Recent studies have revealed that many, perhaps most women with hormone-responsive breast cancer have low adherence to tamoxifen adjuvant hormonal therapy. However, limited data are available on tamoxifen adherence in male breast cancer (MBC) patients. The goal of this study was to assess tamoxifen adherence and its relationship to mortality in MBC patients. A cohort of 116 men who were diagnosed with receptor-positive breast cancer between June 1987 and July 2012 was recruited for the study using the cancer prevention and treatment system database of Heilongjiang Province. From the 116 patients who received a five-year tamoxifen prescription, only 64.6 % were still taking their medication 1 year later, and this percentage decreased to 46.4 and 28.7 % after 2 and 3 years, respectively, to 25.8 % after 4 years, and to 17.7 % in the last year. After multivariate adjustment, factors that significantly decreased tamoxifen adherence were low social support [Hazard ratio (HR) = 2.45, 95 % CI 1.32–4.55], age (HR = 1.10, 95 % CI 1.01–1.21), and adverse effects (HR = 2.19, 95 % CI 1.57–3.04). The primary endpoints in the adherence or low-adherence groups from this study were overall survival (OS) and disease-free survival (DFS) of the MBC patients. The five- and ten-year OS of the patients was 97.9 and 79.6 %, respectively, in the adherence group, and 84.7 and 50.4 %, respectively, in the low-adherence group (p = 0.008). The five- and ten-year DFS of the patients was 95.4 and 72.8 %, respectively, in the adherence group, and 72.6 and 42.3 %, respectively, in the low-adherence group (p = 0.007). The consequences of low treatment adherence in men, who have a potentially long life expectancy, may be significant. In light of these findings, there is an urgent need to acknowledge and tackle the issue of tamoxifen adherence in this patient group.
Adherence Male breast cancer MBC Tamoxifen Overall survival OS Disease free survival DFS Adjuvant endocrine treatment
This is a preview of subscription content, log in to check access.
We would like to thank both the men who agreed to participate in this study and their physicians for the time they devoted to medical data collection. We would also like to thank the physicians and technicians who contributed to patient selection and data extraction.
Conflict of interest
Authors declare that they have no conflict of interest.
Anelli TF, Anelli A, Tran KN, Lebwohl DE, Borgen PI (1994) Tamoxifen administration is associated with a high rate of treatment-limiting symptoms in male breast cancer patients. Cancer 74:74–77. doi:10.1002/1097-0142PubMedCrossRefGoogle Scholar
Goss PE, Reid C, Pinttile M, Banerjee SS, Cramer A (1999) Male breast carcinoma: a review of 229 patients who presented to the Princess Margaret Hospital during 40 years: 1995–1996 Cancer 85:629–639Google Scholar
Mc Cowan C, Shearer J, Donnan PT, Dewar JA, Crilly M, Thompson AM, Fahey TP (2008) Cohort study examining tamoxifen adherence and its relationship to mortality in women with breast cancer. Br J Cancer 99:1763–1768. doi:10.1038/sj.bjc.6604758CrossRefGoogle 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 28:4120–4128. doi:10.1200/JCO.2009.25.9655PubMedCrossRefGoogle Scholar
Early Breast Cancer Trialists Collaborative Group (2005) Effects of chemotherapy and hormonal therapy for early breast cancer on recurrence and 15-year survival: an overview of the randomized trials. Lancet 365:1687–1717CrossRefGoogle Scholar
The WHOQOL Group (1998) Development of the World Health Organization WHOQOL-BREF quality of life assessment. Psychol Med 28:551–558CrossRefGoogle Scholar
Baumann C, Erpelding ML, Regat S, Collin JF, Briancon S (2010) The WHOQOL-BREF questionnaire: French adult population norms for the physical health, psychological health and social relationship dimensions. Rev Epidemiol Sante Publique 58:33–39PubMedCrossRefGoogle Scholar
Fuhrer R, Wessely S (1995) The epidemiology of fatigue and depression: a French primary-care study. Psychol Med 25:895–905PubMedCrossRefGoogle Scholar
Andrade SE, Kahler KH, Frech F, Chan KA (2006) Methods for evaluation of medication adherence and persistence using automated databases. Pharmacoepidemiol Drug Saf 15:565–574PubMedCrossRefGoogle Scholar
Cramer JA, Roy A, Burrell A, Fairchild CJ, Fuldeore MJ, Ollendorf DA, Wong PK (2008) Medication compliance and persistence: terminology and definitions. Value Health 11:44–47PubMedCrossRefGoogle Scholar
Fisher B, Costantino J, Redmond C et al (1989) A randomized clinical trial evaluates tamoxifen in the treatment of patients with node-negative breast cancer who have estrogen-receptor-positive tumors. N Engl J Med 320:479–484PubMedCrossRefGoogle Scholar
Waterhouse DM, Calzone KA, Mele C, Brenner DE (1993) Adherence to oral tamoxifen: a comparison of patient self-report, pill counts, and microelectronic monitoring. J Clin Oncol 11:1189–1197PubMedGoogle Scholar
Huiart L, Bouhnike A-D, Rey D, Tarpin C, Cluze C, Bendiane MK, Viens P, Giorgi R (2012) Early discontinuation of tamoxifen intake in younger women with breast cancer: is it time to rethink the way it is prescribed? Eur J Cancer 48:1939–1946. doi:10.1016/j.ejca.2012.03.004PubMedCrossRefGoogle Scholar
Kirk MC, Hudis CA (2008) Insight into barriers against optimal adherence to oral hormonal therapy in women with breast cancer. Clin Breast Cancer 8:155–161PubMedCrossRefGoogle Scholar
Owusu C, Buist DSM, Field TS, Lash TL, Thwin SS, Geiger AM, Quinn VP, Frost F, Prout M, Ulcickas Yood M, Wei F, Silliman RA (2008) Predictors of tamoxifen discontinuation among older women with estrogen receptor positive breast cancer. J Clin Oncol 26:3125–3127. doi:10.1200/JCO.2006.10.1022PubMedCrossRefGoogle Scholar
Chlebowski RT, Geller ML (2006) Adherence to endocrine therapy for breast cancer. Oncology 71:1–9PubMedGoogle Scholar
Dezentje VO, Guchelaar HJ, Nortier JW, vandeVelde CJ, Gelderblom H (2009) Clinical implications of CYP2D6 genotyping in tamoxifen treatment for breast cancer. Clin Cancer Res 15:15–21PubMedCrossRefGoogle Scholar
The Scottish Trial Report from the Breast Cancer Trials Committee (1987) Adjuvant tamoxifen in the management of operable breast cancer. Scottish Cancer Trials Office (MRC). Lancet 2:171–175Google Scholar
Fallow field L, Cella D, Cuzick J (2004) Quality of life of postmenopausal women in the arimidex, tamoxifen, alone or in combination (ATAC) adjuvant breast cancer trial. J Clin Oncol 22:4261–4271. doi:10.1200/JCO.2004.08.029CrossRefGoogle Scholar
Fallow field L, Cella D, on behalf of the CRC Psychosocial Oncology Group (2002) Assessing the quality of life (QOL) of postmenopausal (PM) women randomized into the ATAC (‘Arimidex’, tamoxifen, alone or in combination) adjuvant breast cancer (BC) trial. Proc Am Soc Clin Oncol 21:159Google Scholar