Breast Cancer Research and Treatment

, Volume 126, Issue 2, pp 529–537 | Cite as

Early discontinuation and non-adherence to adjuvant hormonal therapy are associated with increased mortality in women with breast cancer

  • Dawn L. Hershman
  • Theresa Shao
  • Lawrence H. Kushi
  • Donna Buono
  • Wei Yann Tsai
  • Louis Fehrenbacher
  • Marilyn Kwan
  • Scarlett Lin Gomez
  • Alfred I. Neugut


Despite the benefit of adjuvant hormonal therapy (HT) on mortality among women with breast cancer (BC), many women are non-adherent with its use. We investigated the effects of early discontinuation and non-adherence to HT on mortality in women enrolled in Kaiser Permanente of Northern California (KPNC). We identified women diagnosed with hormone-sensitive stage I–III BC, 1996–2007, and used automated pharmacy records to identify prescriptions and dates of refill. We categorized patients as having discontinued HT early if 180 days elapsed from the prior prescription. For those who continued, we categorized patients as adherent if the medication possession ratio was ≥80%. We used Cox proportional hazards models to estimate the association between discontinuation and non-adherence with all-cause mortality. Among 8,769 women who filled at least one prescription for HT, 2,761 (31%) discontinued therapy. Of those who continued HT, 1,684 (28%) were non-adherent. During a median follow-up of 4.4 years, 813 women died. Estimated survival at 10 years was 80.7% for women who continued HT versus 73.6% for those who discontinued (P < 0.001). Of those who continued, survival at 10 years was 81.7 and 77.8% in women who adhered and non-adhered, respectively (P < 0.001). Adjusting for clinical and demographic variables, both early discontinuation (HR 1.26, 95% CI 1.09–1.46) and non-adherence (HR 1.49, 95% CI 1.23–1.81), among those who continued, were independent predictors of mortality. Both early discontinuation and non-adherence to HT were common and associated with increased mortality. Interventions to improve continuation of and adherence to HT may be critical to improve BC survival.


Hormonal therapy Adherence Survival 



Dr. Hershman is the recipient of a grant from the American Cancer Society (RSGT-08-009-01-CPHPS). Dr. Kushi is the recipient of a grant from the National Cancer Institute (R01 CA105274). Dr. Gomez is the recipient of a grant from the Surveillance, Epidemiology and End Results Rapid Response Surveillance Study under contracts N01-PC-35136. Dr. Neugut is the recipient of a grant from the Department of Defense (BC043120).


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Copyright information

© Springer Science+Business Media, LLC. 2010

Authors and Affiliations

  • Dawn L. Hershman
    • 1
    • 2
    • 3
  • Theresa Shao
    • 1
  • Lawrence H. Kushi
    • 4
  • Donna Buono
    • 2
  • Wei Yann Tsai
    • 2
  • Louis Fehrenbacher
    • 4
  • Marilyn Kwan
    • 4
  • Scarlett Lin Gomez
    • 5
  • Alfred I. Neugut
    • 1
    • 2
    • 3
  1. 1.Department of Medicine and the Herbert Irving Comprehensive Cancer CenterCollege of Physicians and Surgeons, Columbia University Medical CenterNew YorkUSA
  2. 2.Departments of Epidemiology and BiostatisticsMailman School of Public Health, Columbia UniversityNew YorkUSA
  3. 3.New York Presbyterian HospitalNew YorkUSA
  4. 4.Division of ResearchKaiser-Permanente of Northern CaliforniaOaklandUSA
  5. 5.Greater Bay Area Cancer RegistryCancer Prevention Institute of California (CPIC)FremontUSA

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