - Zahraa Al-Hilli
- Department of Breast Surgery, Cleveland Clinic, Cleveland, OH
| | | | - Abel Abraham
- Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | - Abram Recht
- Beth Israel Deaconess Medical Center, Boston, MA
| | | | | | - Atif J Khan
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Chirag Shah
- Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
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16
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Lu H, Lei X, Zhao H, Elting L, Siricilla M, Ursani MA, Giordano SH, Suarez-Almazor M. Bone Mineral Density at the Time of Initiating Aromatase Inhibitor Therapy Is Associated With Decreased Fractures in Women With Breast Cancer. J Bone Miner Res 2021; 36:861-871. [PMID: 33484602 DOI: 10.1002/jbmr.4250] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 11/05/2020] [Accepted: 12/06/2020] [Indexed: 12/31/2022]
Abstract
Women with estrogen receptor-positive breast cancer who receive an aromatase inhibitor (AI) are at risk for fractures. We aim to determine if dual-energy X-ray absorptiometry (DXA) scans made at the time of AI initiation are associated with decreased fractures. We retrospectively identified 25,158 women with local or regional breast cancer diagnosed between 2005 and 2013 who received AI therapy between 2007 and 2013 from the Medicare-linked Surveillance, Epidemiology, and End Results Program and Texas Cancer Registry databases. We defined baseline DXA screening using claims made between 1 year before and 6 months after each patient's first AI claim to examine determinants of baseline screening using a multivariable GENMOD model. We included a propensity score adjustment in Cox proportional hazard models to assess the association between time-varying DXA screening and the risk of fractures. Additionally, we compared the use of antiresorptive therapy drugs between the two groups. Of the study cohort, 14,738 (58.6%) received DXA screening. The screening rates increased annually from 52.1% in 2007 to 61.7% in 2013. Higher screening rates were observed in patients with younger age, married status, non-Hispanic white race, localized disease, fewer comorbidities, more than one type of aromatase inhibitor drug claim, no state buy-in (surrogate for low socioeconomic status), higher education level, and prior osteoporosis diagnosis. Baseline DXA screening was associated with decreased risk of subsequent fractures (hazard ratio = 0.91; 95% confidence interval, 0.86-0.97, p < .001) after multivariable and propensity score adjustment. Bone-modifying drugs were prescribed to 4440 (30.1%) patients with screening compared with 1766 (16.9%) without (p < .001). Of the 4440 patients who received treatment, 95% received bisphosphonates. Our study demonstrated baseline DXA screening was associated with a decreased risk of fractures and a higher likelihood of receiving antiresorptive therapies. Improvement of the baseline DXA screening is still needed in practice. © 2021 American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Huifang Lu
- Department of General Internal Medicine, Section of Rheumatology and Clinical Immunology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Xiudong Lei
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Hui Zhao
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Linda Elting
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mamatha Siricilla
- Department of General Internal Medicine, Section of Rheumatology and Clinical Immunology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mohammad Ali Ursani
- Department of General Internal Medicine, Section of Rheumatology and Clinical Immunology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sharon H Giordano
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Maria Suarez-Almazor
- Department of General Internal Medicine, Section of Rheumatology and Clinical Immunology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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17
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Sadigh G, Gray RJ, Sparano JA, Yanez B, Garcia SF, Timsina LR, Sledge GW, Cella D, Wagner LI, Carlos RC. Breast cancer patients' insurance status and residence zip code correlate with early discontinuation of endocrine therapy: An analysis of the ECOG-ACRIN TAILORx trial. Cancer 2021; 127:2545-2552. [PMID: 33793979 DOI: 10.1002/cncr.33527] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 01/25/2021] [Accepted: 02/02/2021] [Indexed: 01/13/2023]
Abstract
BACKGROUND Early discontinuation is a substantial barrier to the delivery of endocrine therapies (ETs) and may influence recurrence and survival. The authors investigated the association between early discontinuation of ET and social determinants of health, including insurance coverage and the neighborhood deprivation index (NDI), which was measured on the basis of patients' zip codes, in breast cancer. METHODS In this retrospective analysis of a prospective randomized clinical trial (Trial Assigning Individualized Options for Treatment), women with hormone receptor-positive, human epidermal growth factor receptor 2-negative breast cancer who started ET within a year of study entry were included. Early discontinuation was calculated as stopping ET within 4 years of its start for reasons other than distant recurrence or death via Kaplan-Meier estimates. A Cox proportional hazards joint model was used to analyze the association between early discontinuation of ET and factors such as the study-entry insurance and NDI, with adjustments made for other variables. RESULTS Of the included 9475 women (mean age, 55.6 years; White race, 84%), 58.0% had private insurance, whereas 11.7% had Medicare, 5.8% had Medicaid, 3.8% were self-pay, and 19.1% were treated at international sites. The early discontinuation rate was 12.3%. Compared with those with private insurance, patients with Medicaid (hazard ratio [HR], 1.53; 95% confidence interval [CI], 1.23-1.92) and self-pay patients (HR, 1.65; 95% CI, 1.25-2.17) had higher early discontinuation. Participants with a first-quartile NDI (highest deprivation) had a higher probability of discontinuation than those with a fourth-quartile NDI (lowest deprivation; HR, 1.34; 95% CI, 1.11-1.62). CONCLUSIONS Patients' insurance and zip code at study entry play roles in adherence to ET, with uninsured and underinsured patients having a high rate of treatment nonadherence. Early identification of patients at risk may improve adherence to therapy. LAY SUMMARY In this retrospective analysis of 9475 women with breast cancer participating in a clinical trial (Trial Assigning Individualized Options for Treatment), Medicaid and self-pay patients (compared with those with private insurance) and those in the highest quartile of neighborhood deprivation scores (compared with those in the lowest quartile) had a higher probability of early discontinuation of endocrine therapy. These social determinants of health assume larger importance with the expected increase in unemployment rates and loss of insurance coverage in the aftermath of the coronavirus disease 2019 pandemic. Early identification of patients at risk and enrollment in insurance optimization programs may improve the persistence of therapy.
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Affiliation(s)
| | - Robert J Gray
- ECOG-ACRIN Biostatistics Center, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Joseph A Sparano
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | | | | | - Lava R Timsina
- Indiana University School of Medicine, Indianapolis, Indiana
| | | | | | - Lynne I Wagner
- Wake Forest University Health Sciences, Winston-Salem, North Carolina
| | - Ruth C Carlos
- University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan
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18
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Shah C, Smith BD, Royce TJ. Balancing Treatment Deintensification Strategies in Early Stage Breast Cancer. Int J Radiat Oncol Biol Phys 2021; 107:959-963. [PMID: 32698978 DOI: 10.1016/j.ijrobp.2020.04.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 04/17/2020] [Accepted: 04/22/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Chirag Shah
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio.
| | - Benjamin D Smith
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Trevor J Royce
- Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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19
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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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20
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Impact of patients' refusal to undergo adjuvant treatment measures on survival. Breast Cancer Res Treat 2020; 185:239-246. [PMID: 32970241 DOI: 10.1007/s10549-020-05939-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 09/12/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE Breast cancer patients receive treatment recommendations from multidisciplinary tumour boards. To determine the consequences of patients' refusal of such recommendations, we analysed the database of the Centre for Breast Cancer at the Ortenau Clinic in Offenburg, Germany. METHODS A total of 4315 patients with non-metastatic primary breast cancer, treated between 1997 and 2019, were analysed with descriptive analyses, Kaplan-Meier survival analyses, and Cox regression analyses regarding the effects of their refusal. RESULTS About 10.7% of the patients rejected the treatment advice. These were significantly elderly (F = 74.4; p < 0.001; one-way ANOVA), with greater tumour size (F = 36.7; p < 0.001; one-way ANOVA), a higher number of affected lymph nodes (F = 4.2; p = .039; one-way ANOVA), and more poorly differentiated tumours (χ2 = 16.8; df = 2; p < 0.001). The refusal of adjuvant treatment resulted in higher rates of local recurrences (χ2radiotherapy = 109.1; df = 1; p < 0.001, χ2chemotherapy = 18.3; df = 1; p < 0.001, χ2endocrine = 32.5; df = 1; p < 0.001) and poorer overall survival (χ2radiotherapy = 184.9; df = 6; p < 0.001; χ2chemotherapy = 191.8; df = 6; p < 0.001). CONCLUSIONS All parts of the adjuvant treatment of breast cancer are clearly associated with improvements regarding disease-free and overall survival. To answer open questions about the background of patients' refusal, an analysis of prospective data collections seems necessary. In addition, patient communication should be improved so that patients understand the background of the multidisciplinary tumour board and the potential consequences of their refusal.
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21
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Love RR, Baum M, Love SM, Straus AM. Clinical practice to address tamoxifen nonadherence. Breast Cancer Res Treat 2020; 184:675-682. [PMID: 32926316 DOI: 10.1007/s10549-020-05912-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 09/01/2020] [Indexed: 10/23/2022]
Abstract
The primary and secondary benefits of tamoxifen as adjuvant therapy in women with hormone-receptor-positive breast cancer are substantial: a 1% decrease in the risk of death each year for 10 years with each additional year of treatment during the first 5 years. Considerable data, however, indicate that these benefits are lost to many patients because of treatment nonadherence. Nonadherence is examined within the framework of the Common-Sense Model of Self-Regulation to describe patients' models of disease and treatment that organize their thinking and behavior, and the crucial role of the practitioner in addressing and altering these models. Common patient education and social communications about patients' hormone-receptor-positive breast cancer and tamoxifen treatment promote an acute disease paradigm in which cancer occurs within specific locations and is either present or absent. We recommend that clinicians communicate the concepts of hormone-receptor-positive breast cancer as follows: i. a non-dichotomous systemic disorder entailing a treatment goal of homeostasis and disease quiescence and ii. a disorder undetectable by currently available tests in subclinical states. Equally important, the clinician can provide a comprehensive picture of the well-documented secondary effects of tamoxifen, noting in particular the beneficial effects. Specific action plans, grounded in individual patient understanding, can be developed and reinforced, in an ongoing process that validates and integrates patient values and goals as they change over time.
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Affiliation(s)
- Richard R Love
- Department of Computer Science, Marquette University, Milwaukee, WI, USA.
| | | | - Susan M Love
- Dr. Susan Love Research Foundation, Encino, CA, USA
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22
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Jackisch C, Kreienberg R, Blettner M, Harbeck N, Lück HJ, Haidinger R, Schmitt DC, Schulte H, Windemuth-Kieselbach C, Zaun S, Hadji P. Assessment of Quality of Life in Postmenopausal Women with Early Breast Cancer Participating in the PACT Trial: The Impact of Additional Patient Information Material Packages and Patient Compliance. Breast Care (Basel) 2020; 15:236-245. [PMID: 32774217 DOI: 10.1159/000500771] [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: 06/20/2018] [Accepted: 05/01/2019] [Indexed: 02/04/2023] Open
Abstract
Background Breast cancer patients' self-understanding of their disease can impact their quality of life (QoL); the relationship between compliance and QoL is poorly understood. Patients and Methods The Patient's Anastrozole Compliance to Therapy (PACT) program, a prospective, randomized study, investigated the effect of additional patient information material (IM) packages on compliance with adjuvant aromatase inhibitor (AI) therapy in postmenopausal women with hormone receptor-positive early breast cancer. The QoL subanalysis presented here examined the impact of IM packages on QoL and the association between QoL and compliance. European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 and QLQ-BR23 questionnaires were completed at baseline, 12 and 24 months, or study termination to assess health-related QoL and disease-related symptoms. Results Of the 4,844 patients randomized to standard therapy or standard therapy + IM packages (1:1), 4,253 were available for QoL analysis. No difference in QoL was observed between groups at baseline. IM packages did not have a statistically significant impact on patient QoL at the 12- or 24-month follow-up. Compliant patients experienced improvement in multiple items across the QLQ-C30 and QLQ-BR23 scales at 12 months. However, those results should be interpreted carefully due to limitations in the statistical analyses. Conclusions Provision of IM packages did not influence patients' QoL or satisfaction with care during AI therapy. Compliant patients appear to experience improved QoL compared to noncompliant patients, perhaps indicating a more self-empowered perception of their condition.
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Affiliation(s)
| | | | - Maria Blettner
- Institute for Medical Biostatistics, Epidemiology and Informatics, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Nadia Harbeck
- Breast Center, University of Munich (LMU), Munich, Germany
| | | | | | | | | | | | | | - Peyman Hadji
- Frankfurt Center of Bone Health, Frankfurt, Germany
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23
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Shinn EH, Broderick G, Fellman B, Johnson A, Wieland E, Moulder S, Symmans WF. Simulating Time-Dependent Patterns of Nonadherence by Patients With Breast Cancer to Adjuvant Oral Endocrine Therapy. JCO Clin Cancer Inform 2020; 3:1-9. [PMID: 31002563 PMCID: PMC6873985 DOI: 10.1200/cci.18.00091] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Nearly 40% of patients with breast cancer discontinue their adjuvant oral endocrine treatment (ET). We measured discontinuation rates of ET at a comprehensive cancer center. We then used an iterative approach to model patterns of determinants associated with discontinuation of ET. METHODS Patients with nonmetastatic breast cancer receiving active adjuvant ET were approached by nurse practitioners to complete an anonymous survey at one time point. We simulated a prospective model by iteratively regressing adverse effects onto adherence status across windowed time periods of 2 to 3 consecutive years, bootstrapping the smaller group of nonadherent patients and subsampling the larger adherent group. RESULTS From February to April 2013, 216 participants were enrolled in the study. Forty patients (18.5%) reported that they had discontinued ET during the first 5 years of ET, and an additional four patients (1.9%) missed > 20% of their doses. Using two-sided significance tests, simulations showed that all 13 ET adverse effects and reasons for discontinuation were significantly related to discontinuation at some time point during ET. Worry about ET cost (odds ratio [OR], 1.79), emotional distress (OR, 1.72), and bone and joint pain (OR, 1.69) were the three most impactful reasons for discontinuation, with varying patterns of influence over time. CONCLUSION These analyses provide preliminary evidence that there are varying patterns of discontinuation of ET. Although some reasons for discontinuation exerted a steady influence over the 6-year ET trajectory (ie, bone and joint pain), other reasons, such as cost, cognitive complaints, and general dislike of pills, became more important in the later years of ET.
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Affiliation(s)
- Eileen H Shinn
- University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Bryan Fellman
- University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | - Stacy Moulder
- University of Texas MD Anderson Cancer Center, Houston, TX
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24
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Cost-effectiveness analysis of endocrine therapy alone versus partial-breast irradiation alone versus combined treatment for low-risk hormone-positive early-stage breast cancer in women aged 70 years or older. Breast Cancer Res Treat 2020; 182:355-365. [PMID: 32468336 DOI: 10.1007/s10549-020-05706-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 05/21/2020] [Indexed: 12/13/2022]
Abstract
PURPOSE We performed a cost-effectiveness analysis of three strategies for the adjuvant treatment of early breast cancer in women age 70 years or older: an aromatase inhibitor (AI-alone) for 5 years, a 5-fraction course of accelerated partial-breast irradiation using intensity-modulated radiation therapy (APBI-alone), or their combination. METHODS We constructed a patient-level Markov microsimulation from the societal perspective. Effectiveness data (local recurrence, distant metastases, survival), and toxicity data were obtained from randomized trials when possible. Costs of side effects were included. Costs were adjusted to 2019 US dollars and extracted from Medicare reimbursement data. Quality-adjusted life-years (QALY) were calculated using utilities extracted from the literature. RESULTS The strategy of AI-alone ($12,637) was cheaper than both APBI-alone ($13,799) and combination therapy ($18,012) in the base case. All approaches resulted in similar QALY outcomes (AI-alone 7.775; APBI-alone 7.768; combination 7.807). In the base case, AI-alone was the cost-effective strategy and dominated APBI-alone, while combined therapy was not cost-effective when compared to AI-alone ($171,451/QALY) or APBI-alone ($107,932/QALY). In probabilistic sensitivity analyses, AI-alone was cost-effective at $100,000/QALY in 50% of trials, APBI-alone in 28% and the combination in 22%. Scenario analysis demonstrated that APBI-alone was more effective than AI-alone when AI compliance was lower than 26% at 5 years. CONCLUSIONS Based on a Markov microsimulation analysis, both AI-alone and APBI-alone are appropriate options for patients 70 years or older with early breast cancer with small cost differences noted. A prospective trial comparing the approaches is warranted.
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25
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Bergqvist J, Lundström S, Wengström Y. Patient interactive digital support for women with adjuvant endocrine therapy in order to increase compliance and quality of life. Support Care Cancer 2020; 29:491-497. [PMID: 32405965 PMCID: PMC7686217 DOI: 10.1007/s00520-020-05476-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 04/15/2020] [Indexed: 01/09/2023]
Abstract
PURPOSE The primary aim of the study was to develop and investigate a patient interactive digital support (an app) for patients on adjuvant endocrine breast cancer treatment. Patient's interactive digital applications are a fast-growing area for research and development. In general, patients want more information and support with regard to their diagnosis, treatment and self-care. At the same time, the health care system has limited resources for follow-up. Our primary endpoints were usability of the app and if it added any value to the patients. METHODS We designed and constructed a prototype, in dialogue with patients, containing four main modules for registration of drug compliance, performed physical exercise, self-care activities, and questions on health and quality of life. The app was then tested by patients and improved further before we completed a pilot study in which 15 patients used the app for 3 months. RESULTS Patients perceived the app easy to use with a very high median system usability score of 88.8, range 30-100. The 15 women registered in total 4251 times, range 118 to 372. The majority of registrations concerned compliance (adherence to treatment) and physical exercise. CONCLUSION The app was perceived easy to use and of support in every-day life of breast cancer survivors. How to best integrate electronically collected patient reported outcome measures in clinical routine needs to be further studied, and future research will show if it will be cost-effective in terms of better health outcome and less resource use.
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Affiliation(s)
- Jenny Bergqvist
- Breast Centre, Department of Surgery, Capio St Görans Hospital, Stockholm, Sweden. .,Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden.
| | - Staffan Lundström
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden.,Palliative Care Services and R&D Department, Stockholms Sjukhem Foundation, Stockholm, Sweden
| | - Yvonne Wengström
- Neurobiology Care Science and Society, Nursing, Karolinska Institutet, Stockholm, Sweden.,Cancer Theme, Breast Centre, Karolinska University Hospital, Stockholm, Sweden
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26
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Paladino AJ, Anderson JN, Krukowski RA, Waters T, Kocak M, Graff C, Blue R, Jones TN, Buzaglo J, Vidal G, Schwartzberg L, Graetz I. THRIVE study protocol: a randomized controlled trial evaluating a web-based app and tailored messages to improve adherence to adjuvant endocrine therapy among women with breast cancer. BMC Health Serv Res 2019; 19:977. [PMID: 31856812 PMCID: PMC6924011 DOI: 10.1186/s12913-019-4588-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 10/09/2019] [Indexed: 11/10/2022] Open
Abstract
Background Long-term use of adjuvant endocrine therapy (AET) among women with early-stage, hormone receptor-positive breast cancer significantly reduces the risk of hospitalizations, cancer recurrence, and mortality. AET is associated with adverse symptoms that often result in poor adherence. A web-enabled app offers a novel way to communicate and manage symptoms for women on AET. In a region with significant racial disparities in breast cancer outcomes, our study tests the impact of a web-enabled app that collects and transmits patient-reported symptoms to healthcare teams to facilitate timely and responsive symptom management on medication adherence. Methods In this randomized controlled trial, we randomize 300 patients initiating AET to one of three arms: 1) an “App” group (n = 100) that receives weekly reminders to use the THRIVE study app; 2) an “App+Feedback” group (n = 100) that receives weekly reminders and tailored feedback based on their use of the app; or 3) a “Usual Care” group (n = 100) that receives usual care only. Participants are stratified by race: 50% White and 50% Black. The duration of the intervention is six months following enrollment, and outcomes are assessed at 12-months. The primary outcome is adherence, which is captured using an electronic monitoring pillbox. Secondary outcomes include symptom burden, quality of life, self-efficacy for managing symptoms, and healthcare costs. We also evaluate the impact of the intervention on racial disparities in adherence. Data are derived from three sources: electronic health record data to capture treatment changes, healthcare utilization, and health outcomes; self-report survey data related to adherence, symptom burden, and quality of life; and an electronic medication monitoring device that captures adherence. Discussion A successful web-enabled intervention could be disseminated across systems, conditions, and populations. By evaluating the impact of this intervention on a comprehensive set of measures, including AET adherence, patient outcomes, and costs, our study will provide valuable and actionable results for providers, policy makers, and insurers who strive to achieve the “Triple Aim” – reduce costs while improving health outcomes and the patient care experience. Trial registration NCT03592771. Prospectively registered on July 19, 2018.
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Affiliation(s)
- Andrew J Paladino
- Department of Health Policy and Management, Emory University, Rollins School of Public Health, 1518 Clifton Road, Atlanta, GA, USA.,The West Cancer Center & Research Institute, Memphis, TN, USA
| | - Janeane N Anderson
- College of Nursing, The University of Tennessee Health Science Center, 920 Madison Avenue, Memphis, TN, USA
| | - Rebecca A Krukowski
- Department of Preventive Medicine, The University of Tennessee Health Science Center, College of Medicine, 66 N Pauline St, Memphis, TN, USA
| | - Teresa Waters
- Department of Health Management and Policy, The University of Kentucky, College of Public Health, Lexington, KY, USA
| | - Mehmet Kocak
- Department of Preventive Medicine, The University of Tennessee Health Science Center, College of Medicine, 66 N Pauline St, Memphis, TN, USA
| | - Carolyn Graff
- College of Nursing, The University of Tennessee Health Science Center, 920 Madison Avenue, Memphis, TN, USA
| | - Ryan Blue
- College of Nursing, The University of Tennessee Health Science Center, 920 Madison Avenue, Memphis, TN, USA
| | - Tameka N Jones
- The West Cancer Center & Research Institute, Memphis, TN, USA
| | - Joanne Buzaglo
- Department of Patient Reported Outcomes, Vector Oncology, Memphis, TN, USA
| | - Gregory Vidal
- The West Cancer Center & Research Institute, Memphis, TN, USA
| | | | - Ilana Graetz
- Department of Health Policy and Management, Emory University, Rollins School of Public Health, 1518 Clifton Road, Atlanta, GA, USA. .,Department of Preventive Medicine, The University of Tennessee Health Science Center, College of Medicine, 66 N Pauline St, Memphis, TN, USA.
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27
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Wassermann J, Gelber SI, Rosenberg SM, Ruddy KJ, Tamimi RM, Schapira L, Borges VF, Come SE, Meyer ME, Partridge AH. Nonadherent behaviors among young women on adjuvant endocrine therapy for breast cancer. Cancer 2019; 125:3266-3274. [PMID: 31120571 DOI: 10.1002/cncr.32192] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 03/07/2019] [Accepted: 03/07/2019] [Indexed: 11/08/2022]
Abstract
BACKGROUND Young age is a known factor associated with suboptimal adherence to endocrine therapy (ET) for adjuvant breast cancer (BC) treatment. This study was aimed at assessing nonadherent behaviors and associated factors among young women with early-stage hormone receptor-positive BC. METHODS As part of a multicenter, prospective cohort of women with a diagnosis of BC at or under the age of 40 years, participants were surveyed 30 months after their diagnosis about adherent behaviors. Among those who reported taking ET, adherence was measured with a 3-item Likert-type scale: Do you ever forget to take your ET? If you feel worse when you take your ET, do you stop taking it? Did you take your ET exactly as directed by your doctor over the last 3 months? Women reporting at least 1 nonadherent behavior were classified as nonadherers. Variables with a P value <.20 were included in a multivariable logistic model. RESULTS Among 384 women, 194 (51%) were classified as nonadherers. Univariate factors that retained significance in the multivariable model included educational level (odds ratio [OR], 0.50 for high vs low; P = .04), level of social support according to the Medical Outcome Study Social Support Survey (OR, 0.98 per 1 point; P = .01), and confidence with the decision regarding ET measured on a 0 to 10 numerical scale (OR, 0.63 for high vs low; P = .04). CONCLUSIONS Findings from this study could help to identify young patients at higher risk for nonadherence. Interventions adapted to the level of education and aimed at reinforcing support and patients' confidence in their decision to take ET could improve adherence and associated outcomes in this population.
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Affiliation(s)
- Johanna Wassermann
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.,Pierre Louis Institute of Epidemiology and Public Health, Sorbonne University, French National Institute of Health and Medical Research, Paris, France
| | - Shari I Gelber
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Shoshana M Rosenberg
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | | | - Rulla M Tamimi
- Department of Medicine, Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Lidia Schapira
- Department of Medicine, Stanford Cancer Institute, Palo Alto, California
| | - Virginia F Borges
- Division of Medical Oncology, Department of Medicine, University of Colorado Cancer Center, Aurora, Colorado
| | - Steven E Come
- Division of Medical Oncology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Meghan E Meyer
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Ann H Partridge
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
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28
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Yavari K, Kooshesh L. Deuterium Depleted Water Inhibits the Proliferation of Human MCF7 Breast Cancer Cell Lines by Inducing Cell Cycle Arrest. Nutr Cancer 2019; 71:1019-1029. [PMID: 31045450 DOI: 10.1080/01635581.2019.1595048] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Recent studies have shown that the depletion of naturally occurring deuterium can result in tumor regression. The aim of the present study was to show the growth inhibitory effects of DDW discretely and in combination with 5-FU on MCF-7 breast cancer cells and to determine possible mechanisms underlying these changes. MCF7 cells were grown in RPMI medium with decreasing deuterium concentrations of DDW individually, 5-FU alone and both for 24, 48, and 72 h. Cell viability was determined with the MTT assay. The cell cycle and antioxidant enzymes status were measured using flow cytometry and quantitative luminescence methods, respectively. Our results showed that treatment with DDW especially in 30-100 ppm concentrations imposed the highest cell growth inhibitory effect. The cell cycle analysis revealed that DDW caused the cell cycle arrest in the G1/S transition, reduced the number of the cells in the S phase and significantly increased the population of cells in the G1 phase in MCF-7 cells. The activities of superoxide dismutase (SOD) and catalase (CAT) enzymes also increased in the same low concentrations of DDW. In conclusion, DDW can open new strategic approach in breast cancer therapy. Highlights DDW cause lethality in cancer cells. DDW augmented 5-FU inhibitory effects on breast cancer cell lines. Cell inhibitory results lead to the discovery of synergic effects of DDW-drug combinations Synergistic anti cancer effects of DDW with 5-FU is enhanced by decreasing deuterium content of the DDW. DDW exerts effects on the cell cycle, changes in cell configuration and induces antioxidant enzymes in vitro. DDW can be considered as an adjuvant to conventional anticancer agents in future trials.
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Affiliation(s)
- Kamal Yavari
- a Nuclear Science and Technology Research Institute , Tehran , Iran
| | - Lida Kooshesh
- b Department of Biology, Tehran North Branch , Islamic Azad University , Tehran , Iran
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29
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Han Y, Ding B, Zhao Z, Zhang H, Sun B, Zhao Y, Jiang L, Zhou J, Ding Y. Immune lipoprotein nanostructures inspired relay drug delivery for amplifying antitumor efficiency. Biomaterials 2018; 185:205-218. [PMID: 30245388 DOI: 10.1016/j.biomaterials.2018.09.016] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 09/04/2018] [Accepted: 09/10/2018] [Indexed: 12/30/2022]
Abstract
Chemo-immunotherapy represents an appealing approach to improving cancer treatment. Simultaneously administrating chemotherapeutics with immunoadjuvants can elicit potent tumor death and immune responses. Herein, high density lipoprotein (HDL) inspired immune lipoprotein was proposed for relay drug delivery and amplifying antitumor therapy. Lipophilic AS1411 aptamer-immunoadjuvant CpG fused sequences (Apt-CpG-DSPE) were conjugated to facilitate decoration onto HDLs; and doxorubicin (Dox) was successively intercalated into the consecutive base pairs of Apt-CpG to complete immune HDL nanodrug imHDL/Apt-CpG-Dox. For relay drug delivery, imHDL/Apt-CpG-Dox underwent site-specific structure collapse in tumor intercellular substances inspired from HDL biofunctions (sequential module I); subsequently, dissociated Apt-CpG-Dox was endocytosed into tumor cells mediated by the recognition of AS1411 and nucleolin (sequential module II), translocating Dox to nucleus and enabling tumor ablation and antigens release. The liberated CpG motif further evoked antigen recognition, induced vast secretion of pro-inflammatory cytokines and potentiated host antitumor immunity. Our studies demonstrated that HDL biomimetic platform based relay drug delivery strategy outperformed the monotherapy counterparts in malignant tumor models, eventually generating an augmented antitumor efficacy.
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Affiliation(s)
- Yue Han
- State Key Laboratory of Natural Medicines, Department of Pharmaceutics, China Pharmaceutical University, 24 Tongjiaxiang, Nanjing, 210009, China
| | - Bixi Ding
- State Key Laboratory of Natural Medicines, Department of Pharmaceutics, China Pharmaceutical University, 24 Tongjiaxiang, Nanjing, 210009, China
| | - Ziqiang Zhao
- State Key Laboratory of Natural Medicines, Department of Pharmaceutics, China Pharmaceutical University, 24 Tongjiaxiang, Nanjing, 210009, China
| | - Huaqing Zhang
- State Key Laboratory of Natural Medicines, Department of Pharmaceutics, China Pharmaceutical University, 24 Tongjiaxiang, Nanjing, 210009, China
| | - Bo Sun
- Department of Radiation Oncology, Lineberger Comprehensive Cancer Center, Carolina Center for Cancer Nanotechnology Excellence, Carolina Institute of Nanomedicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Yuanpei Zhao
- State Key Laboratory of Natural Medicines, Department of Pharmaceutics, China Pharmaceutical University, 24 Tongjiaxiang, Nanjing, 210009, China
| | - Lei Jiang
- State Key Laboratory of Natural Medicines, Department of Pharmaceutics, China Pharmaceutical University, 24 Tongjiaxiang, Nanjing, 210009, China
| | - Jianping Zhou
- State Key Laboratory of Natural Medicines, Department of Pharmaceutics, China Pharmaceutical University, 24 Tongjiaxiang, Nanjing, 210009, China.
| | - Yang Ding
- State Key Laboratory of Natural Medicines, Department of Pharmaceutics, China Pharmaceutical University, 24 Tongjiaxiang, Nanjing, 210009, China.
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30
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Evaluating Candidacy for Hypofractionated Radiation Therapy, Accelerated Partial Breast Irradiation, and Endocrine Therapy After Breast Conserving Surgery. Am J Clin Oncol 2018; 41:526-531. [DOI: 10.1097/coc.0000000000000332] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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31
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Balagamwala EH, Manyam BV, Leyrer CM, Karthik N, Smile T, Tendulkar RD, Cherian S, Radford D, Al-Hilli Z, Vicini F, Shah C. Most patients are eligible for an alternative to conventional whole breast irradiation for early-stage breast cancer: A National Cancer Database Analysis. Breast J 2018; 24:806-810. [DOI: 10.1111/tbj.13051] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Revised: 06/06/2017] [Accepted: 06/07/2017] [Indexed: 11/28/2022]
Affiliation(s)
| | - Bindu V. Manyam
- Department of Radiation Oncology; Cleveland Clinic; Cleveland OH USA
| | | | - Naveen Karthik
- Department of Radiation Oncology; Cleveland Clinic; Cleveland OH USA
| | - Timothy Smile
- Department of Radiation Oncology; Cleveland Clinic; Cleveland OH USA
| | | | - Sheen Cherian
- Department of Radiation Oncology; Cleveland Clinic; Cleveland OH USA
| | - Diane Radford
- Department of General Surgery; Cleveland Clinic; Cleveland OH USA
| | - Zahraa Al-Hilli
- Department of General Surgery; Cleveland Clinic; Cleveland OH USA
| | - Frank Vicini
- Michigan Healthcare Professionals; Farmington Hills MI USA
| | - Chirag Shah
- Department of Radiation Oncology; Cleveland Clinic; Cleveland OH USA
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32
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Blackmore T, Lawrenson R, Lao C, Edwards M, Kuper-Hommel M, Elwood M, Campbell I. The characteristics, management and outcomes of older women with breast cancer in New Zealand. Maturitas 2018; 112:64-70. [PMID: 29704919 DOI: 10.1016/j.maturitas.2018.03.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 03/26/2018] [Accepted: 03/30/2018] [Indexed: 01/18/2023]
Abstract
The aim of this study was to understand the characteristics of older women with breast cancer and to describe the current patterns of treatment and outcomes. The study included data from the combined Auckland and Waikato breast cancer registers, which hold information for 12, 372 women diagnosed with stage I-IV breast cancer between June 2000 and May 2013. Of these women, 2671 (21.6%) were over 70 years of age. Patient characteristics, treatment type and survival were compared across four-year age groups (70-74, 75-79, 80-84, 85+) and hormone receptor status. Of the women aged over 70 years, 2485 (93.0%) had stage I-III disease. Increasing age was significantly associated with decreasing use of surgery, adjuvant radiotherapy, endocrine therapy and chemotherapy, even after adjustment for stage and level of co-morbidity. Nine hundred and one women (33.7%) had co-morbidities at the time of diagnosis. The 5-year breast cancer-specific survival rate for women aged 70-74 and that for women aged 75-79 were similar, but was worse in women aged over 80. Generally, older women are treated as per guidelines, although chemotherapy may be under-used. However, age is a significant factor influencing whether women are treated or not.
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Affiliation(s)
- Tania Blackmore
- Medical Research Centre, University of Waikato, Hamilton, New Zealand.
| | - Ross Lawrenson
- Medical Research Centre, University of Waikato, Hamilton, New Zealand.
| | - Chunhuan Lao
- Medical Research Centre, University of Waikato, Hamilton, New Zealand.
| | - Melissa Edwards
- School of Medicine, University of Auckland, Auckland, New Zealand.
| | | | - Mark Elwood
- School of Population Health, University of Auckland, Auckland, New Zealand.
| | - Ian Campbell
- School of Medicine, University of Auckland, Auckland, New Zealand.
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Gao P, You L, Wu D, Shi A, Miao Q, Rana U, Martin DP, Du Y, Zhao G, Han B, Zheng C, Fan Z. Adherence to endocrine therapy among Chinese patients with breast cancer: current status and recommendations for improvement. Patient Prefer Adherence 2018; 12:887-897. [PMID: 29872274 PMCID: PMC5973402 DOI: 10.2147/ppa.s167004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Postoperative endocrine therapy is known to reduce recurrence and mortality in patients with estrogen receptor (ER)- or progestogen receptor (PR)-positive breast cancer. Correlates and determinants of compliance with endocrine therapy among Chinese patients with breast cancer are not known. The aim of this study was to elucidate the efficacy and adherence of endocrine therapy in China and suggest effective improvements on the adherence. PATIENTS AND METHODS We analyzed the survival of 1,110 patients eligible for endocrine therapy and adherence of 699 patients to endocrine therapy. Kaplan-Meier curves, log-rank tests and Cox proportional hazard models were used to evaluate survival, and logistic regression models were used to assess variables associated with treatment adherence. RESULTS Long-term endocrine therapy was associated with lower recurrence rate (HR 0.72; 95% CI 0.56-0.93; p=0.013). Adherence to endocrine therapy was only 63.1%. Sociodemographic characteristics of patients, clinical- and medication-related characteristics and patients' attitudes were associated with adherence to endocrine therapy. CONCLUSION Adherence to endocrine therapy in Chinese patients with ER+/PR+ breast cancer was <65%. Both patients and physicians should take progressive steps to improve the rate of adherence.
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Affiliation(s)
- Pin Gao
- Department of Breast Surgery, First Hospital of Jilin University, Changchun, Jilin, China
| | - Lili You
- Department of Endocrinology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Di Wu
- Department of Breast Surgery, First Hospital of Jilin University, Changchun, Jilin, China
| | - Aiping Shi
- Department of Breast Surgery, First Hospital of Jilin University, Changchun, Jilin, China
| | - Qing Miao
- Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Ujala Rana
- Division of Neonatology, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
| | | | - Ye Du
- Department of Breast Surgery, First Hospital of Jilin University, Changchun, Jilin, China
| | - Gang Zhao
- Department of Breast Surgery, First Hospital of Jilin University, Changchun, Jilin, China
| | - Bing Han
- Department of Breast Surgery, First Hospital of Jilin University, Changchun, Jilin, China
| | - Chao Zheng
- Department of Breast Surgery, Second Hospital of Shandong University, Jinan, Shandong, China
| | - Zhimin Fan
- Department of Breast Surgery, First Hospital of Jilin University, Changchun, Jilin, China
- Correspondence: Zhimin Fan, Department of Breast Surgery, First Hospital of Jilin University, 71 Xinmin Street, Changchun 130021, Jilin, China, Email
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Meisel J, Zhang C, Neely C, Mendoza P, You S, Han T, Liu Y, Sahin AA, O'Regan R, Li X. Evaluation of Prognosis in Hormone Receptor-Positive/HER2-Negative and Lymph Node-Negative Breast Cancer With Low Oncotype DX Recurrence Score. Clin Breast Cancer 2017; 18:347-352. [PMID: 29305309 DOI: 10.1016/j.clbc.2017.12.006] [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: 08/29/2017] [Revised: 11/13/2017] [Accepted: 12/07/2017] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Hormone receptor-positive/human epidermal growth factor receptor 2 (HER2)-negative breast cancers without lymph node metastasis have good prognosis. We compared the prognosis of hormone receptor-positive, HER2-negative, lymph node-negative cancers with Oncotype DX score ranges of 1 to 10 (1-10 group) and 11 to < 18 (11-18 group). PATIENTS AND METHODS A total of 107 cases in the 1-10 group and 225 cases in the 11-18 group were reviewed. All patients received surgery. The use of chemotherapy, radiotherapy, and endocrine therapy, and overall survival (OS), disease-free survival (DFS), and distant metastasis were compared between groups. RESULTS There were no statistical differences in the use of chemotherapy (5.05% vs. 6.05%, P = .724) or radiotherapy (52.53% vs. 59.07%, P = .276) between the 1-10 group and the 11-18 group, respectively. The median OS and DFS were 47 and 45 months, respectively, in the 1-10 group, and 49 and 48 months in the 11-18 group. No significant difference was seen in OS (P = .995), DFS (P = .148), or rates of metastasis (P = .998). The 11-18 group had more death events and distant metastasis (death, 5 events; recurrence, 2 events; metastasis, 2 events) than the 1-10 group (death, 0 events; recurrence, 4 events; metastasis, 0 events). The majority of recurrences seen in both groups were in young patients who failed to comply with their endocrine therapy regimen. CONCLUSION Patients in both the 1-10 group and the 11-18 group had good prognoses. Those who experienced recurrence were more likely to be premenopausal and to have failed to comply with the recommended endocrine therapy regimen. Endocrine therapy remains important in these patients.
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Affiliation(s)
- Jane Meisel
- Department of Hematology and Oncology, Emory University, Atlanta, GA
| | - Chao Zhang
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA
| | - Cameron Neely
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA
| | - Pia Mendoza
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA
| | - Shuo You
- Winship Institute, Emory University, Atlanta, GA
| | - Tatiana Han
- Winship Institute, Emory University, Atlanta, GA
| | - Yuan Liu
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA
| | - Aysegul A Sahin
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Ruth O'Regan
- Department of Medicine, University of Wisconsin, Madison, WI
| | - Xiaoxian Li
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA.
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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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Chronic pain and other symptoms among breast cancer survivors: prevalence, predictors, and effects on quality of life. Breast Cancer Res Treat 2017; 167:157-169. [DOI: 10.1007/s10549-017-4485-0] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 08/23/2017] [Indexed: 10/19/2022]
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Efficacy and safety of accelerated partial breast irradiation: a meta-analysis of published randomized studies. Oncotarget 2017; 8:59581-59591. [PMID: 28938661 PMCID: PMC5601757 DOI: 10.18632/oncotarget.19225] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 06/29/2017] [Indexed: 01/12/2023] Open
Abstract
Background and purpose Accelerated partial breast irradiation (APBI) technology has theoretical advantages in comparison with traditional adjuvant radiation therapy (whole-breast irradiation; WBI) after breast-conserving surgery. However, published randomized controlled trials have shown inconsistent outcomes. Therefore, a comprehensive assessment of the effectiveness and safety of APBI technology is needed. Results A total of 7 studies of 7452 patients were included in this analysis. All 7 studies reported local recurrence as an outcome. Meta-analysis of 5 trials that included 6486 patients showed significantly different 5-year local recurrence rates for APBI and WBI groups (hazard ratio = 4.54, 95% confidence interval: 1.78–11.61, p = 0.002). Further analysis showed that this difference may be related to the choice of treatment methods. Benefit was conferred to the APBI group for the outcome of non-breast cancer deaths. There was no significant difference between the two groups in terms of nodal recurrence, systemic recurrence, overall survival, or mortality rates. Toxicity side effects and cosmetic effects were similar in both groups, but intraoperative radiotherapy seemed to have a greater acute response. Material and methods Searches for relevant randomized controlled trials of APBI versus WBI were performed using the following sources: PubMed, EMBASE, Cochrane Library, Web of Science. Two independent observers evaluated the identified studies. The meta-analysis was conducted using RevMan 5.2 software. Conclusions Although the analysis showed that patients receiving APBI had a higher local recurrence rate, subgroup analyses suggested that this might be related to treatment options. Patients who receive accurate radiotherapy may have greater benefits. APBI is a promising treatment technology and more phase III clinical trials are expected based on new treatments.
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Mislang AR, Wildes TM, Kanesvaran R, Baldini C, Holmes HM, Nightingale G, Coolbrandt A, Biganzoli L. Adherence to oral cancer therapy in older adults: The International Society of Geriatric Oncology (SIOG) taskforce recommendations. Cancer Treat Rev 2017; 57:58-66. [PMID: 28550714 DOI: 10.1016/j.ctrv.2017.05.002] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Revised: 05/05/2017] [Accepted: 05/06/2017] [Indexed: 01/08/2023]
Abstract
There is an increasing trend towards using oral systemic therapy in patients with cancer. Compared to parenteral therapy, oral cancer agents offer convenience, have similar efficacy, and are preferred by patients, consequently making its use appealing in older adults. However, adherence is required to ensure its efficacy and to avoid compromising treatment outcomes, especially when the treatment goal is curative, or in case of symptomatic/rapidly progressing disease, where dose-intensity is important. This opens a new challenge for clinicians, as optimizing patient adherence is challenging, particularly due to lack of consensus and scarcity of available clinical evidence. This manuscript aims to review the impact of age-related factors on adherence, summarize the evidence on adherence, recommend methods for selecting patients suitable for oral cancer agents, and advise monitoring interventions to promote adherence to treatment.
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Affiliation(s)
- Anna Rachelle Mislang
- Medical Oncology Department, Nuovo Ospedale-Santo Stefano, Instituto Toscano Tumori, Prato 59100, Italy; Cancer Clinical Trials Unit, Department of Medical Oncology, Royal Adelaide Hospital, Adelaide, SA 5000, Australia
| | - Tanya M Wildes
- Division of Medical Oncology, Washington University School of Medicine, St Louis, MO, USA
| | | | - Capucine Baldini
- Medical Hospital Huriez, University Lille Nord de France, Lille, France
| | - Holly M Holmes
- Division of Geriatric and Palliative Medicine, University of Texas McGovern Medical School, Houston, TX, USA
| | - Ginah Nightingale
- Department of Pharmacy Practice, Jefferson College of Pharmacy, Thomas Jefferson University, Philadelphia, PA, USA
| | - Annemarie Coolbrandt
- Oncology Nursing Department, University Hospitals Leuven, Leuven, Belgium; Academic Center for Nursing and Midwifery, Department of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 35, Box 7001, 3000 Leuven, Belgium
| | - Laura Biganzoli
- Medical Oncology Department, Nuovo Ospedale-Santo Stefano, Instituto Toscano Tumori, Prato 59100, Italy.
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Abstract
Background Cancer patients with posttraumatic stress disorder can lead to their noncompliant behaviors. However, less is known about the neurocognitive functioning of posttraumatic stress disorder in general cancer types or patient populations. The current study attempted to examine the prevalence of posttraumatic stress disorder and their relationships with executive function in individuals with cancer. Methods A total of 285 cancer patients with posttraumatic stress disorder and 150 healthy individuals were recruited for the present study. The Clinician Administered PTSD Scale, Tower of Hanoi, Wisconsin Card Sorting Test, and Wechsler Adult Intelligence Scale-Revised Chinese revision were administered to all participants. Results Significant differences in the score of Tower of Hanoi, Wisconsin Card Sorting Test, and Wechsler Adult Intelligence Scale-Revised Chinese revision were observed between the posttraumatic stress disorder group and the healthy control group ( p < 0.001). Significant correlations were found between all posttraumatic stress disorder symptoms and executive function. Conclusions These findings suggest that individuals with cancer-related posttraumatic stress disorder exhibit more severe impairment in executive function than healthy controls do.
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Affiliation(s)
- Juan Yang
- 1 Department of Psychology, Hainan Medical University, Haikou, P. R. China
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Fioretti C, Mazzocco K, Pravettoni G. Psychological Support in Breast Cancer Patients: A Personalized Approach. Breast Cancer 2017. [DOI: 10.1007/978-3-319-48848-6_73] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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de Souza BF, de Moraes JA, Inocenti A, dos Santos MA, Silva AEBDC, Miasso AI. Women with breast cancer taking chemotherapy: depression symptoms and treatment adherence. Rev Lat Am Enfermagem 2016; 22:866-73. [PMID: 25493684 PMCID: PMC4292673 DOI: 10.1590/0104-1169.3564.2491] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Accepted: 05/20/2014] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE: to verify depressive symptoms and adherence to chemotherapy among women with
breast cancer who are served by the Pharmacy of the Chemotherapy Center of a
university hospital. METHOD: cross-sectional study with quantitative approach conducted with 112 women
receiving chemotherapy. Structured interviews guided by a script addressing
socio-demographic, clinical and therapeutic information, the Morisky Test, and the
Beck Depression Inventory were used to collect data. RESULTS: 12.50% and 1.78% of the patients experienced "moderate" and "severe" depression,
respectively, while 10.59% did not use antidepressant medication. A statistically
significant association was found between levels of depression and the use of
antidepressants. Lack of adherence was identified in 46.43% of the participants.
CONCLUSION: these findings show the need to regularly screen for depressive symptoms and for
adherence to chemotherapy treatment among women with breast cancer, in order to
provide early detection and appropriate treatment centered on patients, and to
improve their quality of life.
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Affiliation(s)
- Bianca Fresche de Souza
- Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Faculdade de Ciências Farmacêuticas de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Jéssica Andrade de Moraes
- Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Faculdade de Ciências Farmacêuticas de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Aline Inocenti
- Prefeitura Municipal da Estância Turística de Batatais, Batatais, SP, Brazil
| | - Manoel Antônio dos Santos
- Faculdade de Filosofia, Ciências e Letras de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | | | - Adriana Inocenti Miasso
- Centre for Nursing Research Development, Departamento de Enfermagem Psiquiátrica e Ciências Humanas, Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
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Nichols E, Kesmodel SB, Bellavance E, Drogula C, Tkaczuk K, Cohen RJ, Citron W, Morgan M, Staats P, Feigenberg S, Regine WF. Preoperative Accelerated Partial Breast Irradiation for Early-Stage Breast Cancer: Preliminary Results of a Prospective, Phase 2 Trial. Int J Radiat Oncol Biol Phys 2016; 97:747-753. [PMID: 28244410 DOI: 10.1016/j.ijrobp.2016.11.030] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Revised: 11/07/2016] [Accepted: 11/19/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE To assess the feasibility of utilizing 3-dimensional conformal accelerated partial-breast irradiation (APBI) in the preoperative setting followed by standard breast-conserving therapy. PATIENTS AND METHODS This was a prospective trial testing the feasibility of preoperative APBI followed by lumpectomy for patients with early-stage invasive ductal breast cancer. Eligible patients had T1-T2 (<3 cm), N0 tumors. Patients received 38.5 Gy in 3.85-Gy fractions delivered twice daily. Surgery was performed >21 days after radiation therapy. Adjuvant therapy was given as per standard of care. RESULTS Twenty-seven patients completed treatment. With a median follow-up of 3.6 years (range, 0.5-5 years), there have been no local or regional failures. A complete pathologic response according to hematoxylin and eosin stains was seen in 4 patients (15%). There were 4 grade 3 seromas. Patient-reported cosmetic outcome was rated as good to excellent in 79% of patients after treatment. CONCLUSIONS Preoperative 3-dimensional conformal radiation therapy-APBI is feasible and well tolerated in select patients with early-stage breast cancer, with no reported local recurrences and good to excellent cosmetic results. The pathologic response rates associated with this nonablative APBI dose regimen are particularly encouraging and support further exploration of this paradigm.
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Affiliation(s)
- Elizabeth Nichols
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland.
| | - Susan B Kesmodel
- Department of Surgical Oncology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Emily Bellavance
- Department of Surgical Oncology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Cynthia Drogula
- Department of Surgical Oncology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Katherine Tkaczuk
- Department of Medical Oncology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Randi J Cohen
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Wendla Citron
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Michelle Morgan
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Paul Staats
- Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Steven Feigenberg
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland
| | - William F Regine
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland
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Koskas M, Huchon C, Amant F. Characteristics and prognosis of patients with early-stage endometrial cancer who refuse adjuvant radiotherapy. Gynecol Oncol 2016; 141:428-433. [DOI: 10.1016/j.ygyno.2016.03.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2016] [Revised: 03/05/2016] [Accepted: 03/11/2016] [Indexed: 12/15/2022]
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Greer JA, Amoyal N, Nisotel L, Fishbein JN, MacDonald J, Stagl J, Lennes I, Temel JS, Safren SA, Pirl WF. A Systematic Review of Adherence to Oral Antineoplastic Therapies. Oncologist 2016; 21:354-76. [PMID: 26921292 DOI: 10.1634/theoncologist.2015-0405] [Citation(s) in RCA: 218] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Accepted: 12/08/2015] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Oral antineoplastic therapies not only improve survival but also reduce the burden of care for patients. Yet patients and clinicians face new challenges in managing adherence to these oral therapies. We conducted a systematic literature review to assess rates and correlates of adherence to oral antineoplastic therapies and interventions aimed at improving adherence. METHODS Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we conducted a comprehensive literature search of the Ovid MEDLINE database from January 1, 2003 to June 30, 2015, using relevant terminology for oral antineoplastic agents. We included observational, database, and intervention studies. At least two researchers evaluated each paper to ensure accuracy of results and determine risk of bias. RESULTS We identified 927 records from the search and screened 214 abstracts. After conducting a full-text review of 167 papers, we included in the final sample 51 papers on rates/correlates of adherence to oral antineoplastic therapy and 12 papers on intervention studies to improve adherence. Rates of adherence varied widely, from 46% to 100%, depending on patient sample, medication type, follow-up period, assessment measure, and calculation of adherence. Of the intervention studies, only 1 of the randomized trials and 2 of the cohort studies showed benefit regarding adherence, with the majority suffering high risk of bias. CONCLUSIONS Although no reliable estimate of adherence to oral antineoplastic therapies can be gleaned from the literature, a substantial proportion of patients struggle to adhere to these medications as prescribed. The few intervention studies for adherence have notable methodological concerns, thereby limiting the evidence to guide practice in promoting medication adherence among patients with cancer.
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Affiliation(s)
- Joseph A Greer
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Nicole Amoyal
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Lauren Nisotel
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Joel N Fishbein
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - James MacDonald
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Jamie Stagl
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Inga Lennes
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Jennifer S Temel
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | | | - William F Pirl
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
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Walker HE, Rosenberg SM, Stanton AL, Petrie KJ, Partridge AH. Perceptions, Attributions, and Emotions Toward Endocrine Therapy in Young Women with Breast Cancer. J Adolesc Young Adult Oncol 2015; 5:16-23. [PMID: 26812461 DOI: 10.1089/jayao.2015.0051] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
PURPOSE The aims of this study were to describe symptoms attributed to endocrine therapy (ET) and perceptions of ET in a sample of young women with breast cancer and to explore whether these factors are associated with adherence to ET. METHODS An online questionnaire was completed by 106 young women taking ET for hormone receptor-positive breast cancer. In addition to demographic and medical characteristics, the survey assessed symptom attribution, emotions, and perceptions related to ET. A supplemental survey measuring adherence to ET was completed by 82/106 women. Means, medians, and frequency distributions were calculated for continuous and categorical covariates, respectively. An exploratory analysis evaluated whether adherence was associated with patient characteristics and views. RESULTS The mean age of respondents was 39 years (range 22-45 years). Two-thirds of women had stage 1 or 2 breast cancer. Women attributed an average of nine symptoms to ET; hot flashes, night sweats, and decreased libido were the most frequently attributed symptoms. Positive emotions toward ET were more common than negative emotions were, although only 48% of respondents believed that ET was essential. Women of higher financial status and those who reported more positive emotions toward ET reported greater adherence with ET. A significant difference in symptom attribution was not detected between less and more adherent respondents. CONCLUSIONS Young women's views regarding ET may play an important role in determining adherence behavior. Given that young women have a higher risk of recurrence, some of which may be attributable to ET non-adherence, further work is needed to confirm these findings and determine whether interventions designed to modify young women's perceptions of ET could promote adherence.
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Affiliation(s)
| | - Shoshana M Rosenberg
- 1 Harvard Medical School , Boston, Massachusetts.,2 Dana-Farber Cancer Institute , Boston, Massachusetts
| | - Annette L Stanton
- 3 Departments of Psychology and Psychiatry/Biobehavioral Sciences and Jonsson Comprehensive Cancer Center, University of California , Los Angeles, California
| | | | - Ann H Partridge
- 1 Harvard Medical School , Boston, Massachusetts.,2 Dana-Farber Cancer Institute , Boston, Massachusetts
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Patil VM, Noronha V, Joshi A, Muddu V, Dhumal S, Bhattacharjee A, Prabhash K. Compliance With Neoadjuvant Chemotherapy in T4 Oral Cancers: Place, Person, Socioeconomic Status, or Assistance. J Glob Oncol 2015; 1:65-72. [PMID: 28804775 PMCID: PMC5539870 DOI: 10.1200/jgo.2015.000265] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Approximately 15% to 20% of our patients with head and neck cancer receiving neoadjuvant chemotherapy (NACT) discontinue therapy because of various nonmedical reasons. We sought to analyze the factors associated with treatment default and noncompliance among these patients. PATIENTS AND METHODS We performed a retrospective analysis of patients with T4 oral cancer treated with NACT between January 2011 and December 2012. We included patients who discontinued treatment for nonmedical reasons before the second cycle of NACT. The factors analyzed were income, education, socioeconomic status, age, sex, place of residence, habits, and payment pattern (government supported or personal capacity). Pearson χ2 test was used to identify significant factors associated with noncompliance. RESULTS Of 486 patients, 91 patients (18.7%) were noncompliant. Percentages of noncompliant patients in the age groups < 30, between 30 and 60, and > 60 years were 25.0%, 17.4%, and 25.5%, respectively (P = .27). Percentages of noncompliance in patients residing within the city, same state, or different state were 20.7%, 20.9%, and 17.1%, respectively (P = .44). Noncompliance rates were 20.3%, 15.7%, 18.1%, and 22.5% in upper middle, lower middle, upper lower, and lower economic strata, respectively (P = .60). Similarly, there was no significant difference in noncompliance according to occupation, education level, payment pattern, sex, or habits. CONCLUSION Our analysis failed to identify any specific significant factor associated with noncompliance with NACT among our patients with T4 oral cancers.
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Sawesi S, Carpenter JS, Jones J. Reasons for nonadherence to tamoxifen and aromatase inhibitors for the treatment of breast cancer: a literature review. Clin J Oncol Nurs 2015; 18:E50-7. [PMID: 24867124 DOI: 10.1188/14.cjon.e50-e57] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Despite improved breast cancer survival rates with the use of tamoxifen and aromatase inhibitors, patients remain at risk for cancer recurrence and mortality because of nonadherence to medication. The objective of this review was to identify factors associated with nonadherence among patients with breast cancer. Electronic databases were searched for studies, and potentially relevant studies were retrieved and assessed for eligibility. Potential factors associated with nonadherence were identified, and they included patient-related factors (e.g., patient beliefs and knowledge, fear of adverse effects, forgetfulness, smoking, age, race), therapy-related factors (e.g., duration, side effects, additional prescribed medications, treatment interfering with lifestyle), healthcare system factors (e.g., patient/provider relationships), socioeconomic factors (e.g., medication costs, burden, scheduling problems, religion, marital status), and disease-related factors (e.g., comorbidities, stage of breast cancer). Those findings highlight the need for development of interventions to promote long-term adherence in patients with breast cancer.
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Affiliation(s)
- Suhila Sawesi
- Department of BioHealth Informatics, School of Informatics, Indiana University-Purdue University in Indianapolis
| | - Janet S Carpenter
- Center for Enhancing Quality of Life in Chronic Illness, School of Nursing, Indiana University-Purdue University in Indianapolis
| | - Josette Jones
- Department of BioHealth Informatics in the School of Informatics, Indiana University-Purdue University in Indianapolis
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Kimmick G, Edmond SN, Bosworth HB, Peppercorn J, Marcom PK, Blackwell K, Keefe FJ, Shelby RA. Medication taking behaviors among breast cancer patients on adjuvant endocrine therapy. Breast 2015; 24:630-6. [PMID: 26189978 DOI: 10.1016/j.breast.2015.06.010] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2014] [Revised: 05/28/2015] [Accepted: 06/26/2015] [Indexed: 01/15/2023] Open
Abstract
PURPOSE To explore how symptoms and psychosocial factors are related to intentional and unintentional non-adherent medication taking behaviors. METHODS Included were postmenopausal women with hormone receptor positive, stage I-IIIA breast cancer, who had completed surgery, chemotherapy, and radiation, and were taking endocrine therapy. Self-administered, standardized measures were completed during a routine clinic visit: Brief Fatigue Inventory, Brief Pain Inventory, Menopause Specific Quality of Life Questionnaire, Functional Assessment of Cancer Therapy General and Neurotoxicity scales, and Self-Efficacy for Appropriate Medication Use Scale. Regression analyses were performed to determine the degree to which demographic, medical, symptom, and psychosocial variables, explain intentional, such as changing one's doses or stopping medication, and unintentional, such as forgetting to take one's medication, non-adherent behaviors. RESULTS Participants were 112 women: mean age 64 (SD = 9) years; 81% white; mean time from surgery 40 (SD = 28) months; 49% received chemotherapy (39% including a taxane); mean time on endocrine therapy, 35 (SD = 29.6) months; 82% taking an aromatase inhibitor. Intentional and unintentional non-adherent behaviors were described in 33.9% and 58.9% of participants, respectively. Multivariate analysis showed that higher self-efficacy for taking medication was associated with lower levels of unintentional (p = 0.002) and intentional (p = 0.004) non-adherent behaviors. The presence of symptoms (p = 0.03) and lower self-efficacy for physician communication (p = 0.009) were associated with higher levels of intentional non-adherent behaviors. CONCLUSIONS These results suggest that women who report greater symptoms, lower self-efficacy for communicating with their physician, and lower self-efficacy for taking their medication are more likely to engage in both intentional and unintentional non-adherent behaviors.
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Affiliation(s)
- Gretchen Kimmick
- Duke Cancer Institute, Duke University Medical Center, DUMC Box 3204, Durham, NC 27710, USA.
| | - Sara N Edmond
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, USA
| | - Hayden B Bosworth
- Department of Medicine, Psychiatry, and School of Nursing, Duke University Medical Center; Center for Health Services Research, Durham VAMC, USA
| | - Jeffrey Peppercorn
- Duke Cancer Institute, Duke University Medical Center, DUMC Box 3204, Durham, NC 27710, USA
| | - Paul K Marcom
- Duke Cancer Institute, Duke University Medical Center, DUMC Box 3204, Durham, NC 27710, USA
| | - Kimberly Blackwell
- Duke Cancer Institute, Duke University Medical Center, DUMC Box 3204, Durham, NC 27710, USA
| | - Francis J Keefe
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, USA
| | - Rebecca A Shelby
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, USA
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Mausbach BT, Schwab RB, Irwin SA. Depression as a predictor of adherence to adjuvant endocrine therapy (AET) in women with breast cancer: a systematic review and meta-analysis. Breast Cancer Res Treat 2015; 152:239-46. [PMID: 26077640 DOI: 10.1007/s10549-015-3471-7] [Citation(s) in RCA: 100] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Accepted: 06/12/2015] [Indexed: 12/21/2022]
Abstract
The purpose of this meta-analysis was to analyze the available evidence concerning the effects of depression on non-adherence to adjuvant endocrine therapy (AET) in women with breast cancer. MEDLINE and PsycInfo databases from inception through May 1, 2015 were searched using terms related to AET adherence. Articles were reviewed and selected based on predetermined selection criteria, and effect sizes from included studies were extracted. Pooled effect estimates were obtained using random-effects meta-analyses. Of the 312 articles identified, 9 met the inclusion criteria. Overall, depression was significantly associated with non-adherence to AET (Cohen's d = 0.35, 95% CI 0.19-0.52). This effect was not significantly moderated by patient age (<65 vs ≥65 years), length of study follow-up (<18 months vs ≥18 months), or method of assessing adherence (objective vs self-report). However, within these subgroups, significant effects of depression were found only for younger patients (d = 0.46; 95% CI 0.19-0.72) and in studies of shorter duration (<18 months) (d = 0.49; 95% CI 0.22-0.76). These results suggest that AET adherence may be lower among women with greater depressive symptoms, and this effect may be exacerbated in younger women during the early phases (<18 months) of AET. Management of depressive symptoms in women with breast cancer may help in enhancing adherence to AET and improve cancer treatment outcomes.
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Affiliation(s)
- Brent T Mausbach
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093-0680, USA,
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Cheung WY, Lai ECC, Ruan JY, Chang JT, Setoguchi S. Comparative adherence to oral hormonal agents in older women with breast cancer. Breast Cancer Res Treat 2015; 152:419-27. [PMID: 26070268 DOI: 10.1007/s10549-015-3455-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 06/03/2015] [Indexed: 12/17/2022]
Abstract
We aim to (1) compare compliance of anastrozole, letrozole, exemestane, and tamoxifen in women and (2) identify clinical factors associated with medication non-adherence and non-persistence. Female Medicare beneficiaries who were new users of anastrozole, letrozole, exemestane, or tamoxifen between 2007 and 2010 were analyzed. Multivariate-modified Poisson and Cox regression models were constructed to compare non-adherence and non-persistence, respectively, across the different oral agents. A total of 5,150 women were included: mean age was 76.4 years, 2352 initiated anastrozole, 1401 letrozole, 248 exemestane, and 1149 tamoxifen. Non-adherence and non-persistence were 41 and 49% respectively, with exemestane being associated with the worst non-adherence and non-persistence (RR 1.57, 95% CI 1.37-1.80, p < 0.001; HR 1.93, 95% CI 1.63-2.30, respectively, p < 0.001), followed by letrozole (RR 1.39, 95% CI 1.26-1.53, p < 0.001; HR 1.47, 95% CI 1.32-1.64, respectively, p < 0.001), and anastrozole (RR 1.16, 95% CI 1.05-1.27, p = 0.003; HR 1.14, 95%CI 1.03-1.27, respectively, p = 0.011), whereas tamoxifen was associated with the best compliance. Use of statins and osteoporosis medications was correlated with improved adherence (RR 0.89, 95 % CI 0.82-0.96, p = 0.002 and RR 0.84, 95 % CI 0.76-0.92, p < 0.001, respectively, for non-adherence) and persistence (HR 0.86, 95 % CI 0.79-0.94, p < 0.001 and HR 0.86, 95 % CI 0.78-0.96, p = 0.005, respectively, for non-persistence), but chronic kidney disease was correlated with worse non-persistence (HR 1.15, 95 % CI 1.04-1.33, p = 0.04). Age ≥ 70 years was also associated with worse compliance. Compliance to oral hormonal therapy varied depending on the type of agent, age, and concurrent medications, highlighting specific opportunities to improve adherence and persistence in older women with breast cancer.
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Affiliation(s)
- Winson Y Cheung
- Division of Medical Oncology, British Columbia Cancer Agency, 600 West 10th Avenue, Vancouver, BC, V5Z 4E6, Canada,
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