Fatores associados à adesão e à persistência na hormonioterapia em mulheres com câncer de mama

Digging in real-word electronic database for assessing CDK 4/6 inhibitors adherence in breast cancer patients from Romania

Introduction: It is imperative for patients to respect the prescribed treatments to achieve the anticipated clinical outcomes, including the outpatients receiving oral anti-cancer drugs such as selective cyclin-dependent kinase 4/6 inhibitors (CDK 4/6i). With the introduction of three CDK 4/6i drugs in the Romanian pharmaceutical market in 2018, our study aimed to evaluate medication adherence and the influencing factors among patients undergoing treatment with palbociclib, ribociclib, or abemaciclib for advanced or metastatic breast cancer. Methods: Medication adherence was assessed using the Proportion of Days Covered (PDC) method, and Spearman correlation analysis was conducted to explore the relationships between adherence, age, gender, and follow-up duration. Results: The study enrolled 330 breast cancer patients, with an average follow-up period of 14.6 ± 12.5 months for palbociclib, 10.6 ± 7.1 months for ribociclib, and 8.6 ± 6.4 months for abemaciclib-treated patients. A small proportion of patients demonstrated non-adherence: 12.8% for palbociclib, 14.6% for ribociclib, and 14.7% for abemaciclib. Among patients receiving palbociclib, there was no significant correlation between adherence, age (rho = 0.07, p = 0.35), or gender (rho = -0.144, p = 0.054). However, a significant correlation was found with the duration of follow-up (rho = -0.304, p < 0.0001). Similar results were observed for patients receiving ribociclib or abemaciclib. Most patients received combination therapy with letrozole (46%) and exemestane (13%) for palbociclib, letrozole (48%) and fulvestrant (19%) for ribociclib, and fulvestrant (39%) and letrozole (27%) for abemaciclib, Discussion: High adherence rates were observed among patients treated with CDK 4/6i drugs, with no significant differences noted among the three drugs in this class. However, the collected patient data was limited, lacking information on adverse reactions that could potentially lead to treatment discontinuation, as determined by the oncologist's decision not to prescribe. Consequently, a comprehensive understanding of all factors contributing to the low adherence levels is hindered.

Adherence to Chemotherapy and Associated Factors Among Patients With Cancer in Amhara Region, Northeastern Ethiopia, 2022. A Cross-Sectional Study

BACKGROUND

Cancer is the leading cause of death worldwide, and poor adherence to chemotherapy has become a public health issue in developing countries, including Ethiopia.

OBJECTIVE

To assess chemotherapy adherence and associated factors among patients with cancer in the Amhara Region, Northeast Ethiopia.

METHODS

A hospital-based prospective cross-sectional study design was employed, and a total of 460 cancer patients were enrolled using a systematic random sampling method at Felege Hiwot and Dessie comprehensive specialized hospitals from May 15, 2022, to July 15, 2022, in the Amhara region. The data was gathered through a review of medical records and a face-to-face interview and entered into Epi-Data version 4.6 before being exported to SPSS version 26 for analysis. Furthermore, at 95% confident interval (CI), multivariable binary logistic regression was used, and variables with P-values of <.05 were found to be significant.

RESULT

The overall response rate in this study was 94.1% (433), with 42.3% of patients adhering to chemotherapy. Moreover, having a family history of cancer [AOR = 3.58, 95% CI (2.22, 5.76)], being female [Adjusted Odds ratio (AOR) = 2.17, 95% CI: (1.31, 3.60)], having no history of comorbidity [AOR = 2.74, 95% CI (1.56, 4.81)], having side effects from chemotherapy [AOR = 3.50, 95% CI (1.55, 7.90)], and having social support [AOR = 1.52, 95% CI (1.21, 1.95)] were important predictors of chemotherapy adherence.

CONCLUSION

and recommendations: Patients' understanding of illness characteristics and treatment should be improved through health education. Involving family members in the treatment plan will also improve adherence to chemotherapy in this context.

Factors influencing five-year adherence to adjuvant endocrine therapy in breast cancer patients: A systematic review

Purpose

This systematic review aimed to determine the rate and identify correlates of adherence and persistence over five years of treatment with adjuvant endocrine therapy in female breast cancer patients.

Methods

Relevant articles were identified from Medline, Embase, AMED, PsycINFO, International Pharmaceutical Abstracts, and APA PsycArticles. Studies that measured patient adherence in the implementation or persistence phase for a period of at least five years using objective or multiple measures of adherence and investigated correlates of adherence were included. The titles, abstracts and full articles were screened and reviewed by two authors and any discrepancies were discussed with a third author.

Results

Twenty-six studies were included. Mean rate of adherence at five-year for implementation phase was 66.2% (SD = 17.3%), and mean persistence was 66.8% (SD = 14.5%). On average, adherence decreased by 25.5% (SD = 9.3%) from the first to fifth year. Higher rate of adherence was observed through self-report in comparison to database or medical record. Older age, younger age, higher comorbidity index, depression and adverse effects were associated with lower adherence. Treatment with aromatase inhibitors, received chemotherapy, and prior medication use were associated with improved adherence.

Conclusion

Adherence to adjuvant endocrine therapy decreased from the first to fifth year of treatment. On average, one-third of patients were not adherent to treatment by the fifth year. Nineteen recurring factors were found to be significantly associated with long-term adherence in multiple studies. Further research using objective or multiple measures of adherence are needed to improve validity of results.

•

On average, adherence fell by 25.5% from the first to the fifth year of treatment.

•

Self-reported adherence may overestimate patient adherence.

•

Nineteen recurring factors were associated with adherence.

•

Having adverse effects was negatively associated with adherence.

Imidazolidine Derivatives in Cancer Research: What is known?

Even though cancer is the second leading cause of death globally, a number of open issues persist in cancer treatment, despite the achievements of the field. This review aims at discussing the fundamental role of Imidazolidine derivatives in the industry of cancer treatment. Compelling data from 1996 to 2021 will introduce Imidazolidine derivatives as a relevant tool to modulate cancer progression.

The role of the clinical pharmacist in guiding adjuvant hormonal therapy in patients with breast cancer

Breast cancer is the most prevalent type of cancer among women, affecting about 2.1 million worldwide and is responsible for the highest number of cancer-related deaths among women. Approximately 80% of breast cancers express on the surface of hormone receptor cells, such as progesterone and estrogen. In these cases, Adjuvant Hormonal Therapy (AHT) is indicated for a period of five to ten years and consists of taking a daily oral pill. The two most used drugs in AHT are tamoxifen and Aromatase Inhibitors. One of the issues most faced by individuals who are subjected to long periods of treatment is the lack of medication adherence and, consequently, therapeutic inefficiency. It is believed that the monitoring by the pharmacist can contribute to the reduction of errors inherent to the medication, making the treatment more effective and improving the patient's quality of life. The present study aimed to know the perception of patients who live with breast cancer and who do AHT in relation to the educational performance of the clinical pharmacist. This is a qualitative, descriptive and exploratory study, carried out from March to October 2020, with 15 women undergoing treatment at the oncology unit of a tertiary-care hospital in south of Brazil. The data were obtained through a semi-structured interview using an instrument composed of two parts, one referring to the characterization of the participants and the other with the guiding question of the research: "How do you perceive the role of the pharmacist in relation to the guidelines for the use of adjuvant hormonal therapy?". The method of theoretical saturation was used to perform the sample closure and the thematic analysis was used to analyze the data. The participants were between 32 and 74 years old, seven were on tamoxifen therapy and eight on anastrozole, ten were on the first year of treatment, two on the second and three on the third year. The themes that emerged were: pharmacist-patient interaction as a safety factor in hormone therapy; role of the pharmacist in the development of strategies for self-management of the patients during hormone therapy; and, challenges for the pharmacist in relation to hormone therapy through continued guidance. It was evident that the pharmacist's educational action encouraged the participants to carry out the treatment in a more confident and assertive manner according to their particularities and beliefs.

Using data mining technology to predict medication-taking behaviour in women with breast cancer: A retrospective study

Aims

Medication‐taking behaviours of breast cancer survivors undergoing adjuvant hormone therapy have received considerable attention. This study aimed to determine factors affecting medication‐taking behaviours in people with breast cancer using data mining.

Design

A longitudinal observational retrospective cohort study with a hospital‐based survey.

Methods

A total of 385 subjects were surveyed, analysing existing data from January 2010 to December 2017 in Taiwan. Three data mining approaches—multiple logistic regression, decision tree and artificial neural network—were used to build the prediction models and rank the importance of influencing factors. Accuracy, specificity and sensitivity were used as assessment indicators for the prediction models.

Results

Multiple logistic regression was the most effective approach, achieving an accuracy of 96.37%, specificity of 96.75% and sensitivity of 96.12%. The duration of adjuvant hormone therapy discontinuation, duration of adjuvant hormone therapy use and age at diagnosis by data mining were the three most critical factors influencing the medication‐taking behaviours of people with breast cancer.

Adherence to treatment with oral antineoplastic therapy in outpatients

BACKGROUND

Multiple factors have defined the success of treatment with oral antineoplastic, especially adherence to the therapeutic regimen. The aim of this study was to describe the profile of individuals in treatment with oral antineoplastic according to the sociodemographic and clinical epidemiology factors as well as to estimate the association with those to Non-adherence to the treatment with oral antineoplastic.

METHODS

A cross-sectional observational study was performed in the chemotherapy outpatient's department from December 2015 to March 2016 at a teaching hospital. The outcome Non-adherence was evaluated according to Morisky Green test. The variables which have reached statistical significance in the bivariate analysis were tested in the multivariate model to evaluate if they remained associated to "Non-adherence" according to the Poisson logistic regression and corrected by robust variance.

RESULTS

In total, 233 patients were analyzed and 60.9% were found in Non-adherence to the treatment with oral antineoplastic according Morisky Green test (MMAS8), in which forgetfulness were often and had driven to non-adherence outcome. Multivariate analysis found three final predictors for Non-adherence which were own income, carer, unease and had needed urgency services in the last year.

CONCLUSION

This study reveals several factors associated with nonadherence. Those outcomes show that the patient's journey during antineoplastic treatment must be discussed and addressed in a broad way together with measures in public health policies.

Adherence to thalidomide in patients with multiple myeloma: A cross-sectional study in a Brazilian metropolis

PURPOSE

The treatment of multiple myeloma (MM) has advanced with the introduction of immunomodulators (IMiDS). Thalidomide is the IMiD available in Brazil with free access to MM patients. Adherence to treatment with IMiDs is essential for a successful therapy. The study proposed to describe adherence to thalidomide treatment in patients diagnosed with MM in onco-hematological outpatient clinics.

METHODS

This is a cross-sectional study with patients over 18 years of age diagnosed with MM undergoing thalidomide treatment. Adherence was measured by the Proportion of Days Covered (PDC), which is an indirect method of measuring adherence that uses database-related medication dispensing information. Patients with PDC ≥90 were classified as adherent. The association between adherence and independent variables was assessed in univariate and multivariate analyses using logistic regression.

RESULTS

A total of 65 patients with a median age of 62.6 years were identified. The median PDC was 93.7%. The frequency of adherence to thalidomide was 56.9%. Adherence to thalidomide showed a negative association with hospitalization in the last 12 months (OR = 0.202; 95% CI = 0.060-0.687) and with higher schooling (OR =0.161; 95% CI = 0.039-0.667) and a positive association with higher income (OR = 5.115; 95% CI = 1.363-19.190).

CONCLUSION

Most patients from onco-hematological outpatient clinics in a metropolitan region of southeastern Brazil showed high adherence to thalidomide, which was independently associated with higher income, hospitalization, and higher schooling. More studies are required to understand better the determinants of adherence to thalidomide in the country.