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Concurrent factors associated with adherence to adjuvant endocrine therapy among women with non-metastatic breast cancer

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Abstract

Purpose

Adjuvant endocrine therapy (AET) reduces breast cancer morbidity and mortality, yet women often report suboptimal adherence. Though correlates of AET adherence are well-documented, few studies examine the relative importance of multi-level factors associated with adherence. The aim of this study was to identify factors most strongly associated with AET adherence in women with breast cancer.

Methods

Between 10/2019 and 6/2021, women (N = 100) with non-metastatic, hormone receptor-positive breast cancer, taking AET who reported AET-related distress enrolled into a clinical trial. Participants completed baseline measures, including the Medication Adherence Rating Scale-5, sociodemographics, and validated measures of anxiety, depression, medication-taking self-efficacy, social support, and treatment satisfaction. We created a latent factor and tested associations between sociodemographic, medical, and psychosocial characteristics and adherence. Associated predictors (p < .10) were entered into a structural model, which was corroborated via multivariate regression modeling.

Results

A four-indicator latent adherence factor demonstrated good model fit. Participants (Mage = 56.1 years, 91% White) who were unemployed (B = 0.27, SE = 0.13, p = .046) and reported greater treatment convenience (B = 0.01, SE = 0.01, p = .046) reported greater adherence. Scores of participants who reported greater medication-taking self-efficacy (p = .097) and social support (p = .062) approached better adherence. Greater medication-taking self-efficacy (B = 0.08, SE = 0.02, p < .001) and being unemployed (B = 0.28, SE = .14, p = .042) were most strongly associated with greater adherence, independent of other predictors. Multivariate modeling confirmed similar findings.

Conclusions

Medication-taking self-efficacy and employment status were associated with AET adherence above other related factors.

Implications for Cancer Survivors

Enhancing patients’ confidence in their ability to take AET for breast cancer may represent an important intervention target to boost adherence.

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Data availability

Data is available from the corresponding author per reasonable request.

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Funding

This work was supported by the National Cancer Institute (#K07CA211107, PI: Jacobs).

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Authors and Affiliations

  1. Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd, Fifth Floor, Coral Gables, FL, 33146, USA

    Emily A. Walsh & Michael H. Antoni

  2. Massachusetts General Hospital, Boston, MA, USA

    Leah E. Walsh, Max Hernand, Nora Horick, Jennifer S. Temel, Joseph A. Greer & Jamie M. Jacobs

  3. Harvard Medical School, Boston, MA, USA

    Leah E. Walsh, Jennifer S. Temel, Joseph A. Greer & Jamie M. Jacobs

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  1. Emily A. Walsh
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Contributions

EW and JJ conceptualized the study and conducted the formal analysis. EW, LW, MH, and NH wrote the main, original manuscript test. JJ acquired study funding. All authors reviewed, edited, and approved the final manuscript.

Corresponding author

Correspondence to Emily A. Walsh.

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Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all participants included in the study.

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Not applicable.

Conflict of interest

Ms. Emily Walsh, Ms. Leah Walsh, Mr. Max Hernand, Ms. Nora Horick, and Dr. Jennifer Temel: no conflicts of interest or financial interests. Dr. Michael Antoni: paid consultant for Blue Note Therapeutics and Atlantis Healthcare; co-inventor of cognitive behavioral stress management, filed as IP with the University of Miami (UMIP-483), which is licensed to Blue Note Therapeutics. Dr. Joseph Greer: paid consultant for BeiGene, research funding from Blue Note Therapeutics, royalties for an edited book from Oxford University Press. Dr. Jamie Jacobs: prior financial interest in VivorCare, Inc. (reviewed and managed by MGH and Mass General Brigham); paid consultant for VivorCare, Inc.; paid consultant for Reunion Neuroscience Inc.

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NCT03837496.

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Walsh, E.A., Walsh, L.E., Hernand, M. et al. Concurrent factors associated with adherence to adjuvant endocrine therapy among women with non-metastatic breast cancer. J Cancer Surviv (2024). https://doi.org/10.1007/s11764-024-01556-9

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