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Zheng D, Thomas J. Survival benefits associated with being adherent and having longer persistence to adjuvant hormone therapy across up to five years among U.S. Medicare population with breast cancer. Breast Cancer Res Treat 2023:10.1007/s10549-023-06992-2. [PMID: 37326766 DOI: 10.1007/s10549-023-06992-2] [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: 02/01/2023] [Accepted: 05/24/2023] [Indexed: 06/17/2023]
Abstract
PURPOSE To assess associations between adherence to and persistence with adjuvant hormone therapy and mortality among older women with breast cancer. METHODS The surveillance, epidemiology, and end results data linked with U.S. Medicare claims was used. This study included older women diagnosed with stage I-III hormone receptor-positive breast cancer from 2009 through 2017. Adherence was defined as having proportion of days covered (PDC) ≥ 0.80. Persistence was defined as having no discontinuation, i.e., no break of ≥ 180 continuous days. Length of persistence was calculated as time from therapy initiation to discontinuation. Cox models with time-dependent covariates were used to assess associations between adherence and persistence with mortality. RESULTS This study included 25,796 women. Adherence rates were 78.1 percent, 75.2 percent, 72.4 percent, 70.0 percent, and 61.5 percent from year 1 to year 5 after hormone therapy initiation. Persistence rates were 87.5 percent, 81.7 percent, 77.1 percent, 72.9 percent, and 68.9 percent through cumulative intervals of 1 year up to 5 years. Adherence was associated with all-cause mortality but not associated with breast cancer-specific mortality. Persistent women had lower risk of all-cause mortality and breast cancer-specific mortality. Each additional year of persistence had additional contributions to survival benefits (11% decreased risk of all-cause mortality and 37% decreased risk of breast cancer-specific mortality). CONCLUSION This study confirms the detrimental effect of nonadherence to adjuvant hormone therapy across up to 5 years on all-cause survival in older U.S. women. It also reveals the survival benefits associated with having longer persistence across up to 5 years.
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Affiliation(s)
- Dandan Zheng
- Department of Pharmacy Practice, College of Pharmacy, Purdue University, West Lafayette, IN, 47907, USA.
| | - Joseph Thomas
- Department of Pharmacy Practice, College of Pharmacy, Purdue University, West Lafayette, IN, 47907, USA
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2
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Fleming L, Agnew S, Peddie N, Crawford M, Dixon D, MacPherson I. The impact of medication side effects on adherence and persistence to hormone therapy in breast cancer survivors: A quantitative systematic review. Breast 2022; 64:63-84. [PMID: 35609380 PMCID: PMC9130570 DOI: 10.1016/j.breast.2022.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 04/26/2022] [Accepted: 04/27/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Hormone Therapy (HT) is recommended for most women with HR-positive primary breast cancer. When taken as intended, HT reduces breast cancer recurrence by 40% and mortality by one-third. The recommended duration of treatment ranges from 5 to 10 years depending on risk of recurrence and the specific HT regimen. However, recent data indicates that rates of HT non-adherence are high and research suggests this may be due to the impact of HT side effects. The contribution of side effects to non-adherence and non-persistence behaviours has rarely been systematically explored, thereby hindering the implementation of targeted intervention strategies. Our aim is to identify, evaluate and summarise the relationship between HT side effects and patterns of adherence and persistence. METHODS Electronic searches were conducted from inception and were completed by September 2021, utilising Cochrane CENTRAL, Medline, Embase, Web of Science and PsycINFO databases. Searches included a combination of terms related to breast cancer, adherence, hormone therapy and side effects. RESULTS Sixty-two eligible papers were identified and study quality varied by study type. Most observational and cross-sectional studies were rated good quality, whereas most controlled intervention studies were rated fair quality. Three studies were rated poor quality. The most frequently measured side effects were pain, low mood, hot flashes, insomnia, anxiety, fatigue, weight gain, concentration/memory problems. CONCLUSIONS This review identified a lack of consistency in the measurement of adherence and the definition of persistence across studies. The instruments used to measure side effects also varied significantly. This variation and lack of consistency makes it difficult to evaluate and summarise the role of HT side effects in HT adherence and persistence behaviour.
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Affiliation(s)
| | - Sommer Agnew
- University of Strathclyde, George Street, Glasgow, UK
| | - Nicola Peddie
- University of Strathclyde, George Street, Glasgow, UK
| | | | - Diane Dixon
- University of Aberdeen, Kings College, Aberdeen, UK
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3
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Font R, Buxó M, Ameijide A, Martínez JM, Marcos-Gragera R, Carulla M, Puigdemont M, Vilardell M, Civit S, Viñas G, Espinàs JA, Galceran J, Izquierdo Á, Borràs JM, Clèries R. Using population-based data to evaluate the impact of adherence to endocrine therapy on survival in breast cancer through the web-application BreCanSurvPred. Sci Rep 2022; 12:8097. [PMID: 35577853 PMCID: PMC9110408 DOI: 10.1038/s41598-022-12228-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 04/22/2022] [Indexed: 11/26/2022] Open
Abstract
We show how the use and interpretation of population-based cancer survival indicators can help oncologists talk with breast cancer (BC) patients about the relationship between their prognosis and their adherence to endocrine therapy (ET). The study population comprised a population-based cohort of estrogen receptor positive BC patients (N = 1268) diagnosed in Girona and Tarragona (Northeastern Spain) and classified according to HER2 status (+ / −), stage at diagnosis (I/II/III) and five-year cumulative adherence rate (adherent > 80%; non-adherent ≤ 80%). Cox regression analysis was performed to identify significant prognostic factors for overall survival, whereas relative survival (RS) was used to estimate the crude probability of death due to BC (PBC). Stage and adherence to ET were the significant factors for predicting all-cause mortality. Compared to stage I, risk of death increased in stage II (hazard ratio [HR] 2.24, 95% confidence interval [CI]: 1.51–3.30) and stage III (HR 5.11, 95% CI 3.46–7.51), and it decreased with adherence to ET (HR 0.57, 95% CI 0.41–0.59). PBC differences were higher in non-adherent patients compared to adherent ones and increased across stages: stage I: 6.61% (95% CI 0.05–13.20); stage II: 9.77% (95% CI 0.59–19.01), and stage III: 22.31% (95% CI 6.34–38.45). The age-adjusted survival curves derived from this modeling were implemented in the web application BreCanSurvPred (https://pdocomputation.snpstats.net/BreCanSurvPred). Web applications like BreCanSurvPred can help oncologists discuss the consequences of non-adherence to prescribed ET with patients.
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Affiliation(s)
- Rebeca Font
- Pla Director d'Oncología, IDIBELL, Av. Gran Vía 199-203, 08908, Hospitalet de Llobregat, Barcelona, Spain.,Institut d'Investigació Biomèdica de Bellvitge, IDIBELL, Av. Gran Via de L'Hospitalet, 199-203 - 1a planta, 08908, Hospitalet de Llobregat, Barcelona, Spain
| | - Maria Buxó
- Institut d'Investigació Biomèdica de Girona, IDIBGI, C/Dr.Castany S/N. Edifici M2. Parc Hospitalari Martí I Julià, 17190, Salt, Spain
| | - Alberto Ameijide
- Registre de Càncer de Tarragona, Servei d'Epidemiologia i Prevenció del Càncer, Hospital Universitari Sant Joan de Reus, IISPV, Reus, Spain
| | - José Miguel Martínez
- Department de Estadística I Investigació Operativa de La Universitat Politècnica de Catalunya. EDIFICI H, Diagonal 647, 08028, Barcelona, Spain.,Grupo de Investigación en Salud Pública, Universidad de Alicante, 03690, Alicante, Spain
| | - Rafael Marcos-Gragera
- Registre de Cáncer de Girona - Unitat d'Epidemiologia. Pla Director d'Oncologia. Institut Català d'Oncología. Grup d'Epidemiologia Descriptiva, Genètica I Prevenció del Càncer de Girona-IDIBGI, 17005, Girona, Spain.,Facultat de Medicina, Universitat de Girona (UdG), Girona, Spain.,Centro de Investigación Biomédica en Red: Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Marià Carulla
- Registre de Càncer de Tarragona, Servei d'Epidemiologia i Prevenció del Càncer, Hospital Universitari Sant Joan de Reus, IISPV, Reus, Spain
| | - Montse Puigdemont
- Registre de Cáncer de Girona - Unitat d'Epidemiologia. Pla Director d'Oncologia. Institut Català d'Oncología. Grup d'Epidemiologia Descriptiva, Genètica I Prevenció del Càncer de Girona-IDIBGI, 17005, Girona, Spain
| | | | - Sergi Civit
- Secció de Estadística del Departament de Genètica, Microbiología i Estadística de La Facultat de Biologia. Universitat de Barcelona, 08028, Barcelona, Spain
| | - Gema Viñas
- Servei d'Oncología Médica, Institut Català d'Oncología. Hospital Universitari de Girona Doctor Josep Trueta, 17005, Girona, Spain
| | - Josep A Espinàs
- Pla Director d'Oncología, IDIBELL, Av. Gran Vía 199-203, 08908, Hospitalet de Llobregat, Barcelona, Spain.,Institut d'Investigació Biomèdica de Bellvitge, IDIBELL, Av. Gran Via de L'Hospitalet, 199-203 - 1a planta, 08908, Hospitalet de Llobregat, Barcelona, Spain
| | - Jaume Galceran
- Registre de Càncer de Tarragona, Servei d'Epidemiologia i Prevenció del Càncer, Hospital Universitari Sant Joan de Reus, IISPV, Reus, Spain
| | - Ángel Izquierdo
- Registre de Cáncer de Girona - Unitat d'Epidemiologia. Pla Director d'Oncologia. Institut Català d'Oncología. Grup d'Epidemiologia Descriptiva, Genètica I Prevenció del Càncer de Girona-IDIBGI, 17005, Girona, Spain.,Servei d'Oncología Médica, Institut Català d'Oncología. Hospital Universitari de Girona Doctor Josep Trueta, 17005, Girona, Spain
| | - Josep M Borràs
- Pla Director d'Oncología, IDIBELL, Av. Gran Vía 199-203, 08908, Hospitalet de Llobregat, Barcelona, Spain.,Institut d'Investigació Biomèdica de Bellvitge, IDIBELL, Av. Gran Via de L'Hospitalet, 199-203 - 1a planta, 08908, Hospitalet de Llobregat, Barcelona, Spain.,Department de Ciències Clíniques de La Universitat de Barcelona, 08907, Barcelona, Spain
| | - Ramon Clèries
- Pla Director d'Oncología, IDIBELL, Av. Gran Vía 199-203, 08908, Hospitalet de Llobregat, Barcelona, Spain. .,Institut d'Investigació Biomèdica de Bellvitge, IDIBELL, Av. Gran Via de L'Hospitalet, 199-203 - 1a planta, 08908, Hospitalet de Llobregat, Barcelona, Spain. .,Department de Ciències Clíniques de La Universitat de Barcelona, 08907, Barcelona, Spain.
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Inotai A, Ágh T, Maris R, Erdősi D, Kovács S, Kaló Z, Senkus E. Systematic review of real-world studies evaluating the impact of medication non-adherence to endocrine therapies on hard clinical endpoints in patients with non-metastatic breast cancer. Cancer Treat Rev 2021; 100:102264. [PMID: 34388473 DOI: 10.1016/j.ctrv.2021.102264] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 07/27/2021] [Accepted: 07/28/2021] [Indexed: 11/30/2022]
Abstract
Breast cancer, one of the most common malignancies, is associated with significant economic and health burden both at the patient and societal level. Although medication non-adherence to endocrine breast cancer therapies is common, so far only limited systematic evidence has been available on its quantitative consequences, as previous systematic reviews focused mainly on factors contributing to medication non-adherence. The objective of this review was to explore the implications of medication non-adherence to endocrine therapies on hard clinical outcomes in breast cancer based on real-world studies. A systematic literature review was conducted on PubMed; empirical evidence on hard clinical endpoints (i.e., survival, disease-free survival, metastasis and recurrence) were extracted from uni- or multivariate statistical analyses from retrospective or prospective cohort studies. Of the 2,360 identified records, 12 studies met the inclusion criteria. Two studies identified significant positive association between medication non-adherence and the risk of distant metastasis, three articles between medication non-adherence and the recurrence of breast cancer, two studies between medication non-adherence- and non-persistence and of worse disease-free survival and eight articles between medication non-adherence and mortality. There was only one study where the positive association between medication adherence and survival did not apply to all subgroups. The strong evidence on the negative health consequences of non-adherence to breast cancer treatments indicates the need for the regular monitoring of medication adherence. Furthermore, explicit inclusion of adherence enhancing interventions into health policy agenda would be warranted to improve medication adherence also at a system level.
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Affiliation(s)
- András Inotai
- Semmelweis University, Center for Health Technology Assessment, Budapest, Hungary; Syreon Research Institute, Budapest, Hungary.
| | - Tamás Ágh
- Syreon Research Institute, Budapest, Hungary.
| | | | - Dalma Erdősi
- Semmelweis University, Center for Health Technology Assessment, Budapest, Hungary; University of Pécs, Faculty of Pharmacy, Department of Pharmacoeconomics, Pécs, Hungary.
| | - Sándor Kovács
- Syreon Research Institute, Budapest, Hungary; University of Pécs, Faculty of Pharmacy, Department of Pharmacoeconomics, Pécs, Hungary.
| | - Zoltán Kaló
- Semmelweis University, Center for Health Technology Assessment, Budapest, Hungary; Syreon Research Institute, Budapest, Hungary.
| | - Elżbieta Senkus
- Department of Oncology and Radiotherapy, Medical University of Gdańsk, Gdańsk, Poland.
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5
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Shah CH, Balkrishnan R, Diaby V, Xiao H. Examining factors associated with adherence to hormonal therapy in breast cancer patients. Res Social Adm Pharm 2020; 16:574-582. [DOI: 10.1016/j.sapharm.2019.08.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 07/30/2019] [Accepted: 08/01/2019] [Indexed: 12/14/2022]
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6
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Iioka Y, Iwata T, Yamauchi H. Symptoms and QOL in breast cancer patients receiving hormone therapy in Japan. Breast Cancer 2019; 27:62-69. [PMID: 31297685 DOI: 10.1007/s12282-019-00993-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 07/01/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND The aim was to clarify subjective symptoms and quality of life (QOL) in breast cancer patients receiving hormone therapy. METHODS After obtaining approval from the research ethics committee, an observational study using a self-administered questionnaire was conducted at outpatient clinical oncology offices in 3 facilities that targeted breast cancer patients under the age of 50 who had been undergoing hormone therapy for less than 1 year. The study examined elements such as the breast cancer patients' basic information, symptoms, pain in daily life, QOL, and depression/anxiety. RESULTS There were 214 valid responses. The respondents had an average age of 43.6. Of them, 100% were also treated with Tamoxifen and 30% with LH-RH agonist. There were 75% who were cognizant of side effects. Difficult symptoms that occurred with high frequency were stiff shoulders/back pain, decreased physical strength, hot flashes, and sweating. Over half the respondents were uncertain as to whether the subjective symptoms were side effects. They lost confidence in their physical strength and felt distressed over weight gain. There were 51 with a HADS anxiety score of 8 or higher, and 46 who scored 8 points or higher for depression. CONCLUSION Breast cancer patients undergoing hormone therapy experience a variety of pains, and some also have serious psychological symptoms. Reassessing support systems to examine screening and self-care support is an issue going forward.
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Affiliation(s)
- Yukiko Iioka
- Graduate Course of Health and Social Services, Saitama Prefectural University, 820 San-Nomiya, Koshigaya-shi, Saitama, 343-8540, Japan.
| | - Takako Iwata
- Department of Breast Center, St Luke's International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo, 104-8560, Japan
| | - Hideko Yamauchi
- Department of Breast Center, St Luke's International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo, 104-8560, Japan
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7
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Sheppard VB, He J, Sutton A, Cromwell L, Adunlin G, Salgado TM, Tolsma D, Trout M, Robinson BE, Edmonds MC, Bosworth HB, Tadesse MG. Adherence to Adjuvant Endocrine Therapy in Insured Black and White Breast Cancer Survivors: Exploring Adherence Measures in Patient Data. J Manag Care Spec Pharm 2019; 25:578-586. [PMID: 31039059 PMCID: PMC6758918 DOI: 10.18553/jmcp.2019.25.5.578] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Adjuvant endocrine therapy (AET) is a critical therapy in that it improves survival in women with hormone receptor-positive (HR+) breast cancer (BC), but adherence to AET is suboptimal. The purpose of this study was to fill scientific gaps about predictors of adherence to AET among black and white women diagnosed with BC. OBJECTIVE To assess AET adherence in black and white insured women using multiple measures, including one that uses an innovative statistical approach. METHODS Black and white women newly diagnosed with HR+ BC were identified from 2 health maintenance organizations. Pharmacy records captured the type of oral AET prescriptions and all fill dates. Multivariable logistic regression was used to identify predictors of adherence defined in terms of proportion of days covered (PDC; ≥ 80%) and medication gap of ≤ 10 days. A zero-inflated negative binomial (ZINB) regression model was used to identify variables associated with the total number of days of medication gaps. RESULTS 1,925 women met inclusion criteria. 80% were PDC adherent (> 80%); 44% had a medication gap of ≤ 10 days; and 24% had no medication gap days. Race and age were significant in all multivariable models. Black women were less likely to be adherent based on PDC than white women (OR = 0.72, 95% CI = 0.57-0.90, P < 0.01), and they were less likely to have a medication gap of ≤ 10 days (OR = 0.65, 95% CI = 0.54-0.79, P < 0.001). Women aged 25-49 years were less likely to be PDC adherent than women aged 65-93 years (OR = 0.65, 95% CI = 0.48-0.87, P < 0.001). In the ZINB model, women were without their medication for an average of 37 days (SD = 50.5). CONCLUSIONS Racial disparities in adherence to AET in the study highlight a need for interventions among insured women. Using various measures of adherence may help better understand this multidimensional concept. There might be benefits from using both more common dichotomous measures (e.g., PDC) and integrating novel statistical approaches to allow tailoring adherence to patterns within a specific sample. DISCLOSURES This research was funded by the National Institutes of Health (R01CA154848). It was also supported in part by the NIH-NCI Cancer Center Support Grant P30 CA016059, the Laboratory of Telomere Health P30 CA51008, and the TSA Award No. UL1TR002649 from the National Center for Advancing Translational Sciences. The contents of this study are solely the responsibility of the authors and do not necessarily represent official views of the National Center for Advancing Translational Sciences or the National Institutes of Health. Bosworth reports grants from Sanofi, Otsuka, Johnson & Johnson, and Blue Cross/Blue Shield of NC and consulting fees from Sanofi and Otsuka. The other authors have nothing to disclose. The datasets generated during and/or analyzed during the current study are not publicly available due to privacy reasons but are available from the corresponding author on reasonable request. The author does not own these data. Data use was granted to the author as part of a data use agreement between specific agencies and organizations.
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Affiliation(s)
- Vanessa B. Sheppard
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine and VCU Massey Cancer Center, Richmond, Virginia
| | - Jun He
- Department of Health Behavior and Policy and Department of Biostatistics, Virginia Commonwealth University School of Medicine
| | - Arnethea Sutton
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine and VCU Massey Cancer Center, Richmond, Virginia
| | - Lee Cromwell
- Kaiser Permanente Center for Research and Evaluation, Atlanta, Georgia
| | | | - Teresa M. Salgado
- Department of Pharmacotherapy & Outcomes Science, Virginia Commonwealth University School of Pharmacy
| | - Dennis Tolsma
- Kaiser Permanente Center for Research and Evaluation, Atlanta, Georgia
| | - Martha Trout
- Southeast Permanente Medical Group, Atlanta, Georgia
| | | | - Megan C. Edmonds
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | | | - Mahlet G. Tadesse
- Department of Mathematics and Statistics, Georgetown University, Washington, DC
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Suskin J, Shapiro CL. Osteoporosis and musculoskeletal complications related to therapy of breast cancer. Gland Surg 2018; 7:411-423. [PMID: 30175057 DOI: 10.21037/gs.2018.07.05] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Aromatase inhibitors (AIs) are the treatment of choice for the majority of postmenopausal women with estrogen receptor (ER) positive breast cancers in early and advanced stage settings. One of most frequent side effects of AIs is bone loss that is of sufficient magnitude to increase risk of osteoporotic fractures. Osteoporosis is primarily a complex genetic disease with few modifiable risk factors. As the lifespan increases, and breast mortality decreases, more women with breast cancer will be at risk of osteoporotic fractures, or falls that result in fractures. The screening, prevention, and treatment of osteoporosis do not differ in women with or without breast cancer. Rather, breast cancer treatments, including AIs, chemotherapy-induced ovarian failure, and gonadotropin-releasing hormone (GnRH) agonists, all decrease estrogen, which causes net bone resorption, leading some women to experience fracture. Occurring in about fifty-percent of women, AI-induced arthralgia is one of the most common side effects, and causes of nonadherence and discontinuation. Registry studies show that nonadherence and discontinuation may contribute to higher breast cancer mortality. Thus, understanding the mechanisms, risk factors, and interventions to mitigate symptoms of AI-induced arthralgia is a high priority.
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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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10
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Provider perspectives on barriers and facilitators to adjuvant endocrine therapy-related symptom management. Support Care Cancer 2017; 25:3723-3731. [PMID: 28681126 DOI: 10.1007/s00520-017-3799-0] [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: 02/10/2017] [Accepted: 06/12/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE Adjuvant endocrine therapy (AET) utilization is linked to improved clinical outcomes among breast cancer survivors (BCS); yet, AET adherence rates remain suboptimal. Little is known about provider perspectives regarding barriers and facilitators to AET-related symptom management (SM). In this study, we examined provider perspectives on the barriers and facilitators to AET-related SM among BCS and opportunities for improvement. METHODS We conducted three focus groups (FGs) with a multidisciplinary group of healthcare providers (n = 13) experienced in caring for BCS undergoing AET. We utilized semi-structured discussion guides to elicit provider perspectives on AET-related SM. FGs were audiotaped, transcribed, and analyzed using qualitative software to identify key themes. RESULTS Providers described patient-, provider-, and system-level barriers and facilitators to AET-related SM. At the patient-level, barriers included competing demands, limited time/resources, and possible misattribution of some symptoms to AET, while family/social relationships and insurance emerged as important facilitators. Discomfort with SM, limited time, and challenges distinguishing AET-related symptoms from other conditions were key provider-level barriers. Provider-level facilitators included routine symptom documentation and strong provider relationships. Care fragmentation and complexity of the cancer care delivery system were described as system-level barriers; however, survivor clinics were endorsed by providers. CONCLUSIONS Provider perspectives on AET-related SM can shed light on SM barriers and facilitators spanning multiple levels of the cancer care delivery system. Strategies for improving AET-related SM in BCS include increasing patients' knowledge and engagement in SM, equipping providers with efficient SM strategies, and improving coordination of symptom-related services through survivorship programs.
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11
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Tan X, Camacho TF, LeBaron VT, Blackhall LJ, Balkrishnan R. Opioid use among female breast cancer patients using different adjuvant endocrine therapy regimens. Breast Cancer Res Treat 2017. [PMID: 28639031 DOI: 10.1007/s10549-017-4348-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE To explore differences in opioid use across different adjuvant endocrine therapy (AET) regimens, factors associated with opioid use, and the impact of opioid use on overall survival in female breast cancer patients treated with AET. METHODS This retrospective study analyzed 2006-2012 SEER-Medicare datasets, following patients for at least two years from the index date, defined as the first date they filled an AET prescription. The study included adult women with incident, primary, hormone-receptor-positive, stage I-III breast cancer. They were also first-time AET users, and fee-for-service Medicare enrollees continuously enrolled in Medicare Parts A, B, and D. The main independent variable was the AET regimen. We measured whether patients used opioids after the initiation of AET. RESULTS After the adjustment of inverse probability treatment weights and unbalanced covariates, the average treatment effect probabilities of opioid use were similar between those who used aromatase inhibitors (AI) only and those used tamoxifen (TAM) only (56.2 vs. 55.3%, respectively). Opioid use probabilities for those who switched from AI to TAM were higher than those for the TAM-only and AI-only groups. Opioid use was also significantly associated with AET non-adherence. Opioid users had a significantly higher risk of death (adjusted hazard ratio [HR] = 1.59, p < 0.001). CONCLUSIONS Switching from AI to TAM was associated with a high likelihood of opioid use. Opioid use was significantly associated with AET non-adherence and higher risk of mortality in female Medicare beneficiaries with breast cancer even after adjusting for adherence.
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Affiliation(s)
- Xi Tan
- Department of Pharmaceutical Systems and Policy, School of Pharmacy, West Virginia University, Morgantown, WV, USA
| | - Tareq Fabian Camacho
- Department of Public Health Sciences, School of Medicine, University of Virginia, 560 Ray C. Hunt Drive, Charlottesville, VA, 22903, USA
| | - Virginia T LeBaron
- Department of Acute & Specialty Care, School of Nursing, University of Virginia, Charlottesville, VA, USA
| | - Leslie J Blackhall
- Department of Internal Medicine, School of Medicine, University of Virginia, Charlottesville, VA, USA
| | - Rajesh Balkrishnan
- Department of Public Health Sciences, School of Medicine, University of Virginia, 560 Ray C. Hunt Drive, Charlottesville, VA, 22903, USA.
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Camacho FT, Tan X, Alcalá HE, Shah S, Anderson RT, Balkrishnan R. Impact of patient race and geographical factors on initiation and adherence to adjuvant endocrine therapy in medicare breast cancer survivors. Medicine (Baltimore) 2017; 96:e7147. [PMID: 28614244 PMCID: PMC5478329 DOI: 10.1097/md.0000000000007147] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
To evaluate variations in the use of adjuvant endocrine therapy (AET) by race and geography, this research examined their influence on initiation and adherence to AET in female Medicare enrollees with breast cancer, diagnosed between 2007 and 2011.Using SEER (Surveillance, Epidemiology, and End Results Program)-Medicare data from 2007 to 2001, logistic regressions with random intercept for county of residence were used to predict AET initiation during 1st year and AET adherence assessed by the medication possession ratio (MPR) during year after initiation in a sample of fee-for-service medicare beneficiaries. Part D enrollment was required for the examination of adherence. Independent variables examined were race (black, white, or other) and geographical indicators (area deprivation, non-metropolitan status, and physician shortage).Overall, 23% of patients did not initiate AET within 1 year and 26% of the initiation sample was not adherent to AET, with average follow-up time among initiators of 141 days and an average MPR of 0.84. Significant heterogeneity (P < .01) was found between SEER sites, with initiation rates as low as 69% for Washington and as high as 81% for New Jersey; MPR adherence varied from 77% in New Jersey to 68% in Utah.Blacks had lower initiation, enrollees not in Medicaid had lower adherence, lower area deprivation counties had lower initiation, earlier SEER-Medicare years had both later initiation and nonadherence, and significant (P < .05) variations between SEER sites remained after accounting for area deprivation index, metropolitan status, and physician shortage. Subgroup analysis showed particular pockets of lower initiation for blacks with stage III tumors, on chemotherapy and lower adherence for blacks in youngest age group, with stage III tumors, tamoxifen use and blacks/others in oldest age group.Black women and women living in states with more rurality in the United States were less likely to receive guideline-recommended AET, which necessitates future efforts to alleviate these disparities to improve AET use and ultimately pursue more survival gains through optimizing adjuvant treatment use among cancer survivors.
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Affiliation(s)
- Fabian T. Camacho
- Department of Public Health Science, University of Virginia School of Medicine
| | - Xi Tan
- West Virginia, School of Pharmacy, Charlottesville, VA
| | - Héctor E. Alcalá
- Department of Public Health Science, University of Virginia School of Medicine
| | - Surbhi Shah
- University of Georgia, College of Pharmacy, Athens, GA
| | - Roger T. Anderson
- Department of Public Health Science, University of Virginia School of Medicine
| | - Rajesh Balkrishnan
- Department of Public Health Science, University of Virginia School of Medicine
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Lin B, Zhang L, Li D, Sun H. MED23 in endocrinotherapy for breast cancer. Oncol Lett 2017; 13:4679-4684. [PMID: 28588722 PMCID: PMC5452902 DOI: 10.3892/ol.2017.6036] [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: 07/29/2016] [Accepted: 02/21/2017] [Indexed: 12/29/2022] Open
Abstract
We investigated the role of the transcriptional mediator subunit 23 (MED23) in everolimus drug resistance, invasion and metastasis during breast cancer treatment and its molecular mechanism. We also evaluated the endocrinotherapy and prevention method for breast cancer. Breast cancer cell strains were established that can continuously express MED23, as well as inducible MED23-shRNA expression plasmids. The inductive agent, doxycycline (Dox), was added to the water for long-term silencing of MED23 in intratumoral cells. We conducted experiments on the role of MED23 in the regulation of invasion and metastasis of breast cancer using cell culture, western blotting, MTT proliferation experiment, fluorescent quantitative PCR and chromatin immunoprecipitation (ChIP). The silencing of MED23 significantly inhibited cellular growth and proliferation as well as soft agar cloning. Silencing of MED23 strengthened the sensitivity of the everolimus-resistant breast cancer cell strains BT474 and MCF-7/ADM cells to everolimus medication. The silencing of MED23, in combination with everolimus, inhibits the cell cycle progress of breast cancer cells. ChIP indicated that the mutual regulation of HER2 and MED23 also participates in the formation of the everolimus drug resistance mechanism. Therefore, MED23 plays an important role in everolimus drug resistance, invasion, and metastasis of breast cancer. As a potential molecular therapeutic target of breast cancer, MED23 overcomes drug resistance in clinical endocrinotherapy and controls the distal relapse and metastasis in breast cancer by the targeted silencing of MED23.
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Affiliation(s)
- Benrui Lin
- Department of General Surgery, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, Liaoning 121000, P.R. China
| | - Lan Zhang
- Department of Thoracic Surgery, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, Liaoning 121000, P.R. China
| | - Dinuo Li
- Department of General Surgery, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, Liaoning 121000, P.R. China
| | - Hongzhi Sun
- Department of General Surgery, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, Liaoning 121000, P.R. China
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Tan X, Camacho F, Marshall VD, Donohoe J, Anderson RT, Balkrishnan R. Geographic disparities in adherence to adjuvant endocrine therapy in Appalachian women with breast cancer. Res Social Adm Pharm 2016; 13:796-810. [PMID: 27641308 DOI: 10.1016/j.sapharm.2016.08.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 07/07/2016] [Accepted: 08/15/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND Appalachia is a largely rural, mountainous, poor and underserved region of the United States. Adherence to adjuvant endocrine therapy among Appalachian women with breast cancer is suboptimal. OBJECTIVES To explore small-area geographic variations and clustering patterns of breast cancer patient adherence to adjuvant endocrine therapy and associated factors in Appalachia. METHODS In this retrospective study, we analyzed Medicare claims data linked with cancer registries from four Appalachian states (PA, OH, KY, and NC) in 2006-2008. We included adult women who were diagnosed with stage I-III, hormone-receptor positive, primary breast cancer and who newly started adjuvant endocrine therapy after the primary treatment for breast cancer. Hot spot analysis was conducted to explore geographic variations in adjuvant endocrine therapy adherence. Geographically weighted logistic regression (GWLR) was used to examine whether the impacts of factors associated with adherence varied across the region. RESULTS Breast cancer patients living in PA and OH showed higher adherence to adjuvant endocrine therapy than those living in KY and NC. We identified clusters of high adherence in most of PA but poor adherence in Erie County, PA and in Buncombe, Transylvania, Henderson, and Polk Counties, NC. Adherence to adjuvant endocrine therapy was significantly associated with the Health Professional Shortage Area designation, catastrophic coverage, dual-eligibility status of Medicaid and Medicare, adjuvant endocrine therapy drug class, and side effects. And among these factors, the impacts of dual-eligibility status and the use of pain medications to treat side effects on adherence were more pronounced in KY and NC than in PA. CONCLUSIONS There were significant geographic disparities in adherence to adjuvant endocrine therapy in the Appalachian counties in PA, OH, KY, and NC. This study explored these geographic areas with poor adherence as well as geographically varying effects of predictors on adherence; our results may provide more localized information that may be used to improve adjuvant therapy use and breast cancer care in these high-risk and underserved areas.
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Affiliation(s)
- Xi Tan
- West Virginia University, School of Pharmacy, Robert C. Byrd Health Sciences Center-North, P.O. Box 9510, Morgantown, WV 26505, USA
| | - Fabian Camacho
- University of Virginia, School of Medicine, P.O. Box 800717, Charlottesville, VA 22908, USA
| | - Vincent D Marshall
- University of Michigan, College of Pharmacy, 428 Church Street, Ann Arbor, MI 48105, USA
| | - Joseph Donohoe
- Mountain-Pacific Quality Health, 3404 Cooney Drive, Helena, MT 59602, USA
| | - Roger T Anderson
- University of Virginia, School of Medicine, P.O. Box 800717, Charlottesville, VA 22908, USA
| | - Rajesh Balkrishnan
- University of Virginia, School of Medicine, P.O. Box 800717, Charlottesville, VA 22908, USA.
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Tan X, Feng X, Chang J, Higa G, Wang L, Leslie D. Oral antidiabetic drug use and associated health outcomes in cancer patients. J Clin Pharm Ther 2016; 41:524-31. [PMID: 27453485 DOI: 10.1111/jcpt.12430] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2016] [Accepted: 07/06/2016] [Indexed: 12/19/2022]
Affiliation(s)
- X. Tan
- School of Pharmacy; West Virginia University; Morgantown WV USA
| | - X. Feng
- School of Pharmacy; West Virginia University; Morgantown WV USA
| | - J. Chang
- School of Pharmacy; University of Texas; El Paso TX USA
| | - G. Higa
- School of Pharmacy; West Virginia University; Morgantown WV USA
| | - L. Wang
- Public Health Sciences; Penn State University College of Medicine; Hershey PA USA
| | - D. Leslie
- Public Health Sciences; Penn State University College of Medicine; Hershey PA USA
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Neugut AI, Hillyer GC, Kushi LH, Lamerato L, Buono DL, Nathanson SD, Bovbjerg DH, Mandelblatt JS, Tsai WY, Jacobson JS, Hershman DL. A prospective cohort study of early discontinuation of adjuvant chemotherapy in women with breast cancer: the breast cancer quality of care study (BQUAL). Breast Cancer Res Treat 2016; 158:127-138. [PMID: 27287779 PMCID: PMC5492513 DOI: 10.1007/s10549-016-3855-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 06/03/2016] [Indexed: 10/21/2022]
Abstract
For many women with non-metastatic breast cancer, adjuvant chemotherapy prevents recurrence and extends survival. Women who discontinue chemotherapy early may reduce those benefits, but little is known about what predicts early discontinuation. We sought to determine prospectively the rate and reasons for early discontinuation of adjuvant chemotherapy in women with breast cancer. We conducted a prospective cohort study among three U.S. health care organizations. Of 1158 women with newly diagnosed non-metastatic breast cancer, 2006-2010, we analyzed 445 (38.4 %) patients who initiated standard adjuvant chemotherapy as defined by accepted guidelines. We interviewed patients at baseline and twice during treatment regarding sociodemographic/psychosocial factors and treatment decision-making and collected clinical data. They were categorized according to the number of cycles required by the chemotherapy regimen they had initiated. The outcome was early discontinuation (<80 % of planned cycles). Of patients analyzed, 392 (88.1 %) completed the prescribed therapy. The strongest predictor was receipt of a regimen entailing >4 cycles of therapy (18.1 % for longer regimens, 7.4 % for 4 cycles) (odds ratio [OR] 2.59, 95 % CI 1.32-5.08), controlling for race, age, stage, hormone receptor status, social support, optimism, spirituality, stress, and physical symptoms. Higher levels of psychological symptoms on the Memorial symptom assessment scale also increased the odds of early discontinuation (OR 1.92, 95 % CI 0.998-3.68). The large majority of patients who initiated adjuvant chemotherapy for breast cancer completed their prescribed regimens, but early discontinuation was associated with lengthier regimens and, with borderline statistical significance, for those with psychological side effects.
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Affiliation(s)
- Alfred I Neugut
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY, USA.
- Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons, Columbia University, New York, NY, USA.
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.
- Columbia University Medical Center, 722 W 168th Street, Room 725, New York, NY, 10032, USA.
| | - Grace Clarke Hillyer
- Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Lawrence H Kushi
- Division of Research, Kaiser Permanente of Northern California, Oakland, CA, USA
| | - Lois Lamerato
- Department of Public Health Sciences, Henry Ford Health System, Detroit, MI, USA
| | - Donna L Buono
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | | | - Dana H Bovbjerg
- Departments of Psychiatry, Psychology and Behavioral & Community Health Sciences, University of Pittsburgh, University of Pittsburgh Cancer Institute, Pittsburgh, PA, USA
| | - Jeanne S Mandelblatt
- Department of Oncology and Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
| | - Wei-Yann Tsai
- Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Judith S Jacobson
- Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Dawn L Hershman
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
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