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



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.


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.


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.


adherence breast cancer tamoxifen 



Data collection and analyses were supported by grants R01 CA/AG70818 from the National Cancer Institute and National Institute on Aging and R01 CA84506 from the National Cancer Institute. Dr Lash was supported, in part, by K07 CA87724 from the National Cancer Institute. Dr Silliman was supported, in part, by K05 CA92395 from the National Cancer Institute.


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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

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