Breast Cancer Research and Treatment

, Volume 134, Issue 1, pp 419–428

Non-initiation of adjuvant hormonal therapy in women with hormone receptor-positive breast cancer: The Breast Cancer Quality of Care Study (BQUAL)

  • Alfred I. Neugut
  • Grace Clarke Hillyer
  • Lawrence H. Kushi
  • Lois Lamerato
  • Nicole Leoce
  • S. David Nathanson
  • Christine B. Ambrosone
  • Dana H. Bovbjerg
  • Jeanne S. Mandelblatt
  • Carol Magai
  • Wei-Yann Tsai
  • Judith S. Jacobson
  • Dawn L. Hershman
Epidemiology

DOI: 10.1007/s10549-012-2066-9

Cite this article as:
Neugut, A.I., Hillyer, G.C., Kushi, L.H. et al. Breast Cancer Res Treat (2012) 134: 419. doi:10.1007/s10549-012-2066-9

Abstract

Adjuvant hormonal therapy for non-metastatic hormone receptor (HR)-positive breast cancer decreases risk of breast cancer recurrence and increases survival. However, some women do not initiate this life-saving treatment. We used a prospective cohort design to investigate factors related to non-initiation of hormonal therapy among women with newly diagnosed, non-metastatic HR-positive breast cancer recruited from three U.S. sites. Serial interviews were conducted at baseline and during treatment to examine sociodemographic factors, tumor characteristics, and treatment decision-making factors. Multivariate modeling assessed associations between variables of interest and hormonal therapy initiation. Of 1,050 breast cancer patients recruited, 725 (69 %) had HR-positive breast cancer, of whom 87 (12.0 %) based on self-report and 122 (16.8 %) based on medical record/pharmacy fill rates did not initiate hormonal therapy. In a multivariable analysis, non-initiation of hormonal therapy, defined by medical record/pharmacy, was associated with having greater negative beliefs about efficacy of treatment (OR 1.42, 95 % CI 1.18–1.70). Non-initiation was less likely in those who found the quality of patient/physician communication to be higher (OR 0.96, 95 % CI 0.93–0.99), the hormonal therapy treatment decision an easy one to make (OR 0.45, 95 % CI 0.23–0.90) or neither easy nor difficult (OR 0.34, 95 % CI 0.20–0.58); and had more positive beliefs about hormonal therapy efficacy (OR 0.40, 95 % CI 0.34–0.62). Factors influencing non-initiation of adjuvant hormonal therapy are complex and influenced by patient beliefs regarding treatment efficacy and side effects. Educational interventions to women about the benefits of hormonal therapy may decrease negative beliefs and increase hormone therapy initiation.

Keywords

Breast cancerHormonal therapyInitiationAdherenceDecision-makingQuality of care

Copyright information

© Springer Science+Business Media, LLC. 2012

Authors and Affiliations

  • Alfred I. Neugut
    • 1
    • 2
    • 3
    • 12
  • Grace Clarke Hillyer
    • 1
  • Lawrence H. Kushi
    • 5
  • Lois Lamerato
    • 6
  • Nicole Leoce
    • 4
  • S. David Nathanson
    • 7
  • Christine B. Ambrosone
    • 8
  • Dana H. Bovbjerg
    • 9
  • Jeanne S. Mandelblatt
    • 10
  • Carol Magai
    • 11
  • Wei-Yann Tsai
    • 4
    • 2
  • Judith S. Jacobson
    • 2
    • 3
  • Dawn L. Hershman
    • 1
    • 2
    • 3
  1. 1.Department of Medicine, College of Physicians and SurgeonsColumbia UniversityNew YorkUSA
  2. 2.Herbert Irving Comprehensive Cancer Center, College of Physicians and SurgeonsColumbia UniversityNew YorkUSA
  3. 3.Department of Epidemiology, Mailman School of Public HealthColumbia UniversityNew YorkUSA
  4. 4.Department of Biostatistics, Mailman School of Public HealthColumbia UniversityNew YorkUSA
  5. 5.Division of ResearchKaiser-Permanente of Northern CaliforniaOaklandUSA
  6. 6.Department of Public Health SciencesHenry Ford Health SystemDetroitUSA
  7. 7.Department of Surgery, Henry Ford Health SystemDetroitUSA
  8. 8.Department of Cancer Prevention and ControlRoswell Park Cancer InstituteBuffaloUSA
  9. 9.Departments of Psychiatry, Psychology and Behavioral & Community Health SciencesUniversity of Pittsburgh, and the University of Pittsburgh Cancer InstitutePittsburghUSA
  10. 10.Department of Oncology and Lombardi Comprehensive Cancer CenterGeorgetown University Medical CenterWashingtonUSA
  11. 11.Long Island UniversityBrooklynUSA
  12. 12.Division of Medical OncologyColumbia University Medical CenterNew YorkUSA