Discontinuation and non-adherence to endocrine therapy in breast cancer patients: is lack of communication the decisive factor?
Non-adherence to anti-hormonal therapy is a major problem in gynecologic oncology. Reasons reported are side effects and lack of support. The aim of our study was an analysis of influence of experiences of patients with endocrine therapy and communication and information on this topic and their influence on adherence.
We developed a structured questionnaire which was tested in a pilot version and then programmed as online questionnaire and presented to patient members of self-help and breast cancer organizations.
Patients only had received scarce information on endocrine therapy. Only 12.8 % stated that their questions were answered in detail, 43.2 % got no answers or only non-detailed answers. 76 % had side effects limiting functions of daily life. 60 % of physicians did not react on these side effects. There is a significant correlation between number and intensity of side effects and non-adherence or disruption of therapy (p = 0.029 and p < 0.01, respectively). Women who reported having received detailed answers to their questions also reported better adherence (p = 0.014).
In order to improve adherence, detailed information on side effects and answers in case of symptoms are most important. Physicians should not rely on presenting written information but should mainly engage in direct communication.
KeywordsEndocrine therapy Non-adherence Communication Side effects
- Hadjy P, Blettner M, Harbeck N, Jackisch C, Lück HJ, Windemuth-Kieselbach C, Zaun S, Kreienberg R (2013) The patient’s anastrozole compliance to therapy (PACT) program: a randomized, in-practice study in the impact of a standardized information program on persistence and compliance to adjuvant endocrine therapy in postmenopausal women with early breast cancer. Ann Oncol 24:505–512Google Scholar
- Hershman DL, Kushi LH, Shao T, Buono D, Kershenbaum A, Tsai WY, Fehrenbacher L, Gomez SL, Miles S, Neugut AI (2010) Early discontinuation and nonadherence to adjuvant hormonal therapy in a cohort of 8,769 early-stage breast cancer patients. J Clin Oncol 28(27):4120–4128PubMedCentralPubMedCrossRefGoogle Scholar
- Howell A, Cuzick J, Baum M, Buzdar A, Dowsett M, Forbes JF, Hoctin-Boes G, Houghton J, Locker GY, Tobias JS (2005) ATAC Trialists’ group: results of the ATAC (Arimidex, Tamoxifen, Alone or in Combination) trial after completion of 5 years’ adjuvanttreatment for breast cancer. Lancet 365:60–62PubMedCrossRefGoogle Scholar
- Land SR, Cronin WM, Wickerham DL, Costantino JP, Christian NJ, Klein WM, Ganz PA (2011) Cigarette smoking, obesity, physical activity, and alcohol use as predictors of chemoprevention adherence in the National Surgical Adjuvant Breast and Bowel Project P-1 Breast Cancer Prevention Trial. Cancer Prev Res (Phila) 4(9):1393–1400CrossRefGoogle Scholar
- Thurlimann B, Coates AS, Mouridsen H, Mauriac L, Forbes JF, Paridaens R, Castiglione-Gertsch M, Gelber RD, Rabaglio M, Smith I, Wardley A, Price KN, Goldhirsch A (2005) Breast international group (BIG) 1–98 collaborative group: a comparison of letrozole and tamoxifen in postmenopausal women with early breast cancer. N Engl J Med 353:2747–2757PubMedCrossRefGoogle Scholar
- van de Water W, Bastiaannet E, Hille ET, Meershoek-Klein Kranenbarg EM, Putter H, Seynaeve CM, Paridaens R, de Craen AJ, Westendorp RG, Liefers GJ, van de Velde CJ (2012) Age-specific nonpersistence of endocrine therapy in postmenopausal patients diagnosed with hormone receptor-positive breast cancer: a TEAM study analysis. Oncologist 17(1):55–63PubMedCentralPubMedCrossRefGoogle Scholar
- van Herk-Sukel MP, van de Poll-Franse LV, Voogd AC, Nieuwenhuijzen GA, Coebergh JW, Herings RM (2010) Half of breast cancer patients discontinue tamoxifen and any endocrine treatment before the end of the recommended treatment period of 5 years: a population-based analysis. Breast Cancer Res Treat 122(3):843–851PubMedCrossRefGoogle Scholar