Breast Cancer Research and Treatment

, Volume 99, Issue 2, pp 215–220 | Cite as

Adherence to tamoxifen over the five-year course

  • Timothy L. Lash
  • Matthew P. Fox
  • Jennifer L. Westrup
  • Aliza K. Fink
  • Rebecca A. Silliman
Epidemiology

Summary

Purpose

To estimate the proportion of older women who fail to complete 5 years of tamoxifen therapy and to identify predictors of non-adherence.

Patients and methods

We followed 462 women 65-years-old or older with stage I–IIIA breast cancer diagnosed in four US regions between 1996 and 1999 and who initiated tamoxifen therapy. We interviewed patients annually to assess tamoxifen adherence and collected information about predictors of adherence by medical record review, patient interview, and physician questionnaire.

Results

Thirty-one percent of patients who started tamoxifen failed to complete the recommended 5-year course. Patients who had initial severe side effects [hazard ratio (HR) per side effect=1.2, 95% confidence interval (CI) 0.97, 1.5] or developed them (HR per new side effect=1.3, 95% CI 1.0, 1.6) were more likely to discontinue. Patients with more prescription medications at baseline were less likely to discontinue (HR per baseline prescription equaled 0.90, 95% CI 0.81, 0.99), whereas patients who added a prescription were more likely to discontinue (HR per new prescription equaled 1.2, 95% CI 1.0, 1.4). Patients with positive views of tamoxifen at baseline (HR for a 10-point higher score=0.93, 95% CI 0.83, 1.0) and an improving view over follow-up (HR for a 10-point positive change=0.93, 95% CI 0.87, 1.0) were less likely to discontinue.

Conclusion

Five years of tamoxifen confers a significant benefit beyond 1–2 years of tamoxifen, so physicians should ask patients about side effects, other prescriptions, and beliefs about tamoxifen and should educate them about the benefits of completing adjuvant therapy.

Keywords

adherence breast cancer tamoxifen 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Early Breast Cancer Trialists’ Collaborative Group Effects of chemotherapy and hormonal therapy for early breast cancer on recurrence and 15-year survival: an overview of the randomized trials Lancet 365: 1687–1717, 2005CrossRefGoogle Scholar
  2. 2.
    Lash TL, Silliman RA. Re: Prevalence of cancer Letter to the editor. J Natl Cancer Inst 90: 399–400, 1998CrossRefGoogle Scholar
  3. 3.
    Powles T, Eeles R, Ashley S, Easton D, Chang J, Dowsett M, Tidy A, Viggers J, Davey J. Interim analysis of the incidence of breast cancer in the Royal Marsden Hospital tamoxifen randomised chemoprevention trial Lancet 352: 98–101, 1998PubMedGoogle Scholar
  4. 4.
    Fink AK, Gurwitz J, Rakowski W, Guadagnoli E, Silliman RA. Patient beliefs and tamoxifen continuance in older women with estrogen receptor-positive breast cancer J Clin Oncol 22: 3309–3315, 2004PubMedCrossRefGoogle Scholar
  5. 5.
    Haynes RB, McDonald HP, Garg AX. Helping patients follow prescribed treatment: clinical applications JAMA 288: 2880–2883, 2002PubMedCrossRefGoogle Scholar
  6. 6.
    Jackevicius CA, Mamdani M, Tu JV. Adherence with statin therapy in elderly patients with and without acute coronary syndromes JAMA 288: 462–467, 2002PubMedCrossRefGoogle Scholar
  7. 7.
    Demissie S, Silliman RA, Lash TL. Adjuvant tamoxifen: predictors of use, side effects, and discontinuation in older women J Clin Oncol 19: 322–328, 2001PubMedGoogle Scholar
  8. 8.
    Partridge AH, Wang PS, Winer EP, Avorn J. Non-adherence to adjuvant tamoxifen therapy in women with primary breast cancer J Clin Oncol 21: 602–606, 2003PubMedCrossRefGoogle Scholar
  9. 9.
    van Servellen G, Chang B, Garcia L, Lombardi E. Individual and system level factors associated with treatment non-adherence in human immunodeficiency virus-infected men and women AIDS Patient Care STDS 16: 269–281, 2002PubMedCrossRefGoogle Scholar
  10. 10.
    Balkrishnan R. Predictors of medication adherence in the elderly Clin Ther 20: 764–771, 1998PubMedCrossRefGoogle Scholar
  11. 11.
    Grunfeld EA, Hunter MS, Sikka P, Mittal S. Adherence beliefs among breast cancer patients taking tamoxifen Patient Educ Couns 59: 97–102, 2005PubMedCrossRefGoogle Scholar
  12. 12.
    Silliman RA, Guadagnoli E, Rakowski W, Landrum MB, Lash TL, Wolf R, Fink A, Ganz PA, Gurwitz J, Borbas C, Mor V. Adjuvant tamoxifen prescription in women 65 years and older with early stage breast cancer J Clin Oncol 20: 2680–2688, 2002PubMedCrossRefGoogle Scholar
  13. 13.
    Fleming ID. AJCC Cancer Staging Manual 5th Edn. Lippincott Williams & Wilkins Philadelphia 1997Google Scholar
  14. 14.
    Ware J. SF-36 Health Survey, Manual and Interpretation Guide The Health Institute Boston 1993Google Scholar
  15. 15.
    Coscarelli-Schag CA, Ganz PA, Heinrich RL. Cancer rehabilitation evaluation system – short form (CARES-SF): a cancer-specific rehabilitation and quality of life instrument Cancer 68: 1406–1413, 1991CrossRefGoogle Scholar
  16. 16.
    Day R, Ganz PA, Costantino JP, Cronin WM, Wickerham DL, Fisher B. Health-related quality of life and tamoxifen in breast cancer prevention: a report from the National Surgical Adjuvant Breast and Bowel Project P-1 Study J Clin Oncol 17: 2659–2669, 1999PubMedGoogle Scholar
  17. 17.
    Fisher B, Costantino J, Redmond C, Poisson R, Bowman D, Couture J, Dimitrov NV, Wolmark N, Wickerham DL, Fisher ER. A randomized clinical trial evaluating tamoxifen in the treatment of patients with node-negative breast cancer who have estrogen-receptor-positive tumors N Engl J Med 320: 479–484, 1989PubMedCrossRefGoogle Scholar
  18. 18.
    Fisher B, Costantino JP, Wickerham DL, Redmond CK, Kavanah M, Cronin WM, Vogel V, Robidoux A, Dimitrov N, Atkins J, Daly M, Wieand S, Tan-Chiu E, Ford L, Wolmark N. Tamoxifen for prevention of breast cancer: report of the National Surgical Adjuvant Breast and Bowel Project P-1 Study J Natl Cancer Inst 90: 1371–1388, 1998PubMedCrossRefGoogle Scholar
  19. 19.
    Winer EP, Hudis C, Burstein HJ, Wolff AC, Pritchard KI, Ingle JN, Chlebowski RT, Gelber R, Edge SB, Gralow J, Cobleigh MA, Mamounas EP, Goldstein LJ, Whelan TJ, Powles TJ, Bryant J, Perkins C, Perotti J, Braun S, Langer AS, Browman GP, Somerfield MR. American society of clinical oncology technology assessment on the use of aromatase inhibitors as adjuvant therapy for post-menopausal women with hormone-receptor-positive breast cancer: status report 2004 J Clin Oncol 23: 619–629, 2005PubMedCrossRefGoogle Scholar
  20. 20.
    Prochaska JO, Velicer WF, Rossi JS, Goldstein MG, Marcus BH, Rakowski W, Fiore C, Harlow LL, Redding CA, Rosenbloom D. Stages of change and decisional balance for 12 problem behaviors Health Psychol 13: 39–46, 1994PubMedCrossRefGoogle Scholar
  21. 21.
    Janis IL, Mann L. Psychological Analysis of Conflict, Choice, and Commitment Macmillan London 1977Google Scholar
  22. 22.
    Horne R, Weinman J. Patients’ beliefs about prescribed medicines and their role in adherence to treatment in chronic physical illness J Psychosom Res 47: 555–567, 1999PubMedCrossRefGoogle Scholar
  23. 23.
    Ruggiero L. Transtheoretical model: applications in the prevention and treatment of cancer Med Pediatr Oncol 1: 69–74, 1998PubMedCrossRefGoogle Scholar
  24. 24.
    Rakowski W, Andersen MR, Stoddard AM, Urban N, Rimer BK, Lane DS, Fox SA, Costanza ME. Confirmatory analysis of opinions regarding the pros and cons of mammography Health Psychol 16: 433–441, 1997PubMedCrossRefGoogle Scholar
  25. 25.
    Osterberg L, Blaschke T. Adherence to medication N Engl J Med 353: 487–497, 2005PubMedCrossRefGoogle Scholar
  26. 26.
    Garber MC, Nau DP, Erickson SR. The concordance of self-report with other measures of medication adherence: a summary of the literature Med Care 42: 649–652, 2004PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, Inc. 2006

Authors and Affiliations

  • Timothy L. Lash
    • 1
    • 2
    • 6
  • Matthew P. Fox
    • 2
    • 3
  • Jennifer L. Westrup
    • 4
  • Aliza K. Fink
    • 5
  • Rebecca A. Silliman
    • 1
    • 2
  1. 1.Department of EpidemiologyBoston University School of Public Health BostonUSA
  2. 2.Department of Medicine, Geriatrics SectionBoston University School of MedicineBostonUSA
  3. 3.Department of International HealthBoston University School of Public HealthBostonUSA
  4. 4.Department of Medicine, Hematology and Medical Oncology SectionBoston University School of Medicine BostonUSA
  5. 5.ORC MacroBethesdaUSA
  6. 6.Department of EpidemiologyBoston University School of Public Health BostonUSA

Personalised recommendations