Journal
BREAST CANCER RESEARCH AND TREATMENT
Volume 138, Issue 3, Pages 931-939Publisher
SPRINGER
DOI: 10.1007/s10549-013-2499-9
Keywords
Breast neoplasms; Aromatase inhibitors; Selective estrogen receptor modulators; Medication taking; Health services research
Categories
Funding
- National Cancer Institute [R01 CA109696, R01 CA088370]
- Pathway to Independence Award from the National Institute for Nursing Research [R00NR01570]
- Established Investigator Award in Cancer Prevention, Control, Behavioral, and Population Sciences Research from the National Cancer Institute [K05CA111340]
- Mentored Research Scholar Grant from the American Cancer Society [MRSG-09-145-01]
- California Department of Public Health as part of the statewide cancer reporting program mandated by California Health and Safety Code [103885]
- National Cancer Institute's Surveillance, Epidemiology, and End Results Program [N01-PC-35139, N01-PC-35145]
- Public Health Institute [N01-PC-54404, 1U58DP00807-01]
- NATIONAL CANCER INSTITUTE [R01CA088370, R01CA109696, R55CA054404, R01CA139014, R01CA119202, R01CA054404, K05CA111340] Funding Source: NIH RePORTER
- NATIONAL CENTER FOR CHRONIC DISEASE PREV AND HEALTH PROMO [U58DP000807] Funding Source: NIH RePORTER
- NATIONAL INSTITUTE OF NURSING RESEARCH [R00NR010750] Funding Source: NIH RePORTER
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Adjuvant endocrine therapy for breast cancer reduces recurrence and improves survival rates. Many patients never start treatment or discontinue prematurely. A better understanding of factors associated with endocrine therapy initiation and persistence could inform practitioners how to support patients. We analyzed data from a longitudinal study of 2,268 women diagnosed with breast cancer and reported to the Metropolitan Detroit and Los Angeles SEER cancer registries in 2005-2007. Patients were surveyed approximately both 9 months and 4 years after diagnosis. At the 4-year mark, patients were asked if they had initiated endocrine therapy, terminated therapy, or were currently taking therapy (defined as persistence). Multivariable logistic regression models examined factors associated with initiation and persistence. Of the 743 patients eligible for endocrine therapy, 80 (10.8 %) never initiated therapy, 112 (15.1 %) started therapy but discontinued prematurely, and 551 (74.2 %) continued use at the second time point. Compared with whites, Latinas (OR 2.80, 95 % CI 1.08-7.23) and black women (OR 3.63, 95 % CI 1.22-10.78) were more likely to initiate therapy. Other factors associated with initiation included worry about recurrence (OR 3.54, 95 % CI 1.31-9.56) and inadequate information about side effects (OR 0.24, 95 % CI 0.10-0.55). Factors associated with persistence included two or more medications taken weekly (OR 4.19, 95 % CI 2.28-7.68) and increased age (OR 0.98, 95 % CI 0.95-0.99). Enhanced patient education about potential side effects and the effectiveness of adjuvant endocrine therapy in improving outcomes may improve initiation and persistence rates and optimize breast cancer survival.
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