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Breast Cancer Research and Treatment
Published in: Breast Cancer Research and Treatment 1/2020

01-01-2020 | Breast Cancer | Epidemiology

Factors associated with endocrine therapy adherence among post-menopausal women treated for early-stage breast cancer in Ontario, Canada

Authors: Phillip S. Blanchette, Melody Lam, Lucie Richard, Britney Allen, Salimah Z. Shariff, Ted Vandenberg, Kathleen I. Pritchard, Kelvin K. W. Chan, Alexander V. Louie, Danielle Desautels, Jacques Raphael, Craig C. Earle

Published in: Breast Cancer Research and Treatment | Issue 1/2020

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Abstract

Purpose

Adherence to adjuvant endocrine therapy among post-menopausal breast cancer patients is an important survivorship care issue. We explored factors associated with endocrine therapy adherence and survival in a large real-world population-based study.

Methods

We used health administrative databases to follow women (aged ≥ 66 years) who were diagnosed with breast cancer and started on adjuvant endocrine therapy from 2005 to 2010. Adherence was measured by medical possession ratio (MPR) and characterized as low (< 39% MPR), intermediate (40–79% MPR), or high (≥ 80% MPR) over a 5-year period. We investigated factors associated with adherence using a multinomial logistic regression model. Factors associated with all-cause mortality (5 years after starting endocrine therapy) were investigated using a multivariable Cox proportional hazards model.

Results

We identified 5692 eligible patients starting adjuvant endocrine therapy who had low, intermediate, and high adherence rates of 13% (n = 749), 13% (n = 733), and 74% (n = 4210), respectively. Lower rates of adherence were associated with increased age [low vs. high adherence: odds ratio (OR) 1.03, 95% CI 1.02–1.05 (per year); intermediate vs. high adherence: OR 1.02, 95% CI 1.01–1.04 (per year)]. High adherence was associated with previous use of adjuvant chemotherapy (low versus high adherence OR 0.42, 95% CI 0.30–0.59) and short-term follow-up with a medical oncologist within 4 months of starting endocrine therapy (low versus high adherence OR 0.83, 95% CI 0.69–0.99). Unadjusted analysis showed increased survival among patients with high endocrine therapy adherence. However, an independent association was no longer clearly detected after controlling for confounders.

Conclusion

Interventions to improve adjuvant endocrine therapy adherence are warranted. Non-adherence may be a more significant issue among elderly patients. Short-term follow-up visit by a patient’s medical oncologist after starting endocrine therapy may help to improve compliance.
Appendix
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Metadata
Title
Factors associated with endocrine therapy adherence among post-menopausal women treated for early-stage breast cancer in Ontario, Canada
Authors
Phillip S. Blanchette
Melody Lam
Lucie Richard
Britney Allen
Salimah Z. Shariff
Ted Vandenberg
Kathleen I. Pritchard
Kelvin K. W. Chan
Alexander V. Louie
Danielle Desautels
Jacques Raphael
Craig C. Earle
Publication date
01-01-2020
Publisher
Springer US
Published in
Breast Cancer Research and Treatment / Issue 1/2020
Print ISSN: 0167-6806
Electronic ISSN: 1573-7217
DOI
https://doi.org/10.1007/s10549-019-05430-6

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