Hormone therapy adherence in breast cancer: Predictive factors in Uruguay
Main Article Content
Natalia Camejo
http://orcid.org/0000-0002-8684-0291
Cecilia Castillo
http://orcid.org/0000-0002-0417-0512
Lucía Argenzio
http://orcid.org/0009-0005-1719-5558
Diego Santana
http://orcid.org/0009-0009-8408-1269
Dahiana Amarillo
http://orcid.org/0000-0002-8615-8639
Guadalupe Herrera
http://orcid.org/0000-0001-6888-2343
María Guerrina
http://orcid.org/0000-0002-5983-0688
Carolina Dörner
http://orcid.org/0000-0003-3758-2545
Gabriel Krygier
http://orcid.org/0000-0002-0518-1854
http://orcid.org/0000-0002-8684-0291
Cecilia Castillo
http://orcid.org/0000-0002-0417-0512
Lucía Argenzio
http://orcid.org/0009-0005-1719-5558
Diego Santana
http://orcid.org/0009-0009-8408-1269
Dahiana Amarillo
http://orcid.org/0000-0002-8615-8639
Guadalupe Herrera
http://orcid.org/0000-0001-6888-2343
María Guerrina
http://orcid.org/0000-0002-5983-0688
Carolina Dörner
http://orcid.org/0000-0003-3758-2545
Gabriel Krygier
http://orcid.org/0000-0002-0518-1854
Abstract
Background/Aim: Adjuvant hormone therapy (HT) significantly improves survival in patients with hormone receptor-positive breast cancer, yet adherence to this therapy is critical and tends to decrease over time. This study aims to identify risk factors for suboptimal adherence to adjuvant HT among patients treated at the Hospital de Clínicas and the Hospital Departamental de Soriano, Uruguay, to inform future strategies to improve adherence.
Materials and Methods: A retrospective, cross-sectional study was conducted, including 96 breast cancer patients in stages I-III treated with HT for at least three years. Adherence was assessed using the Morisky-Green questionnaire. Statistical analysis was employed to estimate the odds ratios (OR) for non-adherence, with a significance threshold of α=0.05.
Results: Out of the 96 patients included, 22.9% demonstrated suboptimal adherence to hormone therapy. Analysis revealed that the use of tamoxifen (adjusted OR of 4.86, p<0.05) and living with others were significant predictors of non-adherence. The aggressiveness of the treatment did not show a statistically significant correlation with adherence. Additionally, the analysis highlighted that sociodemographic characteristics, such as marital status and employment situation, did not directly influence adherence, underscoring the complexity of factors contributing to treatment adherence. Intriguingly, the analysis showed a trend towards greater adherence among postmenopausal patients and those with a history of combined treatment of tamoxifen and aromatase inhibitors, though these results warrant further exploration.
Conclusion: Suboptimal adherence to adjuvant HT in breast cancer patients is significantly influenced by the type of hormone therapy prescribed and the patient's social environment. It is necessary to develop personalized interventions that address these factors to improve adherence.
Keywords:
Adjuvant hormonal therapy, Breast cancer, Medication adherence, Risk Factors, Tamoxifen, Aromatase inhibitors
Article Details
How to Cite
CAMEJO, Natalia et al.
Hormone therapy adherence in breast cancer: Predictive factors in Uruguay.
Medical Research Archives, [S.l.], v. 12, n. 6, june 2024.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/5397>. Date accessed: 02 july 2024.
doi: https://doi.org/10.18103/mra.v12i6.5397.
Section
Research Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
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10. Bright EE, Finkelstein LB, Nealis MS, et al. A Systematic Review and Meta-Analysis of Interventions to Promote Adjuvant Endocrine Therapy Adherence Among Breast Cancer Survivors. J Clin Oncol. 2023;41(28):4548-4561. doi:10.1200/JCO.23.00697
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12. Hurtado-de-Mendoza A, Cabling ML, Lobo T, Dash C, Sheppard VB. Behavioral Interventions to Enhance Adherence to Hormone Therapy in Breast Cancer Survivors: A Systematic Literature Review. Clin Breast Cancer. 2016;16(4):247-255.e3. doi:10.1016/j .clbc.2016.03.006
13. Ekinci E, Nathoo S, Korattyil T, et al. Interventions to improve endocrine therapy adherence in breast cancer survivors: what is the evidence?. J Cancer Surviv. 2018;12(3):34 8-356. doi:10.1007/s11764-017-0674-4
14. Toivonen KI, Carlson LE, Rash JA, Campbell TS. A Survey of Potentially Modifiable Patient-Level Factors Associated with Self-Report and Objectively Measured Adherence to Adjuvant Endocrine Therapies After Breast Cancer. Patient Prefer Adherence. 2021;15:2039-2050. Published 2021 Sep 15. doi:10.2147/PPA.S319087
15. Walsh EA, Walsh LE, Hernand M, et al. Concurrent factors associated with adherence to adjuvant endocrine therapy among women with non-metastatic breast cancer. J Cancer Surviv. Published online February 24, 2024. doi:10.1007/s11764-024-01556-9
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17. Risser J, Jacobson TA, Kripalani S. Development and psychometric evaluation of the Self-efficacy for Appropriate Medication Use Scale (SEAMS) in low-literacy patients with chronic disease. J Nurs Meas. 2007;15(3): 203-219. doi:10.1891/106137407783095757
18. Kimmick G, Edmond SN, Bosworth HB, et al. Medication taking behaviors among breast cancer patients on adjuvant endocrine therapy. Breast. 2015;24(5):630-636. doi:10.1 016/j.breast.2015.06.010
19. Evans M, Engberg S, Faurby M, Fernandes JDDR, Hudson P, Polonsky W. Adherence to and persistence with antidiabetic medications and associations with clinical and economic outcomes in people with type 2 diabetes mellitus: A systematic literature review. Diabetes Obes Metab. 2022;24(3):377-390. doi:10.1111/dom.14603
20. Inoue T, Sano H, Kojima Y, Yamada S, Shirakawa O. Real-World Treatment Patterns and Adherence to Oral Medication Among Patients with Bipolar Disorders: A Retrospective, Observational Study Using a Healthcare Claims Database. Neuropsychiatr Dis Treat. 2021;17:821-833. Published 2021 Mar 18. doi:10.2147/NDT.S299005
21. Holdt-Caspersen NS, Dethlefsen C, Vestergaard P, Hejlesen O, Hangaard S, Jensen MH. Adherence to newer second-line oral antidiabetic drugs among people with type 2 diabetes-A systematic review. Pharmacol Res Perspect. 2024;12(2):e1185. doi:10.1002/prp2.1185
22. Naser AY, Ofori-Asenso R, Awawdeh SA, Qadus S, Alwafi H, Liew D. Real World Adherence to and Persistence With Oral Oncolytics in Multiple Myeloma: A Systematic Review and Meta-analysis. Clin Lymphoma Myeloma Leuk. 2022;22(10):760-773. doi:10. 1016/j.clml.2022.05.003
23. Burstein HJ, Lacchetti C, Anderson H, et al. Adjuvant Endocrine Therapy for Women With Hormone Receptor-Positive Breast Cancer: ASCO Clinical Practice Guideline Focused Update. J Clin Oncol. 2019;37(5):423 -438. doi:10.1200/JCO.18.01160
24. Curigliano G, Burstein HJ, Gnant M, et al. Understanding breast cancer complexity to improve patient outcomes: The St Gallen International Consensus Conference for the Primary Therapy of Individuals with Early Breast Cancer 2023. Ann Oncol. 2023;34(11): 970-986. doi:10.1016/j.annonc.2023.08.017
25. Burstein HJ, Curigliano G, Thürlimann B, et al. Customizing local and systemic therapies for women with early breast cancer: the St. Gallen International Consensus Guidelines for treatment of early breast cancer 2021. Ann Oncol. 2021;32(10):1216-1235. doi:10.1016/j.annonc.2021.06.023
26. Loibl S, André F, Bachelot T, et al. Early breast cancer: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up. Ann Oncol. 2024;35(2):159-182. doi:10.10 16/j.annonc.2023.11.016
27. Hershman DL, Shao T, Kushi LH, et al. Early discontinuation and non-adherence to adjuvant hormonal therapy are associated with increased mortality in women with breast cancer. Breast Cancer Res Treat. 2011;126(2): 529-537. doi:10.1007/s10549-010-1132-4
28. Makubate B, Donnan PT, Dewar JA, Thompson AM, McCowan C. Cohort study of adherence to adjuvant endocrine therapy, breast cancer recurrence and mortality. Br J Cancer. 2013;108(7):1515-1524. doi:10.1038/ bjc.2013.116
29. Barron TI, Cahir C, Sharp L, Bennett K. A nested case-control study of adjuvant hormonal therapy persistence and compliance, and early breast cancer recurrence in women with stage I-III breast cancer. Br J Cancer. 2013;109(6):1513-1521. doi:10.1038/bjc.2013.518
30. Robinson B, Dijkstra B, Davey V, Tomlinson S, Frampton C. Adherence to Adjuvant Endocrine Therapy in Christchurch Women with Early Breast Cancer. Clin Oncol (R Coll Radiol). 2018;30(1):e9-e15. doi:10.101 6/j.clon.2017.10.015
31. Nekhlyudov L, Li L, Ross-Degnan D, Wagner AK. Five-year patterns of adjuvant hormonal therapy use, persistence, and adherence among insured women with early-stage breast cancer. Breast Cancer Res Treat. 2011;130(2): 681-689. doi:10.1007/s10549-011-1703-z
32. Partridge AH, LaFountain A, Mayer E, Taylor BS, Winer E, Asnis-Alibozek A. Adherence to initial adjuvant anastrozole therapy among women with early-stage breast cancer. J Clin Oncol. 2008;26(4):556-562. doi:10.1200/JCO.2007.11.5451
33. Murphy CC, Bartholomew LK, Carpentier MY, Bluethmann SM, Vernon SW. Adherence to adjuvant hormonal therapy among breast cancer survivors in clinical practice: a systematic review. Breast Cancer Res Treat. 2012;134(2): 459-478. doi:10.1007/s10549-012-2114-5
34. Hershman DL, Kushi LH, Shao T, et al. Early discontinuation and nonadherence to adjuvant hormonal therapy in a cohort of 8,769 early-stage breast cancer patients. J Clin Oncol. 2010;28(27):4120-4128. doi:10.12 00/JCO.2009.25.9655
35. Wigertz A, Ahlgren J, Holmqvist M, et al. Adherence and discontinuation of adjuvant hormonal therapy in breast cancer patients: a population-based study. Breast Cancer Res Treat. 2012;133(1):367-373. doi:10.1007/s105 49-012-1961-4
36. Kimmick G, Anderson R, Camacho F, Bhosle M, Hwang W, Balkrishnan R. Adjuvant hormonal therapy use among insured, low-income women with breast cancer. J Clin Oncol. 2009;27(21):3445-3451. doi:10.1200/ JCO.2008.19.2419
2. Davies S, Voutsadakis IA. Adherence to adjuvant hormonal therapy in localised breast cancer. Eur J Cancer Care (Engl). 2022;31(6): e13729. doi:10.1111/ecc.13729
3. Rosso R, D'Alonzo M, Bounous VE, et al. Adherence to Adjuvant Endocrine Therapy in Breast Cancer Patients. Curr Oncol. 2023;30(2 ):1461-1472. Published 2023 Jan 21. doi:10.3 390/curroncol30020112
4. Brito C, Portela MC, de Vasconcellos MT. Adherence to hormone therapy among women with breast cancer. BMC Cancer. 2014;14:397. Published 2014 Jun 3. doi:10.11 86/1471-2407-14-397
5. Toivonen KI, Williamson TM, Carlson LE, Walker LM, Campbell TS. Potentially Modifiable Factors Associated with Adherence to Adjuvant Endocrine Therapy among Breast Cancer Survivors: A Systematic Review. Cancers (Basel). 2020;13(1):107. Published 2020 Dec 31. doi:10.3390/cancers13010107.
6. Clancy C, Lynch J, OConnor P, Dowling M. Breast cancer patients' experiences of adherence and persistence to oral endocrine therapy: A qualitative evidence synthesis. Eur J Oncol Nurs. 2020;44:101706. doi:10.1016/j.ejon.20 19.101706
7. Eliassen FM, Blåfjelldal V, Helland T, et al. Importance of endocrine treatment adherence and persistence in breast cancer survivorship: a systematic review. BMC Cancer. 2023;23(1):625. Published 2023 Jul 4. doi:10.1186/s12885-023-11122-8
8. Camejo-Martínez N, Castillo-Leska C, Artagaveytia-Cóppola NA, et al. Adhesión a la hormonoterapia adyuvante en pacientes con cáncer de mama [Adherence to adjuvant hormonal therapy in patients with breast cancer]. Rev Med Inst Mex Seguro Soc. 2019;57(6):357-363. Published 2019 Dec 30.
9. Camejo N, Castillo C, Tambasco C, et al. Assessing Adherence to Adjuvant Hormone Therapy in Breast Cancer Patients in Routine Clinical Practice. World J Oncol. 2023;14(4) :300-308. doi:10.14740/wjon1647
10. Bright EE, Finkelstein LB, Nealis MS, et al. A Systematic Review and Meta-Analysis of Interventions to Promote Adjuvant Endocrine Therapy Adherence Among Breast Cancer Survivors. J Clin Oncol. 2023;41(28):4548-4561. doi:10.1200/JCO.23.00697
11. Finitsis DJ, Vose BA, Mahalak JG, Salner AL. Interventions to promote adherence to endocrine therapy among breast cancer survivors: A meta-analysis. Psychooncology. 2019;28(2):255-263. doi:10.1002/pon.4959
12. Hurtado-de-Mendoza A, Cabling ML, Lobo T, Dash C, Sheppard VB. Behavioral Interventions to Enhance Adherence to Hormone Therapy in Breast Cancer Survivors: A Systematic Literature Review. Clin Breast Cancer. 2016;16(4):247-255.e3. doi:10.1016/j .clbc.2016.03.006
13. Ekinci E, Nathoo S, Korattyil T, et al. Interventions to improve endocrine therapy adherence in breast cancer survivors: what is the evidence?. J Cancer Surviv. 2018;12(3):34 8-356. doi:10.1007/s11764-017-0674-4
14. Toivonen KI, Carlson LE, Rash JA, Campbell TS. A Survey of Potentially Modifiable Patient-Level Factors Associated with Self-Report and Objectively Measured Adherence to Adjuvant Endocrine Therapies After Breast Cancer. Patient Prefer Adherence. 2021;15:2039-2050. Published 2021 Sep 15. doi:10.2147/PPA.S319087
15. Walsh EA, Walsh LE, Hernand M, et al. Concurrent factors associated with adherence to adjuvant endocrine therapy among women with non-metastatic breast cancer. J Cancer Surviv. Published online February 24, 2024. doi:10.1007/s11764-024-01556-9
16. Morisky DE, Green LW, Levine DM. Concurrent and predictive validity of a self-reported measure of medication adherence. Med Care. 1986;24(1):67-74. doi:10.1097/000 05650-198601000-00007
17. Risser J, Jacobson TA, Kripalani S. Development and psychometric evaluation of the Self-efficacy for Appropriate Medication Use Scale (SEAMS) in low-literacy patients with chronic disease. J Nurs Meas. 2007;15(3): 203-219. doi:10.1891/106137407783095757
18. Kimmick G, Edmond SN, Bosworth HB, et al. Medication taking behaviors among breast cancer patients on adjuvant endocrine therapy. Breast. 2015;24(5):630-636. doi:10.1 016/j.breast.2015.06.010
19. Evans M, Engberg S, Faurby M, Fernandes JDDR, Hudson P, Polonsky W. Adherence to and persistence with antidiabetic medications and associations with clinical and economic outcomes in people with type 2 diabetes mellitus: A systematic literature review. Diabetes Obes Metab. 2022;24(3):377-390. doi:10.1111/dom.14603
20. Inoue T, Sano H, Kojima Y, Yamada S, Shirakawa O. Real-World Treatment Patterns and Adherence to Oral Medication Among Patients with Bipolar Disorders: A Retrospective, Observational Study Using a Healthcare Claims Database. Neuropsychiatr Dis Treat. 2021;17:821-833. Published 2021 Mar 18. doi:10.2147/NDT.S299005
21. Holdt-Caspersen NS, Dethlefsen C, Vestergaard P, Hejlesen O, Hangaard S, Jensen MH. Adherence to newer second-line oral antidiabetic drugs among people with type 2 diabetes-A systematic review. Pharmacol Res Perspect. 2024;12(2):e1185. doi:10.1002/prp2.1185
22. Naser AY, Ofori-Asenso R, Awawdeh SA, Qadus S, Alwafi H, Liew D. Real World Adherence to and Persistence With Oral Oncolytics in Multiple Myeloma: A Systematic Review and Meta-analysis. Clin Lymphoma Myeloma Leuk. 2022;22(10):760-773. doi:10. 1016/j.clml.2022.05.003
23. Burstein HJ, Lacchetti C, Anderson H, et al. Adjuvant Endocrine Therapy for Women With Hormone Receptor-Positive Breast Cancer: ASCO Clinical Practice Guideline Focused Update. J Clin Oncol. 2019;37(5):423 -438. doi:10.1200/JCO.18.01160
24. Curigliano G, Burstein HJ, Gnant M, et al. Understanding breast cancer complexity to improve patient outcomes: The St Gallen International Consensus Conference for the Primary Therapy of Individuals with Early Breast Cancer 2023. Ann Oncol. 2023;34(11): 970-986. doi:10.1016/j.annonc.2023.08.017
25. Burstein HJ, Curigliano G, Thürlimann B, et al. Customizing local and systemic therapies for women with early breast cancer: the St. Gallen International Consensus Guidelines for treatment of early breast cancer 2021. Ann Oncol. 2021;32(10):1216-1235. doi:10.1016/j.annonc.2021.06.023
26. Loibl S, André F, Bachelot T, et al. Early breast cancer: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up. Ann Oncol. 2024;35(2):159-182. doi:10.10 16/j.annonc.2023.11.016
27. Hershman DL, Shao T, Kushi LH, et al. Early discontinuation and non-adherence to adjuvant hormonal therapy are associated with increased mortality in women with breast cancer. Breast Cancer Res Treat. 2011;126(2): 529-537. doi:10.1007/s10549-010-1132-4
28. Makubate B, Donnan PT, Dewar JA, Thompson AM, McCowan C. Cohort study of adherence to adjuvant endocrine therapy, breast cancer recurrence and mortality. Br J Cancer. 2013;108(7):1515-1524. doi:10.1038/ bjc.2013.116
29. Barron TI, Cahir C, Sharp L, Bennett K. A nested case-control study of adjuvant hormonal therapy persistence and compliance, and early breast cancer recurrence in women with stage I-III breast cancer. Br J Cancer. 2013;109(6):1513-1521. doi:10.1038/bjc.2013.518
30. Robinson B, Dijkstra B, Davey V, Tomlinson S, Frampton C. Adherence to Adjuvant Endocrine Therapy in Christchurch Women with Early Breast Cancer. Clin Oncol (R Coll Radiol). 2018;30(1):e9-e15. doi:10.101 6/j.clon.2017.10.015
31. Nekhlyudov L, Li L, Ross-Degnan D, Wagner AK. Five-year patterns of adjuvant hormonal therapy use, persistence, and adherence among insured women with early-stage breast cancer. Breast Cancer Res Treat. 2011;130(2): 681-689. doi:10.1007/s10549-011-1703-z
32. Partridge AH, LaFountain A, Mayer E, Taylor BS, Winer E, Asnis-Alibozek A. Adherence to initial adjuvant anastrozole therapy among women with early-stage breast cancer. J Clin Oncol. 2008;26(4):556-562. doi:10.1200/JCO.2007.11.5451
33. Murphy CC, Bartholomew LK, Carpentier MY, Bluethmann SM, Vernon SW. Adherence to adjuvant hormonal therapy among breast cancer survivors in clinical practice: a systematic review. Breast Cancer Res Treat. 2012;134(2): 459-478. doi:10.1007/s10549-012-2114-5
34. Hershman DL, Kushi LH, Shao T, et al. Early discontinuation and nonadherence to adjuvant hormonal therapy in a cohort of 8,769 early-stage breast cancer patients. J Clin Oncol. 2010;28(27):4120-4128. doi:10.12 00/JCO.2009.25.9655
35. Wigertz A, Ahlgren J, Holmqvist M, et al. Adherence and discontinuation of adjuvant hormonal therapy in breast cancer patients: a population-based study. Breast Cancer Res Treat. 2012;133(1):367-373. doi:10.1007/s105 49-012-1961-4
36. Kimmick G, Anderson R, Camacho F, Bhosle M, Hwang W, Balkrishnan R. Adjuvant hormonal therapy use among insured, low-income women with breast cancer. J Clin Oncol. 2009;27(21):3445-3451. doi:10.1200/ JCO.2008.19.2419