Top

Published in:

01-06-2019 | Breast Cancer | Epidemiology

Influence of adherence to adjuvant endocrine therapy on disease-free and overall survival: a population-based study in Catalonia, Spain

Authors: Rebeca Font, Josep Alfons Espinas, Agustí Barnadas, Angel Izquierdo, Jaume Galceran, Francina Saladie, Rafael Marcos-Gragera, Abigail Torrent, Paula Manchon-Walsh, Josep M. Borras

Published in: Breast Cancer Research and Treatment | Issue 3/2019

Abstract

Objective

To assess adherence to endocrine therapy and its relation to recurrence and mortality in women with early breast cancer.

Methods

This is a retrospective cohort study in population-based cancer registries in two Catalonian provinces of Spain. We included all cases of invasive stage I–III breast cancer diagnosed from 2007 to 2011 and with follow-up to 2017. Adherence to endocrine therapy was measured by means of prescription refills. Patients were considered non-adherent if they filled less than 80% of their prescriptions. After collecting data from patients’ medical records, we analysed clinical variables and their relation with adherence by means of logistic and Cox regression models.

Results

The study included 2413 women. Five-year adherence was 84.5%; the greatest risk for non-adherence was in women under 50 years of age, diagnosed with stage III cancer, treated with neoadjuvant therapy, or receiving tamoxifen or sequential treatment. Adverse effects were associated with greater adherence. Non-adherence was significantly and independently associated with recurrence (hazard ratio [HR] 1.71, 95% confidence interval [CI] 1.16–2.51) and all-cause mortality (HR 2.11, 95% CI 1.62–2.74), after adjusting for age and tumour stage.

Conclusions

Although non-adherence was relatively infrequent in this population-based study, its impact on the risk of recurrence and mortality was considerable. Clinicians should make efforts to ensure therapeutic adherence during clinical follow-up of women with breast cancer.

Senkus E, Kyriadkides S, Ohno S, Penault-Llorca F, Poortmans P, Rutgers E et al (2015) Primary breast cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol 26(suppl 5):v8–v30CrossRefPubMed

Barnadas A, Algara M, Cordoba O, Casas A, Gonzalez M, Marzo M, Montero A, Muñoz M, Ruiz A, Santolaya F, Fernandez T (2018 Jun) Recommendations for the follow-up care of female breast cancer survivors: a guideline of the Spanish Society of Medical Oncology (SEOM), Spanish Society of General Medicine (SEMERGEN), Spanish Society for Family and Community Medicine (SEMFYC), Spanish Society for General and Family Physicians (SEMG), Spanish Society of Obstetrics and Gynecology (SEGO), Spanish Society of Radiation Oncology (SEOR), Spanish Society of Senology and BreastPathology (SESPM), and Spanish Society of Cardiology (SEC). Clin Transl Oncol 20(6):687–694CrossRefPubMed

Early Breast Cancer Trialists Collaborative Dowsett G, Forbes JF et al. Aromatase inhibitors versus tamoxifen in early breast cancer: patient-level meta-analysis of the randomized clinical trials. Lancet 2015; 386: 1341–1352CrossRef

Dowsett M, Cuzick J, Ingle J, Coates A, Forbes J, Bliss J, Buyse M, Baum M, Buzdar A, Colleoni M, Coombes C, Snowdon C, Gnant M, Jakesz R, Kaufmann M, Boccardo F, Godwin J, Davies C, Peto R (2010) Meta-analysis of breast cancer outcomes in adjuvant trials of aromatase inhibitors versus tamoxifen. J Clin Oncol 28(3):509–518CrossRefPubMed

Davies C, Pan H, Godwin J et al (2013) Long term effects of continuing adjuvant tamoxifen to 10 years versus stopping at 5 years after diagnosis of estrogen receptor positive breast cancer: ATLAS a randomized trial. Lancet 381:805–816CrossRefPubMedPubMedCentral

Pan H, Gray R, Braybrooke J, Davies C, Taylor C, McGale P, Peto R, Pritchard KI, Bergh J, Dowsett M, Hayes DF (2017) 20-year risk of breast-cancer recurrence after stopping endocrine therapy at 5 years. N Engl J Med 377(19):1836–1846CrossRefPubMedPubMedCentral

Goldvaser H, Barnes T, Seruga B, Cescon D, Ocna A, Ribnikar D, Amir E (2018) Toxicity of extended adjuvant therapy with aromatase inhibitors in early breast cancer: a systematic review and meta-analysis. J Natl Cancer Inst 110:31–39CrossRef

Moon Z, Moss-Morris R, Hunter M, Carlisle S, Hughes LD (2017) Barriers and facilitators of adjuvant hormone therapy adherence and persistence in women with breast cancer: a systematic review. Patient Prefer Adher 11:305–322CrossRef

Font R, Espinas JA, Gil-Gil M, Barnadas A, Ojeda B, Tusquets I et al (2012) Prescription refill, patient self-report and physician report in assessing the adherence to oral endocrine therapy in early breast cancer patients: a retrospective cohort study in Catalonia, Spain. Br J Cancer 107:1249–1256CrossRefPubMedPubMedCentral

10.

Ruddy K, Mayer E, Partridge A (2009) Patient adherence and persistence with oral anticancer treatment. Cancer J Clin 59:56–66CrossRef

11.

McCowan C, Shearer J, Donnan PT, Dewar JA, Crilly M, Thompson AM, Fahey TP (2008) Cohort study examining tamoxifen adherence and its relationship to mortality in women with breast cancer. Br J Cancer 99:1763–1768CrossRefPubMedPubMedCentral

12.

Makubate B, Donnan PT, Dewar JA, Thompson AM, McCowan C (2013) Cohort study of adherence to adjuvant edocrine therapy, breast cancer recurrence and mortality. Br J Cancer 116:1515–1524CrossRef

13.

Hershman D, Shao T, Kushi L, Buono D, Tsai W, Fehrenbacher L et al (2011) Early discontinuation and non-adherence to adjuvant hormonal therapy are associated with increased mortality in women with breast cancer. Breast Cancer Res Treat 126:529–537CrossRefPubMed

14.

McCowan C, Wang S, Thompson A, Makubate B, Petrie DJ (2013) The value of high adherence to tamoxifen in women with breast cancer: a community-based cohort study. Br J Cancer 109:1172–1180CrossRefPubMedPubMedCentral

15.

Borras JM, Izquierdo A, Vilardell L, Marcos-Gragera R, J Ribes J, Galvez J et al.(2017). Cancer incidence in Girona (2008–2012). In: Bray F, Colombet M, Mery L, Piñeros M, Znaor A, Zanetti R, Ferlay J (eds) Cancer incidence in five continents, vol 11. International Agency for Research on Cancer, Lyon

16.

Galceran J, Carulla M, Cardó X, Ameijide A, Jimenez A, Llauradò L et al (2018) Cancer incidence in Tarragona (2008–2012). In: Bray F, Colombet M, Mery L, Piñeros M, Znaor A, Zanetti R, Ferlay J (eds) Cancer incidence in five continents, vol 11. International Agency for Research on Cancer, Lyon.

17.

Charlson M, Pompei P, Ales K, Mackenzie R (1987) New method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chron Dis 40(5):373–383CrossRef

18.

Hudis CA, Barlow WE, Costantino JP, Gray RJ, Pritchard KI, Chapman JA, Sparano JA, Hunsberger S, Enos RA, Gelber RD, Zujewski JA (2007 May) Proposal for standardized definitions for efficacy end points in adjuvant breast cancer trials: the STEEP system. J Clin Oncol 20(15):2127–2132CrossRef

19.

Cramer JA, Roy A, Burrell A, Fairchild CJ, Fuldeore MJ, Ollendorf DA, Wong PK (2008) Medication compliance and persistence: terminology and definitions. Value Health 11:44–47CrossRefPubMed

20.

Dezentjé VO, van Blijderveen NJ, Gelderblom H, Putter H, van Herk-Sukel MP, Casparie MK, Egberts AC, Nortier JW, Guchelaar HJ (2010) Effect of concomitant CYP2D6 inhibitor use and tamoxifen adherence on breast cancer recurrence in early-stage breast cancer. J Clin Oncol 28(14):2423–2429CrossRefPubMed

21.

Herk-Sukel MP, van de Poll-Franse LV, Voogd AC, Niewenhuijzen GA, Coebergh JW, Herings RM (2010) Half of breast cancer patients discontinue tamoxifen and any endocrine treatment before the end of the recommended treatment period of 5 years: a population based analysis. Breast Cancer Res Treat 122:843–851CrossRefPubMed

22.

Lundgren C, Lindman H, Rolander B, Ekholm M (2018) Good adherence to adjuvant therapy in early breast cancer: a population based study based on the Swedish Prescribed drug register. Acta Oncol 57:935–940CrossRefPubMed

23.

Blok EJ, Kroep JR, Kranenbarg EM-K, Duijm-de Carpentier M, Putter H, Liefers GJ, Nortier JWR, Rutgers EJTh, Seynaeve CM, van de Velde CJH (2018) On behalf of the IDEAL study Group. Relevant factors for the optimal duration of extended endocrine therapy in early breast cancer. Breast Cancer Res Treat 168:413–420CrossRefPubMed

24.

Dowsett M, Sestak I, Regan MM, Dodson A, Viale G, Thürlimann B, Colleoni M, Cuzick J (2018) Integration of clinical variables for the prediction of late distant recurrence in patients with estrogen receptor-positive breastg cancer treated with 5 years of endocrine therapy:CTS5. J Clin Oncol 36:1941–1948CrossRefPubMedPubMedCentral

25.

Wulaningsih W, Garmo H, Ahlgren J, Holmerg L, Folvaljon Y, Wigertz A et al (2018) Determinants of non-adherence to adjuvant endocrine treatment in women with breast cancer: the role of comorbidity. Breast Cancer Res Treat 172:167–177CrossRefPubMedPubMedCentral

26.

Lambert L, Balneaves L, Howard AF, Gotay CC (2018) Patient-reported factors associated with adherence to adjuvant endocrine therapy after breats cancer: an integrative review. Breast Cancer Res Treat 167:615–633CrossRefPubMed

27.

Harrow A, Dryden R, McCowan C, Radley A, Parsons M, Thompson AM, Wells M (2014) A hard pill to swallow: a qualitative study of women’s experiences of adjuvant endocrine therapy fro breast cancer. BMJ Open 4:e005285CrossRefPubMedPubMedCentral

28.

Bosco-Levy P, Jove J, Robinson P, Moore N, Fourrier-Reglat A, Bezin J (2016) Persistenece to 5-year hormonal breast cancer therapy: a French national population based study. Br J Cancer 115:912–919CrossRefPubMedPubMedCentral

29.

Puig-Vives M, Sánchez MJ, Sánchez-Cantalejo J, Torrella-Ramos A, Martos C, Ardanaz E et al (2013) Distribution and prognosis of molecular breast cancer subtypes defined by immunohistochemical biomarkers in a Spanish population-based study. Gynecol Oncol 130(3):609–614CrossRefPubMed

30.

Chirgwin J, Giobbie-Hurder A, Coates A, Price K, Ejlersten B, Debled M et al (2016) Treatment adherence and ints impact on disease free survival in the Breast International Group I-98 Trial of tamoxifen and letrozole, alone and in sequence. J Clin Oncol 34:2452–2459CrossRefPubMedPubMedCentral

31.

Hershman D (2016) Sticking to it: improving outcomes by increasing adherence. J Clin Oncol 34:2440–2443CrossRefPubMed

32.

Kimmick G, Edmond SN, Bosworth HB et al (2015) Medication taking behaviors among breast cancer patients on adjuvant endocrine therapy. Breast 24:630–636CrossRefPubMedPubMedCentral

Title: Influence of adherence to adjuvant endocrine therapy on disease-free and overall survival: a population-based study in Catalonia, Spain
Authors: Rebeca Font
Josep Alfons Espinas
Agustí Barnadas
Angel Izquierdo
Jaume Galceran
Francina Saladie
Rafael Marcos-Gragera
Abigail Torrent
Paula Manchon-Walsh
Josep M. Borras
Publication date: 01-06-2019
Publisher: Springer US
Keywords: Breast Cancer
Breast Cancer
Tamoxifen
Published in: Breast Cancer Research and Treatment / Issue 3/2019
Print ISSN: 0167-6806
Electronic ISSN: 1573-7217
DOI: https://doi.org/10.1007/s10549-019-05201-3

Webinar | 19-02-2024 | 17:30 (CET)

Keynote webinar | Spotlight on antibody–drug conjugates in cancer

Watch now

Antibody–drug conjugates (ADCs) are novel agents that have shown promise across multiple tumor types. Explore the current landscape of ADCs in breast and lung cancer with our experts, and gain insights into the mechanism of action, key clinical trials data, existing challenges, and future directions.

Dr. Véronique Diéras

Prof. Fabrice Barlesi

Developed by: Springer Medicine

At a glance: The STEP trials

Springer Medicine

Abstract

Objective

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 3/2019

Strong CD8+ lymphocyte infiltration in combination with expression of HLA class I is associated with better tumor control in breast cancer patients treated with neoadjuvant chemotherapy

What does risk of future cancer mean to breast cancer patients?

Progression-free survival (PFS) and toxicities of palbociclib in a geriatric population

Prospective evaluation of the cardiac safety of HER2-targeted therapies in patients with HER2-positive breast cancer and compromised heart function: the SAFE-HEaRt study

Efficacy and safety of taxane plus anthracycline with or without cyclophosphamide in Chinese node-positive breast cancer patients: an open-label, randomized controlled trial

Risk of ipsilateral breast tumor recurrence in primary invasive breast cancer following breast-conserving surgery with BRCA1 and BRCA2 mutation in China

Keynote webinar | Spotlight on antibody–drug conjugates in cancer