1
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Lu W, Giobbie-Hurder A, Tanasijevic A, Kassis SB, Park SH, Jeong YJ, Shin IH, Yao C, Jung HJ, Zhu Z, Bao C, Bao T, Yang E, Bierer BE, Ligibel JA. Acupuncture for hot flashes in hormone receptor-positive breast cancer: A pooled analysis of individual patient data from parallel randomized trials. Cancer 2024; 130:3219-3228. [PMID: 38924035 DOI: 10.1002/cncr.35374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Revised: 04/10/2024] [Accepted: 04/15/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND Hot flashes are a common side effect of endocrine therapy (ET) that contribute to poor quality of life and decreased treatment adherence. METHODS Patients with breast cancer wo were receiving ET and experiencing hot flashes were enrolled through three parallel, randomized trials conducted in the United States, China, and South Korea. Participants were randomized to either immediate acupuncture (IA) or delayed acupuncture control (DAC). IA participants received 20 acupuncture sessions over 10 weeks, whereas DAC participants received usual care, then crossed over to acupuncture with a reduced intensity. The primary end point was a change in score on the endocrine symptom subscale of the Functional Assessment of Cancer Therapy (FACT)-Endocrine Symptoms between baseline and week 10. Secondary end points included the hot flash score and the FACT-Breast score. A planned pooled analysis of individual patient data was performed using longitudinal mixed models. RESULTS In total, 158 women with stage 0-III breast cancer were randomized (United States, n = 78; China, n = 40; South Korea, n = 40). At week 10, IA participants reported statistically significant improvements in the endocrine symptom subscale score (mean change ± standard error: 5.1 ± 0.9 vs. 0.2 ± 1.0; p = .0003), the hot flash score (-5.3 ± 0.9 vs. -1.4 ± 0.9; p < .003), and the FACT-Breast total score (8.0 ± 1.6 vs. -0.01 ± 1.6; p = .0005) compared with DAC participants. The effect of the acupuncture intervention differed by site (p = .005). CONCLUSIONS Acupuncture led to statistically and clinically meaningful improvements in hot flashes, endocrine symptoms, and breast cancer-specific quality of life in women undergoing ET for breast cancer in the United States, China, and South Korea.
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Affiliation(s)
- Weidong Lu
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Anita Giobbie-Hurder
- Division of Biostatistics, Department of Data Science, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Anna Tanasijevic
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Sylvia Baedorf Kassis
- The Multi-Regional Clinical Trials Center of Brigham and Women's Hospital and Harvard, Boston, Massachusetts, USA
| | - Sung Hwan Park
- Department of Surgery, Daegu Catholic University, School of Medicine, Daegu, Republic of Korea
| | - Young Ju Jeong
- Department of Surgery, Daegu Catholic University, School of Medicine, Daegu, Republic of Korea
| | - Im Hee Shin
- Department of Medical Statistics and Informatics, Daegu Catholic University, School of Medicine, Daegu, Republic of Korea
| | - Chang Yao
- Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Hyun Jung Jung
- Department of Diagnostics, College of Korean Medicine, Daegu Haany University, Daegu, Republic of Korea
| | - Zhiyuan Zhu
- Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Chao Bao
- Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Ting Bao
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - EunMee Yang
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Barbara E Bierer
- The Multi-Regional Clinical Trials Center of Brigham and Women's Hospital and Harvard, Boston, Massachusetts, USA
- Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Jennifer A Ligibel
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
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2
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Puszkiel A, Dalenc F, Tafzi N, Marquet P, Debled M, Jacot W, Venat-Bouvet L, Ferrer C, Levasseur N, Paulon R, Dauba J, Evrard A, Mauriès V, Filleron T, Chatelut E, Thomas F, White-Koning M. Identification of non-adherence to adjuvant letrozole using a population pharmacokinetics approach in hormone receptor-positive breast cancer patients. Eur J Pharm Sci 2024; 199:106809. [PMID: 38788907 DOI: 10.1016/j.ejps.2024.106809] [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: 11/27/2023] [Revised: 04/05/2024] [Accepted: 05/21/2024] [Indexed: 05/26/2024]
Abstract
BACKGROUND Letrozole, an aromatase inhibitor metabolised via CYP2A6 and CYP3A4/5 enzymes, is used as adjuvant therapy for women with hormone receptor (HR)-positive early breast cancer. The objective of this study was to quantify the impact of CYP2A6 genotype on letrozole pharmacokinetics (PK), to identify non-adherent patients using a population approach and explore the possibility of a relationship between non-adherence and early relapse. METHODS Breast cancer patients enrolled in the prospective PHACS study (ClinicalTrials.gov NCT01127295) and treated with adjuvant letrozole 2.5 mg/day were included. Trough letrozole concentrations (Css,trough) were measured every 6 months for 3 years by a validated LC-MS/MS method. Concentration-time data were analysed using non-linear mixed effects modelling. Three methods were evaluated for identification of non-adherent subjects using the base PK model. RESULTS 617 patients contributing 2534 plasma concentrations were included and led to a one-compartment PK model with linear absorption and elimination. Model-based methods identified 28 % of patients as non-adherent based on high fluctuations of their Css,trough compared to 3 % based on patient declarations. The covariate analysis performed in adherent subjects revealed that CYP2A6 intermediate (IM) and slow metabolisers (SM) had 21 % (CI95 % = 12 - 30 %) and 46 % (CI95 % = 41 - 51 %) lower apparent clearance, respectively, compared to normal and ultrarapid metabolisers (NM+UM). Early relapse (19 patients) was not associated with model-estimated, concentration-based or declared adherence in the total population (p = 0.41, p = 0.37 and p = 0.45, respectively). CONCLUSIONS These findings will help future investigations focusing on the exposure-efficacy relationship for letrozole in adjuvant setting.
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Affiliation(s)
- Alicja Puszkiel
- Cancer Research Center of Toulouse (CRCT), Inserm U1037, Université Paul Sabatier - Toulouse III, 2 Avenue Hubert Curien, Toulouse 31100, France
| | - Florence Dalenc
- Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse - Oncopole, Toulouse, France
| | - Naïma Tafzi
- Department of Pharmacology, Toxicology and Pharmacovigilance, CHU Limoges, Limoges, France
| | - Pierre Marquet
- Department of Pharmacology, Toxicology and Pharmacovigilance, CHU Limoges, Limoges, France
| | - Marc Debled
- Department of Medical Oncology, Institut Bergonié, Bordeaux, France
| | - William Jacot
- Institut du Cancer de Montpellier, ICM, Université de Montpellier, IRCM, Inserm U1194, Montpellier, France
| | | | - Catherine Ferrer
- Department of Medical Oncology, CHU Nîmes-Carémeau, Nîmes, France
| | | | - Rodolphe Paulon
- Department of Medical Oncology, Centre Hospitalier Intercommunal Castres-Mazamet, Castres, France
| | - Jérôme Dauba
- Department of Medical Oncology, CH Mont de Marsan, Mont-de-Marsan, France
| | - Alexandre Evrard
- Institut du Cancer de Montpellier, ICM, Université de Montpellier, IRCM, Inserm U1194, Montpellier, France; Laboratoire de Biochimie et Biologie Moléculaire, CHU Nîmes-Carémeau, Nîmes, France
| | - Vincent Mauriès
- Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse - Oncopole, Toulouse, France
| | - Thomas Filleron
- Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse - Oncopole, Toulouse, France
| | - Etienne Chatelut
- Cancer Research Center of Toulouse (CRCT), Inserm U1037, Université Paul Sabatier - Toulouse III, 2 Avenue Hubert Curien, Toulouse 31100, France; Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse - Oncopole, Toulouse, France
| | - Fabienne Thomas
- Cancer Research Center of Toulouse (CRCT), Inserm U1037, Université Paul Sabatier - Toulouse III, 2 Avenue Hubert Curien, Toulouse 31100, France; Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse - Oncopole, Toulouse, France
| | - Melanie White-Koning
- Cancer Research Center of Toulouse (CRCT), Inserm U1037, Université Paul Sabatier - Toulouse III, 2 Avenue Hubert Curien, Toulouse 31100, France.
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3
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Nicoletti AP, Damin AP. Factors influencing the first and the fifth years adherence to adjuvant endocrine therapy in breast cancer patients in a low income country. Breast Cancer Res Treat 2024; 204:599-606. [PMID: 38225523 DOI: 10.1007/s10549-023-07221-6] [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: 06/28/2023] [Accepted: 12/10/2023] [Indexed: 01/17/2024]
Abstract
PURPOSE Breast cancer is the leading cause of cancer death in Brazil and in many countries around the world. In order to minimize the risk of recurrence and death, adjuvant endocrine therapy (AET) is used in women whose tumors express hormone receptors; however, the therapy is associated with low rates of compliance. Therefore, we sought to evaluate the proportion of patients who are adherent/non-adherent to AET at the beginning of the therapy (1st year) and at its end (5th year). METHODS Cross-sectional study assessing adherence through the Brief Medication Questionnaire. RESULTS It was identified that eventual failures in maintaining the correct adherence to the treatment have risen from 23% of patients in the 1st year of treatment to 35% of patients in the 5th year (p = 0.005). In both groups, use of aromatase inhibitors, polypharmacy of at least 3 mediations and the previous diagnosis of diabetes mellitus (DM) or systemic arterial hypertension (SAH) have contributed to low adherence among patients. CONCLUSION The proportion of patients who are not adherent to AET was high in both cohorts, and the rate of non-adherent patients rises over time. It is essential to incorporate screening methods for lack of compliance to AET, as well as measures to try to reduce non-persistence to the treatment, such as educating the patients on the benefits of the treatment, managing comorbidities through lifestyle changes and, therefore, reducing polypharmacy and, above all, detecting and treating very early the adverse effects of AET that might interfere with its correct use.
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Affiliation(s)
- Antonio Pedro Nicoletti
- Faculty of Medicine, Post Graduation Program in Health Sciences: Gynecology and Obstetrics, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande Do Sul, Brazil.
| | - Andrea P Damin
- Faculty of Medicine, Post Graduation Program in Health Sciences: Gynecology and Obstetrics, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande Do Sul, Brazil
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Johansson H, Guerrieri-Gonzaga A, Gandini S, Bertelsen BE, Macis D, Serrano D, Mellgren G, Lazzeroni M, Thomas PS, Crew KD, Kumar NB, Briata IM, Galimberti V, Viale G, Vornik LA, Aristarco V, Buttiron Webber T, Spinaci S, Brown PH, Heckman-Stoddard BM, Szabo E, Bonanni B, DeCensi A. Alternative dosing regimen of exemestane in a randomized presurgical trial: the role of obesity in biomarker modulation. NPJ Breast Cancer 2024; 10:7. [PMID: 38238336 PMCID: PMC10796398 DOI: 10.1038/s41523-024-00616-8] [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: 04/12/2023] [Accepted: 01/04/2024] [Indexed: 01/22/2024] Open
Abstract
In a 3-arm presurgical trial, four-six weeks exemestane 25 mg three times/week (TIW) was non-inferior to 25 mg/day (QD) in suppressing circulating estradiol in postmenopausal women with ER-positive breast cancer. Since obesity may decrease exemestane efficacy, we analyzed changes in sex steroids, adipokines, Ki-67, and drug levels in relation to obesity. Postmenopausal women with early-stage ER-positive breast cancer were randomized to either exemestane 25 mg QD (n = 57), 25 mg TIW (n = 57), or 25 mg/week (QW, n = 62) for 4-6 weeks before breast surgery. Serum and tissue pre- and post-treatment biomarkers were stratified by body mass index (BMI)< or ≥30 kg/m2. Post-treatment median exemestane and 17-OH exemestane levels were 5-6 times higher in the QD arm compared to the TIW arm. For obese women, TIW maintained comparable reductions to QD in systemic estradiol levels, although the reduction in estrone was less with the TIW regimen. There was less suppression of SHBG with the TIW versus the QD dose schedule in obese women which should result in less systemic bioavailable estrogens. Metabolically, the effect of the TIW regimen was similar to the QD regimen for obese women in terms of leptin suppression and increase in the adiponectin-leptin ratio. Reduction in tissue Ki-67 was less for obese women on the TIW regimen than QD, although changes were similar for non-obese women. Our findings suggest that TIW exemestane should be explored further for primary cancer prevention in both normal weight and obese cohorts.
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Affiliation(s)
| | | | - Sara Gandini
- IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Bjørn-Erik Bertelsen
- Hormone Laboratory, Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway
| | - Debora Macis
- IEO, European Institute of Oncology IRCCS, Milan, Italy
| | | | - Gunnar Mellgren
- Hormone Laboratory, Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | | | | | | | - Nagi B Kumar
- Moffitt Cancer Center, University of South Florida, Tampa, FL, USA
| | | | | | | | - Lana A Vornik
- University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | | | | | | | - Powel H Brown
- University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | | | - Eva Szabo
- Division of Cancer Prevention, NCI Bethesda, MD, USA
| | | | - Andrea DeCensi
- E.O. Galliera Hospital, Genoa, Italy
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
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5
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Reeder-Hayes K, Roberson ML, Wheeler SB, Abdou Y, Troester MA. From Race to Racism and Disparities to Equity: An Actionable Biopsychosocial Approach to Breast Cancer Outcomes. Cancer J 2023; 29:316-322. [PMID: 37963365 PMCID: PMC10651167 DOI: 10.1097/ppo.0000000000000677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
PURPOSE Racial disparities in outcomes of breast cancer in the United States have widened over more than 3 decades, driven by complex biologic and social factors. In this review, we summarize the biological and social narratives that have shaped breast cancer disparities research across different scientific disciplines in the past, explore the underappreciated but crucial ways in which these 2 strands of the breast cancer story are interwoven, and present 5 key strategies for creating transformative interdisciplinary research to achieve equity in breast cancer treatment and outcomes. DESIGN We first review the key differences in tumor biology in the United States between patients racialized as Black versus White, including the overrepresentation of triple-negative breast cancer and differences in tumor histologic and molecular features by race for hormone-sensitive disease. We then summarize key social factors at the interpersonal, institutional, and social structural levels that drive inequitable treatment. Next, we explore how biologic and social determinants are interwoven and interactive, including historical and contemporary structural factors that shape the overrepresentation of triple-negative breast cancer among Black Americans, racial differences in tumor microenvironment, and the complex interplay of biologic and social drivers of difference in outcomes of hormone receptor positive disease, including utilization and effectiveness of endocrine therapies and the role of obesity. Finally, we present 5 principles to increase the impact and productivity of breast cancer equity research. RESULTS We find that social and biologic drivers of breast cancer disparities are often cyclical and are found at all levels of scientific investigation from cells to society. To break the cycle and effect change, we must acknowledge and measure the role of structural racism in breast cancer outcomes; frame biologic, psychosocial, and access factors as interwoven via mechanisms of cumulative stress, inflammation, and immune modulation; take responsibility for the impact of representativeness (or the lack thereof) in genomic and decision modeling on the ability to accurately predict the outcomes of Black patients; create research that incorporates the perspectives of people of color from inception to implementation; and rigorously evaluate innovations in equitable cancer care delivery and health policies. CONCLUSIONS Innovative, cross-disciplinary research across the biologic and social sciences is crucial to understanding and eliminating disparities in breast cancer outcomes.
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Affiliation(s)
| | | | | | - Yara Abdou
- From the Division of Oncology, School of Medicine
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6
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Kim MJ, Kim JY, Lee JJ, Moon KW, Shin K. Reliability and Validity of the Korean Version of the Gout Impact Scale. J Korean Med Sci 2023; 38:e266. [PMID: 37667577 PMCID: PMC10477077 DOI: 10.3346/jkms.2023.38.e266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 04/27/2023] [Indexed: 09/06/2023] Open
Abstract
BACKGROUND The Gout Impact Scale (GIS), part of the Gout Assessment Questionnaire 2.0, measures gout-specific health-related quality of life (HRQOL). This study aimed to translate the GIS into Korean and validate the Korean version (K-GIS) using generic HRQOL measures. METHODS The GIS was translated into Korean and back-translated into English. We asked patients aged 18 years or older who met the 2015 gout classification criteria to fill out the questionnaires (from January 2022 to June 2022); the K-GIS (5 scales [0-100 scores each]), along with the Korean version of Health Assessment Questionnaire (HAQ) and EuroQol-5 dimension (EQ-5D). We investigated the internal consistency, construct validity, and discriminative validity for gout characteristics of K-GIS. The K-GIS form was administrated to patients 4 weeks later to assess the test-retest reliability using the intraclass correlation coefficient (ICC). RESULTS One hundred patients completed the questionnaire. The mean ± standard deviation age of the patients was 53.0 ± 15.1 years, and 99.0% of the patients were men. All scales had high degree of internal consistency (Cronbach's α = 0.59 to 0.96) and test-retest reliability (n = 18, ICC = 0.83 to 0.94, all P < 0.001), except for unmet gout treatment needs. Weak-to-moderate correlations were observed between the K-GIS scales and HAQ or EQ-5D (r = 0.21 to 0.46). The K-GIS scores were significantly higher in the presence of bone erosion, absence of urate-lowering therapy, serum urate levels > 6 mg/dL, frequent gout flares in the past year, and fewer comorbidities. In contrast, neither the HAQ nor the EQ-5D could discern these subsets of patients. CONCLUSION The K-GIS is a reliable and valid HRQOL measure for patients with gout. Higher K-GIS scores were associated with clinical characteristics leading to unfavorable outcomes, which were not demonstrated by the HAQ and EQ-5D.
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Affiliation(s)
- Min Jung Kim
- Division of Rheumatology, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Ju Yeon Kim
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Jennifer Jooha Lee
- Division of Rheumatology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ki Won Moon
- Division of Rheumatology, Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Kichul Shin
- Division of Rheumatology, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
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7
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Nathan M, Beatty L, Coborn J, Wiley A, Srivastava A, Russell J, Joffe H. Targeting psychological and menopausal factors linked to non-adherence to anti-estrogen therapy in women with early-stage hormone-receptor positive breast cancer: A web-based feasibility study of Finding My Way. Psychooncology 2023; 32:1461-1465. [PMID: 37496178 DOI: 10.1002/pon.6195] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 05/26/2023] [Accepted: 07/16/2023] [Indexed: 07/28/2023]
Abstract
Key Points
Reduced adherence to anti‐estrogen therapy (AET; tamoxifen and aromatase inhibitors) in women with early‐stage hormone‐receptor‐positive (HR+) breast cancers leads to adverse clinical outcomes.
Modifiable psychological factors (e.g., depressive symptoms and anxiety) and menopausal symptoms (e.g., sleep disturbance and hot flashes) are linked with diminished adherence.
An intervention targeting psychological and menopausal symptoms has potential to improve AET adherence.
We conducted a pilot study to evaluate the feasibility of a remotely administered behavioral intervention in women with early‐stage HR+ breast cancer taking AET at‐risk for non‐adherence with psychological and menopausal symptoms.
Findings from this preliminary study show that a web‐based behavioral intervention is feasible and may be a potential method of reducing risk for AET non‐adherence in some patients.
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Affiliation(s)
- Margo Nathan
- Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Lisa Beatty
- Flinders University Institute of Mental Health & Wellbeing, College of Education, Psychology & Social Work, Flinders University, Adelaide, South Australia, Australia
| | - Jamie Coborn
- Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Aleta Wiley
- Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Mary Horrigan Connors Center for Women's Health and Gender Biology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Akanksha Srivastava
- Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Julia Russell
- Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Hadine Joffe
- Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Mary Horrigan Connors Center for Women's Health and Gender Biology, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Psychosocial Oncology, Dana Farber Cancer Center, Boston, Massachusetts, USA
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8
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Yang S, Park SW, Bae SJ, Ahn SG, Jeong J, Park K. Investigation of Factors Affecting Adherence to Adjuvant Hormone Therapy in Early-Stage Breast Cancer Patients: A Comprehensive Systematic Review. J Breast Cancer 2023; 26:309-333. [PMID: 37272247 PMCID: PMC10475712 DOI: 10.4048/jbc.2023.26.e22] [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: 11/16/2022] [Revised: 02/05/2023] [Accepted: 04/16/2023] [Indexed: 06/06/2023] Open
Abstract
PURPOSE Adherence and persistence to adjuvant hormone therapy (AHT) are seldom maintained among early-stage hormone receptor-positive breast cancer (BC) survivors, despite the significant clinical benefits of long-term AHT. As the factors influencing adherence to AHT remain unclear, this study aimed to comprehensively identify such factors and classify them into specific dimensions. METHODS PubMed, Cochrane Library, Embase, PsycINFO, and CINAHL were searched for qualified articles. The search mainly focused on three components: early-stage (0-III) BC, oral AHT administration, and adherence to AHT, with keywords derived from MeSH and entry terms. The factors identified were then classified into six categories based on a modified WHO multidimensional model. RESULTS Overall, 146 studies were included; the median sample size was 651 (range, 31-40,009), and the mean age of the population was 61.5 years (standard deviation, 8.3 years). Patient- and therapy-related factors were the most frequently investigated factors. Necessity/concern beliefs and self-efficacy among patient-related factors were consistently related to better adherence than depression. Although drug side effects and medication use cannot be modified easily, a refined prescription strategy for the initiation and switching of AHT is likely to increase adherence levels. CONCLUSION An effective psychological program that encourages positive views and beliefs about medication and management strategies for each therapy may be necessary to improve adherence to AHT. Social support and a sense of belonging can be enhanced through community participation and social media for better adherence to AHT. Patient-centered communication and appropriate recommendations by physicians may be attributable to better adherence outcomes. Findings from systematically organized factors that influence adherence to AHT may contribute to the establishment of intervention strategies to benefit patients with early-stage BC to achieve optimal health.
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Affiliation(s)
- Seongwoo Yang
- HERINGS, The Institute of Advanced Clinical & Biomedical Research, Seoul, Korea
| | - Seong Won Park
- HERINGS, The Institute of Advanced Clinical & Biomedical Research, Seoul, Korea
| | - Soong June Bae
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine/Institute for Breast Cancer Precision Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Gwe Ahn
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine/Institute for Breast Cancer Precision Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Joon Jeong
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine/Institute for Breast Cancer Precision Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Kyounghoon Park
- HERINGS, The Institute of Advanced Clinical & Biomedical Research, Seoul, Korea.
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9
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Unger JM, Qian L, Redman MW, Tavernier SS, Minasian L, Sigal EV, Papadimitrakopoulou VA, Leblanc M, Cleeland CS, Dzingle SA, Summers TJ, Chao H, Madhusudhana S, Villaruz L, Crawford J, Gray JE, Kelly KL, Gandara DR, Bazhenova L, Herbst RS, Gettinger SN, Moinpour CM. Quality-of-life outcomes and risk prediction for patients randomized to nivolumab plus ipilimumab vs nivolumab on LungMAP-S1400I. J Natl Cancer Inst 2023; 115:437-446. [PMID: 36625510 PMCID: PMC10086628 DOI: 10.1093/jnci/djad003] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 12/13/2022] [Accepted: 01/06/2023] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND An important issue for patients with cancer treated with novel therapeutics is how they weigh the effects of treatment on survival and quality of life (QOL). We compared QOL in patients enrolled to SWOG S1400I, a substudy of the LungMAP biomarker-driven master protocol. METHODS SWOG S1400I was a randomized phase III trial comparing nivolumab plus ipilimumab vs nivolumab for treatment of immunotherapy-naïve disease in advanced squamous cell lung cancer. The primary endpoint was the MD Anderson Symptom Inventory-Lung Cancer severity score at week 7 and week 13 with a target difference of 1.0 points, assessed using multivariable linear regression. A composite risk model for progression-free and overall survival was derived using best-subset selection. RESULTS Among 158 evaluable patients, median age was 67.6 years and most were male (66.5%). The adjusted MD Anderson Symptom Inventory-Lung Cancer severity score was 0.04 points (95% confidence interval [CI] = -0.44 to 0.51 points; P = .89) at week 7 and 0.12 points (95% CI = -0.41 to 0.65; P = .66) at week 13. A composite risk model showed that patients with high levels of appetite loss and shortness of breath had a threefold increased risk of progression or death (hazard ratio [HR] = 3.06, 95% CI = 1.88 to 4.98; P < .001) and that those with high levels of both appetite loss and work limitations had a fivefold increased risk of death (HR = 5.60, 95% CI = 3.27 to 9.57; P < .001)-compared with those with neither risk category. CONCLUSIONS We found no evidence of a benefit of ipilimumab added to nivolumab compared with nivolumab alone for QOL in S1400I. A risk model identified patients at high risk of poor survival, demonstrating the prognostic relevance of baseline patient-reported outcomes even in those with previously treated advanced cancer.
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Affiliation(s)
- Joseph M Unger
- SWOG Statistics and Data Management Center, Seattle, WA, USA
- Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Lu Qian
- SWOG Statistics and Data Management Center, Seattle, WA, USA
- Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Mary W Redman
- SWOG Statistics and Data Management Center, Seattle, WA, USA
- Fred Hutchinson Cancer Center, Seattle, WA, USA
| | | | - Lori Minasian
- Division of Cancer Prevention, National Cancer Institute, Community Oncology and Prevention Trials Group, Rockville, MD, USA
| | | | | | - Michael Leblanc
- SWOG Statistics and Data Management Center, Seattle, WA, USA
- Fred Hutchinson Cancer Center, Seattle, WA, USA
| | | | - Samuel A Dzingle
- SWOG Data Operations Center, Cancer Research and Biostatistics, Seattle, WA, USA
| | - Thomas J Summers
- Cookeville Regional Medical Center, Southeast NCORP, Cookeville, TN, USA
| | - Herta Chao
- Veterans Affairs Connecticut Healthcare System, Yale University School of Medicine, Massachusetts Veterans Epidemiology Research and Information Center, New Haven, CT, USA
| | - Sheshadri Madhusudhana
- University Health Truman Medical Center, University of Kansas Cancer Center—Midwest Cancer Alliance Rural MU National Cancer Institute Community Oncology Research Program, Kansas City, MO, USA
| | - Liza Villaruz
- University of Pittsburgh Medical Center Hillman Cancer Center, Pittsburgh, PA, USA
| | | | - Jhanelle E Gray
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Karen L Kelly
- University of California Davis Comprehensive Cancer Center, Sacramento, CA, USA
| | - David R Gandara
- University of California Davis Comprehensive Cancer Center, Sacramento, CA, USA
| | - Lyudmila Bazhenova
- University of California San Diego Moores Cancer Center, La Jolla, CA, USA
| | | | | | - Carol M Moinpour
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
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10
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Hu X, Walker MS, Stepanski E, Kaplan CM, Martin MY, Vidal GA, Schwartzberg LS, Graetz I. Racial Differences in Patient-Reported Symptoms and Adherence to Adjuvant Endocrine Therapy Among Women With Early-Stage, Hormone Receptor-Positive Breast Cancer. JAMA Netw Open 2022; 5:e2225485. [PMID: 35947386 PMCID: PMC9366541 DOI: 10.1001/jamanetworkopen.2022.25485] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
IMPORTANCE Adjuvant endocrine therapy (AET) reduces breast cancer recurrence, but symptom burden is a key barrier to adherence. Black women have lower AET adherence and worse health outcomes than White women. OBJECTIVE To investigate the association between symptom burden and AET adherence differences by race. DESIGN, SETTING, AND PARTICIPANTS A retrospective cohort study using electronic health records with patient-reported data from a large cancer center in the US. Patients included Black and White women initiating AET therapy for early-stage breast cancer from August 2007 to December 2015 who were followed for 1 year from AET initiation. Sixty symptoms classified into 7 physical and 2 psychological symptom clusters were evaluated. For each cluster, the number of symptoms with moderate severity at baseline, and symptoms with 3-point or greater increases during AET were counted. Adherence was measured as the proportion of days covered by AET during the first-year follow-up. Multivariable regressions for patients' adherence adjusting for race, symptom measures, sociodemographic characteristics, and clinical characteristics were conducted. Kitagawa-Blinder-Oaxaca decomposition was used to quantify racial differences in adherence explained by symptoms and patient characteristics. Analyses were conducted from July 2021 to January 2022. EXPOSURES Physical and psychological symptoms at baseline and changes during AET. RESULTS Among 559 patients (168 [30.1%] Black and 391 [69.9%] White; mean [SD] age 65.5 [12.1] years), Black women received diagnoses younger (mean [SD] age at diagnosis, 58.7 [13.7] vs 68.5 [10.0] years old) than White women, with more advanced stages (30 Black participants [17.9%] vs 31 White participants [7.9%] had stage III disease at diagnosis), and lived in areas with fewer adults attaining high school education (mean [SD], 78.8% [7.8%] vs 84.0% [9.3%]). AET adherence in the first year was 78.8% for Black and 82.3% for White women. Black women reported higher severity in most symptom clusters than White women. Neuropsychological, vasomotor, musculoskeletal, cardiorespiratory, distress, and despair symptoms at baseline and increases during the follow-up were associated with 1.2 to 2.6 percentage points decreases in adherence, which corresponds to 4 to 9 missed days receiving AET in the first year. After adjusting for psychological symptoms, being Black was associated with 6.5 percentage points higher adherence than being White. CONCLUSIONS AND RELEVANCE In this cohort study, severe symptoms were associated with lower AET adherence. Black women had lower adherence rates that were explained by their higher symptom burden and baseline characteristics. These findings suggest that better symptom management with a focus on psychological symptoms could improve AET adherence and reduce racial disparities in cancer outcomes.
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Affiliation(s)
- Xin Hu
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | | | | | - Cameron M. Kaplan
- Gehr Family Center for Health Systems Science and Innovation, Keck School of Medicine, University of Southern California, Los Angeles
| | - Michelle Y. Martin
- Center for Innovation in Health Equity Research, Department of Preventive Medicine, College of Medicine, University of Tennessee Health Science Center, Memphis
| | - Gregory A. Vidal
- West Cancer Center and Research Institute, Germantown, Tennessee
- Division of Hematology and Oncology, College of Medicine, University of Tennessee Health Science Center, Memphis
| | | | - Ilana Graetz
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, Georgia
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11
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Garcia SF, Gray RJ, Sparano JA, Tevaarwerk AJ, Carlos RC, Yanez B, Gareen IF, Whelan TJ, Sledge GW, Cella D, Wagner LI. Fatigue and endocrine symptoms among women with early breast cancer randomized to endocrine versus chemoendocrine therapy: Results from the TAILORx patient-reported outcomes substudy. Cancer 2022; 128:536-546. [PMID: 34614209 PMCID: PMC8776586 DOI: 10.1002/cncr.33939] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 07/17/2021] [Accepted: 07/23/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND TAILORx (Trial Assigning Individualized Options for Treatment) prospectively assessed fatigue and endocrine symptoms among women with early-stage hormone receptor-positive breast cancer and a midrange risk of recurrence who were randomized to endocrine therapy (E) or chemotherapy followed by endocrine therapy (CT+E). METHODS Participants completed the Functional Assessment of Chronic Illness Therapy-Fatigue, the Patient-Reported Outcomes Measurement Information System-Fatigue Short Form, and the Functional Assessment of Cancer Therapy-Endocrine Symptoms at the baseline and at 3, 6, 12, 24, and 36 months. Linear regression was used to model outcomes on baseline symptoms, treatment, and other factors. RESULTS Participants (n = 458) in both treatment arms reported greater fatigue and endocrine symptoms at early follow-up in comparison with the baseline. The magnitude of change in fatigue was significantly greater for the CT+E arm than the E arm at 3 and 6 months but not at 12, 24, or 36 months. The CT+E arm reported significantly greater changes in endocrine symptoms from the baseline to 3 months in comparison with the E arm; change scores were not significantly different at later time points. Endocrine symptom trajectories by treatment differed by menopausal status, with the effect larger and increasing for postmenopausal patients. CONCLUSIONS Adjuvant CT+E was associated with greater increases in fatigue and endocrine symptoms at early time points in comparison with E. These differences lessened over time, and this demonstrated early chemotherapy effects more than long-term ones. Treatment arm differences in endocrine symptoms were more evident in postmenopausal patients. LAY SUMMARY Participants in TAILORx (Trial Assigning Individualized Options for Treatment) with early-stage hormone receptor-positive breast cancer and an intermediate risk of recurrence were randomly assigned to endocrine or chemoendocrine therapy. Four hundred fifty-eight women reported fatigue and endocrine symptoms at the baseline and at 3, 6, 12, 24, and 36 months. Both groups reported greater symptoms at early follow-up versus the baseline. Increases in fatigue were greater for the chemoendocrine group than the endocrine group at 3 and 6 months but not later. The chemoendocrine group reported greater changes in endocrine symptoms in comparison with the endocrine group at 3 months but not later.
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Affiliation(s)
| | - Robert J. Gray
- Dana Farber Cancer Institute
- ECOG-ACRIN Biostatistics Center
| | | | | | | | | | - Ilana F. Gareen
- Center for Statistical Sciences & Department of Epidemiology, Brown University School of Public Health
- Center for Statistical Sciences & Department of Epidemiology, Brown University School of Public Health
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12
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Kaufmann TL, Rocque GB. Pathway to Precision Patient-Reported Outcomes. J Clin Oncol 2021; 39:3770-3772. [PMID: 34597155 DOI: 10.1200/jco.21.02163] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Gabrielle B Rocque
- Division of Hematology and Oncology, University of Alabama at Birmingham (UAB), Birmingham, AL.,Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham (UAB), Birmingham, AL
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13
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Reeder-Hayes KE, Troester MA, Wheeler SB. Adherence to Endocrine Therapy and Racial Outcome Disparities in Breast Cancer. Oncologist 2021; 26:910-915. [PMID: 34582070 DOI: 10.1002/onco.13964] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 09/02/2021] [Indexed: 11/10/2022] Open
Abstract
The disparity in outcomes of breast cancer for Black compared with White women in the U.S. is well known and persistent over time, with the largest disparities appearing among women with hormone receptor-positive (HR+) cancers. The racial gap in breast cancer survival first emerged in the 1980s, a time of significantmen treatment advances in early-stage breast cancer, including the introduction of adjuvant endocrine therapy. Since that time, the gap has continued to widen despite steady advances in treatment and survival of breast cancer overall. Although advanced stage at presentation and unfavorable biology undoubtedly contribute to racial differences in survival of HR+ breast, treatment disparities are increasingly acknowledged to play a key role as well. The recent recognition of racial differences in endocrine therapy use may be a key explanatory factor in the persistent racial gap in mortality of HR+ disease, and may be a key focus of intervention to improve breast cancer outcomes for Black women. IMPLICATIONS FOR PRACTICE: Black women with hormone receptor-positive breast cancer experience the greatest racial disparity in survival among all breast cancer subtypes. This survival gap appears consistently across studies and is not entirely explained by differences in presenting stage, tumor biology as assessed by genomic risk scores, or receipt of chemotherapy. Recent research highlights lower adherence to endocrine therapy (ET) for Black women. Health systems and individual providers should focus on improving communication about the importance of ET use, sharing decisions around ET, providing appropriate support for side effects and other ET-related concerns, and equitably delivering survivorship care, including ET adherence assessment.
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Affiliation(s)
- Katherine E Reeder-Hayes
- Division of Oncology, University of North Carolina-Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA.,University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina, USA
| | - Melissa A Troester
- Department of Epidemiology, UNC Gillings School of Global Public Health, Chapel Hill, North Carolina, USA.,University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina, USA
| | - Stephanie B Wheeler
- Department of Health Policy, UNC Gillings School of Global Public Health, Chapel Hill, North Carolina, USA.,University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina, USA
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14
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Wagner LI. Patient-Reported Outcomes Bridge an Important Gap in Identifying Risk for Early Endocrine Therapy Discontinuation. J Natl Cancer Inst 2021; 113:945-947. [PMID: 33585932 DOI: 10.1093/jnci/djab024] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 02/08/2021] [Indexed: 11/14/2022] Open
Affiliation(s)
- Lynne I Wagner
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston Salem, NC, USA
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