Interruption and non-adherence to long-term adjuvant hormone therapy is associated with adverse survival outcome of breast cancer women--an Asian population-based study

Kun-Pin Hsieh, Li-Chia Chen, Kwok-Leung Cheung, Chao-Sung Chang, Yi-Hsin Yang, Kun-Pin Hsieh, Li-Chia Chen, Kwok-Leung Cheung, Chao-Sung Chang, Yi-Hsin Yang

Abstract

This study aimed to evaluate the survival rate of women with breast cancer (BC) comparing persistence versus interruption and adherence versus non-adherence to adjuvant hormonal therapy (HT) in Asian population. Newly-diagnosed BC women from 2003 to 2010 were retrospectively identified from the Taiwan National Health Insurance Research Database. HT prescriptions were extracted to define treatment interruption and medication possession ratio. Their impacts on mortality were estimated by Cox regression with time dependent covariates. Interruption (HR: 1.32; 95% CI: 1.20, 1.46; P<0.0001) and non-adherence (HR: 1.45; 95% CI: 1.32, 1.59; P<0.0001) to adjuvant HT were significantly associated with increased mortality. Interruption to tamoxifen in younger patients and in patients receiving surgery (OP) with adjuvant chemotherapy (CT) was associated with increasing mortality rate when compared with their counterparts. Non-adherence to AIs in both younger and senior age groups and in OP with CT group also resulted in increasing risk. Treatment interruption and non-adherence to adjuvant HT were found to be associated with the increasing all-cause mortality of the Asian BC women; a greater impact of interruption and non-adherence on mortality was especially found in the younger BC population.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist, except that KLC has served as member of advisory board for AstraZeneca and Novartis, and also previously received research funding from AstraZeneca, honorarium from AstraZeneca and Novartis for other research projects. This does not alter the authors adherence to all the PLOS ONE policies on sharing data and materials.

Figures

Figure 1. Kaplan-Meier Survival Curves for comparing…
Figure 1. Kaplan-Meier Survival Curves for comparing persistence against interruption and adherence against non-adherence.
Figure 2. Multivariable adjusted hazard ratios of…
Figure 2. Multivariable adjusted hazard ratios of all-cause mortality for interruption and non-adherence in age and initial treatment strategy subgroups stratified by HT utilization pattern.
Figure 3. Multivariable adjusted hazard ratios of…
Figure 3. Multivariable adjusted hazard ratios of all-cause mortality by various definitions of interruption and non-adherence.

References

    1. Jemal A (2010) Center MM, DeSantis C, Ward EM (2010) Global patterns of cancer incidence and mortality rates and trends. Cancer Epidemiol Biomarkers Prev 19: 1893–1907.
    1. Winer EP, Hudis C, Burstein HJ, Wolff AC, Pritchard KI, et al. (2005) American Society of Clinical Oncology technology assessment on the use of aromatase inhibitors as adjuvant therapy for postmenopausal women with hormone receptor-positive breast cancer: status report 2004. J Clin Oncol 23: 619–629.
    1. Early Breast Cancer Trialists’ Collaborative Group (2005) Effects of chemotherapy and hormonal therapy for early breast cancer on recurrence and 15-year survival: an overview of the randomised trials. Lancet 365: 1687–1717.
    1. Ruddy KJ, Partridge AH (2009) Adherence with adjuvant hormonal therapy for breast cancer. Ann Oncol 20: 401–402.
    1. Chlebowski RT, Geller ML (2006) Adherence to endocrine therapy for breast cancer. Oncology 71: 1–9.
    1. Barron TI, Connolly R, Bennett K, Feely J, Kennedy MJ (2007) Early discontinuation of tamoxifen: a lesson for oncologists. Cancer 109: 832–839.
    1. McCowan C, Shearer J, Donnan PT, Dewar JA, Crilly M, et al. (2008) Cohort study examining tamoxifen adherence and its relationship to mortality in women with breast cancer. Br J Cancer 99: 1763–1768.
    1. Hershman DL, Shao T, Kushi LH, Buono D, Tsai WY, 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: 529–537.
    1. Nekhlyudov L, Li L, Ross-Degnan D, Wagner AK (2011) Five-year patterns of adjuvant hormonal therapy use, persistence, and adherence among insured women with early-stage breast cancer. Breast Cancer Res Treat 130: 681–689.
    1. Leong SP, Shen ZZ, Liu TJ, Agarwal G, Tajima T, et al. (2010) Is breast cancer the same disease in Asian and Western countries? World J Surg 34: 2308–2324.
    1. Bureau of Health Promotion (2012) Cancer Registry Annual Report 2009. Taipei, Taiwan: Department of Health, Exceutive Yuan.
    1. Taiwan Bureau of National Health Insurance Insurance Coverage. Avariable: Accessed 20 April 2013.
    1. Partridge AH, LaFountain A, Mayer E, Taylor BS, Winer E, et al. (2008) Adherence to initial adjuvant anastrozole therapy among women with early-stage breast cancer. J Clin Oncol 26: 556–562.
    1. Sundararajan V, Henderson T, Perry C, Muggivan A, Quan H, et al. (2004) New ICD-10 version of the Charlson comorbidity index predicted in-hospital mortality. J Clin Epidemiol 57: 1288–1294.
    1. Makubate B, Donnan PT, Dewar JA, Thompson AM, McCowan C (2013) Cohort study of adherence to adjuvant endocrine therapy, breast cancer recurrence and mortality. Br J Cancer 108: 1515–1524.
    1. Murphy CC, Bartholomew LK, Carpentier MY, Bluethmann SM, Vernon SW (2012) Adherence to adjuvant hormonal therapy among breast cancer survivors in clinical practice: a systematic review. Breast Cancer Res Treat 134: 459–478.
    1. NCCN (2012) NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) Breast Cancer Version 3.
    1. Osborne CK (1998) Tamoxifen in the treatment of breast cancer. N Engl J Med 339: 1609–1618.
    1. Saphner T, Tormey DC, Gray R (1996) Annual hazard rates of recurrence for breast cancer after primary therapy. J Clin Oncol 14: 2738–2746.
    1. Swedish Breast Cancer Cooperative G (1996) Randomized trial of two versus five years of adjuvant tamoxifen for postmenopausal early stage breast cancer. J Natl Cancer Inst 88: 1543–1549.
    1. Grymonpre R, Cheang M, Fraser M, Metge C, Sitar DS (2006) Validity of a prescription claims database to estimate medication adherence in older persons. Med Care 44: 471–477.

Source: PubMed

Sponsors en medewerkers

Medische omstandigheden

Geneesmiddelinterventies

3
Abonneren