Breast Cancer Research and Treatment

, Volume 137, Issue 3, pp 829–836

Adherence to adjuvant hormone therapy in low-income women with breast cancer: the role of provider–patient communication

  • Yihang Liu
  • Jennifer L. Malin
  • Allison L. Diamant
  • Amardeep Thind
  • Rose C. Maly
Epidemiology

Abstract

To assess the impact of patient–provider communication on adherence to tamoxifen (TAM) and aromatase inhibitors (AIs) 36 months after breast cancer (BC) diagnosis in a low-income population of women. California statewide surveys were conducted among 921 low-income women with BC at 6, 18, and 36 months after BC diagnosis. A subset of 303 women with stage I–III BC who initiated hormone treatment after diagnosis was identified. Bivariate and multivariate logistic regression analyses were performed, and adjusted adherence rates were calculated. The main outcome measure was self-reported hormone use at 36 months after BC diagnosis and the chief independent variables were patient-centered communication after diagnosis by patient report as measured by the Consumer Assessment of Healthcare Providers and Systems (CAHPS) and patients’ self-efficacy in patient–physician interactions (PEPPI). Overall adherence to TAM/AI was relatively high (88 %). Adjusted rates of adherence were 59 and 94 % for patients with the lowest versus highest scores on the CAHPS communication scale (AOR = 1.22, P = 0.006) and 72 versus 91 % for patients with the lowest and highest rating of PEPPI (AOR = 1.04, P = 0.04). Having at least one comorbid condition also increased the odds of adherence to hormonal therapy (AOR = 3.14, P = 0.03). Having no health insurance and experiencing side-effects from hormone treatment were barriers for adherence (AOR = 0.12, P = 0.001; AOR = 0.26, P = 0.003, respectively). Patient-centered communication and perceived self-efficacy in patient–physician interaction were significantly associated with patient adherence to ongoing TAM/AI therapy among low-income women with BC. Interventions on patient–provider communication may provide opportunities to improve patient outcomes in this vulnerable population.

Keywords

Breast cancer Hormone therapy adherence Low-income women 

References

  1. 1.
    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
  2. 2.
    Winer EP, Hudis C, Burstein HJ et al (2005) American Society of Clinical Oncology technology assessment on the use of aromatase inhibitors as adjuvant therapy for postmenopausal women with hormone receptor-positive breast cancer: status report 2004. J Clin Oncol 23:619–629PubMedCrossRefGoogle Scholar
  3. 3.
    Bickell NA, Wang JJ, Oluwole S et al (2006) Missed opportunities: racial disparities in adjuvant breast cancer treatment. J Clin Oncol 24:1357–1362PubMedCrossRefGoogle Scholar
  4. 4.
    Kimmick G, Anderson R, Camacho F et al (2009) Adjuvant hormonal therapy use among insured, low-income women with breast cancer. J Clin Oncol 27:3445–3451PubMedCrossRefGoogle Scholar
  5. 5.
    Gotay C, Dunn J (2011) Adherence to long-term adjuvant hormonal therapy for breast cancer. Expert Rev Pharmacoecon Outcomes Res 11(6):709–715PubMedCrossRefGoogle Scholar
  6. 6.
    Ziller V, Kalder M, Albert US et al (2009) Adherence to adjuvant endocrine therapy in postmenopausal women with breast cancer. Ann Oncol 20(3):431–436PubMedCrossRefGoogle Scholar
  7. 7.
    Partridge AH, Wang PS, Winer EP et al (2003) Nonadherence to adjuvant tamoxifen therapy in women with primary breast cancer. J Clin Oncol 21:602–660PubMedCrossRefGoogle Scholar
  8. 8.
    Lash TL, Fox MP, Westrup JL, Fink AK, Silliman RA (2006) Adherence to tamoxifen over the five-year course. Breast Cancer Res Treat 99:215–220PubMedCrossRefGoogle Scholar
  9. 9.
    Hershman DL, Shao T, Kushi LH et al (2011) Early discontinuation and non-adherence to adjuvant hormonal therapy are associated with increased mortality in women with breast cancer. Breast Cancer Res Treat 126(2):529–537PubMedCrossRefGoogle Scholar
  10. 10.
    Kahn KL, Schneider EC, Malin JL, Adams JL, Epstein AM (2007) Patient centered experiences in breast cancer: predicting long-term adherence to tamoxifen use. Med Care 45(5):431–439PubMedCrossRefGoogle Scholar
  11. 11.
    Fink AK, Gurwitz J, Rakowski W, Guadagnoli E, Silliman RA (2004) Patient beliefs and tamoxifen discontinuance in older women with estrogen receptor-positive breast cancer. J Clin Oncol 22(16):3309–3315PubMedCrossRefGoogle Scholar
  12. 12.
    Demissie S, Silliman RA, Lash TL (2001) Adjuvant tamoxifen: predictors of use, side effects, and discontinuation on older women. J Clin Oncol 19(2):322–328PubMedGoogle Scholar
  13. 13.
    Barron TI, Connolly R, Bennett K, Feely J, Kennedy MJ (2007) Early discontinuation of tamoxifen: a lesion for oncologists. Cancer 109(5):831–839CrossRefGoogle Scholar
  14. 14.
    Grunfeld EA, Hunter MS, Sikka P, Mittal S (2005) Adherence beliefs among breast cancer patients taking tamoxifen. Patient Educ Couns 59(1):97–102PubMedCrossRefGoogle Scholar
  15. 15.
    Piette JD, Heisler M, Krein S, Kerr EA (2005) The role of patient–physician trust in moderating medication nonadherence due to cost pressures. Arch Intern Med 165(15):1749–1755PubMedCrossRefGoogle Scholar
  16. 16.
    Pellegrini I, Sarradon-Eck A, Soussan PB et al (2010) Women’s perceptions and experience of adjuvant tamoxifen therapy account for their adherence: breast cancer patients’ point of view. Psychooncology 19(5):472–479PubMedCrossRefGoogle Scholar
  17. 17.
    Kirk MC, Hudis CA (2008) Insight into barriers against optimal adherence to oral hormonal therapy in women with breast cancer. Clin Breast Cancer 8(2):155–161PubMedCrossRefGoogle Scholar
  18. 18.
    Levenstein JH, McCracken EC, McWhinney IR, Stewart MA, Brown JB (1986) The patient-centered clinical method. 1. A model for the doctor–patient interaction in family medicine. Fam Pract 3:24–30PubMedCrossRefGoogle Scholar
  19. 19.
    Mead N, Bower P (2000) Patient-centeredness: a conceptual framework and review of the empirical literature. Soc Sci Med 51:1087–1110PubMedCrossRefGoogle Scholar
  20. 20.
    Epstein RM, Franks P, Shields CG et al (2005) Patient-centered communication and diagnostic testing. Ann Fam Med 3(5):415–421PubMedCrossRefGoogle Scholar
  21. 21.
    Epstein RM, Street RL (2007) Patient-centered communication in cancer care: promoting healing and reducing suffering, National Cancer Institute, Bethesda, MD; NIH Publication No. 07-6225Google Scholar
  22. 22.
    Little P, Everitt H, Williamson I et al (2001) Observational study of effect of patient centeredness and positive approach on outcomes of general practice consultations. Br Med J 323(7318):908–911CrossRefGoogle Scholar
  23. 23.
    Maly RC, Umezawa Y, Leake B, Silliman RA (2004) Determinants of participation in treatment decision-making by older breast cancer patients. Breast Cancer Res Treat 85(3):201–209PubMedCrossRefGoogle Scholar
  24. 24.
    Joslyn SA (2002) Racial differences in treatment and survival from early-stage breast carcinoma. Cancer 95(8):1759–1766PubMedCrossRefGoogle Scholar
  25. 25.
    Hershman D, McBride R, Jacobson JS et al (2005) Racial disparities in treatment and survival among women with early-stage breast cancer. J Clin Oncol 23(27):6639–6646PubMedCrossRefGoogle Scholar
  26. 26.
    Maly R, Liu Y, Kwong E, Thind A, Diamant A (2009) Breast reconstructive surgery in medically underserved women with breast cancer: the role of patient–physician communication. Cancer 115(20):4819–4827PubMedCrossRefGoogle Scholar
  27. 27.
    Maly RC, Liu Y, Leake B, Thind A, Diamant AL (2010) Treatment-related symptoms among underserved women with breast cancer: the impact of physician–patient communication. Breast Cancer Res Treat 119(3):707–716PubMedCrossRefGoogle Scholar
  28. 28.
    Maly RC, Stein JA, Umezawa Y, Leake B, Anglin MD (2008) Racial/ethnic group differences in breast cancer outcomes among older patients: effects of physician communication and patient empowerment. Health Psychol 27(6):728–736PubMedCrossRefGoogle Scholar
  29. 29.
    Davidson B, Vogel V, Wickerham L (2007) Oncologist–patient discussion of adjuvant hormonal therapy in breast cancer: results of a linguistic study focusing on adherence and persistence to therapy. J Support Oncol 5(3):139–143PubMedGoogle Scholar
  30. 30.
    Livaudais JC, Hwang ES, Karliner L et al (2012) Adjuvant hormonal therapy use among women with ductal carcinoma in situ. J Womens Health (Larchmt) 21(1):35–42CrossRefGoogle Scholar
  31. 31.
    Chen JY, Diamant AL, Thind A, Maly RC (2008) Determinants of breast cancer knowledge among newly diagnosed, low-income, medically underserved women with breast cancer. Cancer 112(5):1153–1161PubMedCrossRefGoogle Scholar
  32. 32.
    Hargraves JL, Hays RD, Cleary PD (2003) Psychometric properties of the Consumer Assessment of Health Plans Study (CAHPS) 2.0 Adult Core Survey. Health Serv Res 38(6 pt 1):1509–1527PubMedCrossRefGoogle Scholar
  33. 33.
    Hurtado MP, Angeles J, Blahut SA, Hays RD (2005) Assessment of the equivalence of the Spanish and English versions of the CAHPS Hospital Survey on the quality of inpatient care. Health Serv Res 40(6 Pt 2):2140–2161PubMedCrossRefGoogle Scholar
  34. 34.
    Maly RC, Frank JC, Marshall GN, DiMatteo MR, Reuben DB (1998) Perceived efficacy in patient–physician interactions (PEPPI): validation of an instrument in older persons. J Am Geriatr Soc 46:889–894PubMedGoogle Scholar
  35. 35.
    Katz JN, Chang LC, Sangha O, Fossel AH, Bates DW (1996) Can comorbidity be measured by questionnaire rather than medical record review? Med Care 34(1):73–84PubMedCrossRefGoogle Scholar
  36. 36.
    Marin G, Sabogal F, Marin B et al (1987) Development of a short acculturation scale for Hispanics. Hisp J Behav Sci 9:183–205CrossRefGoogle Scholar
  37. 37.
    Bernstein R (2005) Hispanic population passes 40 million: census bureau reports. U.S. Census Bureau News, U.S. Department of Commerce, Washington, D.C. http://www.census.gov/population/www/cen2000/briefs.html. Accessed 9 Sept 2010
  38. 38.
    Partridge AH, LaFountain A, Mayer E, Taylor BS, Winer E, Asnis-Alibozek A (2008) Adherence to initial adjuvant anastrozole therapy among women with early-stage breast cancer. J Clin Oncol 26(4):556–562PubMedCrossRefGoogle Scholar
  39. 39.
    Hershman DL, Kushi LH, Shao T et al (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):4120–4128PubMedCrossRefGoogle Scholar
  40. 40.
    Balogh EP, Ganz PA, Murphy SB, Nass SJ, Ferrell BR, Stovall E (2011) Patient-centered cancer treatment planning: improving the quality of oncology care. Summary of an institute of medicine workshop. Oncologist 16(12):1800–1805PubMedCrossRefGoogle Scholar
  41. 41.
    Karliner LS, Hwang ES, Nickleach D, Kaplan CP (2011) Language barriers and patient-centered breast cancer care. Patient Educ Couns 84(2):223–228PubMedCrossRefGoogle Scholar
  42. 42.
    Roundtree AK, Giordano SH, Price A, Suarez-Almazor ME (2011) Problems in transition and quality of care: perspectives of breast cancer survivors. Support Care Cancer 19(12):1921–1929PubMedCrossRefGoogle Scholar
  43. 43.
    Anderson R, Barbara A, Feldman S (2007) What patients want: a content analysis of key qualities that influence patient satisfaction. J Med Pract Manage 22(5):255–261PubMedGoogle Scholar
  44. 44.
    Cleary PD, Edgman-Levitan S, Roberts M et al (1991) Patients evaluate their hospital care: a national survey. Health Aff (Millwood) 10(4):254–267CrossRefGoogle Scholar
  45. 45.
    Cluze C, Rey D, Huiart L et al (2012) Adjuvant endocrine therapy with tamoxifen in young women with breast cancer: determinants of interruptions vary over time. Ann Oncol 23:882–890PubMedCrossRefGoogle Scholar
  46. 46.
    Gradishar WJ (2005) Safety considerations of adjuvant therapy in early breast cancer in postmenopausal women. Oncology 69(1):1–9PubMedCrossRefGoogle Scholar
  47. 47.
    Henry NL, Azzouz F, Desta Z et al (2012) Predictors of aromatase inhibitor discontinuation as a result of treatment-emergent symptoms in early-stage breast cancer. J Clin Oncol 30(9):936–942PubMedCrossRefGoogle Scholar
  48. 48.
    Zeber JE, Miller AL, Copeland LA et al (2011) Medication adherence, ethnicity, and the influence of multiple psychosocial and financial barriers. Adm Policy Ment Health 38(2):86–95PubMedCrossRefGoogle Scholar
  49. 49.
    Yang Y, Thumula V, Pace PF, Banahan BF 3rd, Wilkin NE, Lobb WB (2009) Predictors of medication nonadherence among patients with diabetes in Medicare Part D programs: a retrospective cohort study. Clin Ther 31(10):2178–2188PubMedCrossRefGoogle Scholar
  50. 50.
    Gellad WF, Haas JS, Safran DG (2007) Race/ethnicity and nonadherence to prescription medications among seniors: results of a national study. J Gen Intern Med 22(11):136–145CrossRefGoogle Scholar
  51. 51.
    Janz NK, Hawley ST, Mujahid MS et al (2011) Correlates of worry about recurrence in a multi-ethnic population-based sample of women with breast cancer. Cancer 117(9):1827–1836PubMedCrossRefGoogle Scholar
  52. 52.
    Chen NE, Meyer JP, Avery AK et al (2011) Adherence to HIV treatment and care among previously homeless jail detainees. AIDS Behav (in press)Google Scholar
  53. 53.
    Rahman SM, Dignan MB, Shelton BJ (2003) Factors influencing adherence to guidelines for screening mammography among women aged 40 years and older. Ethn Dis 13(4):477–484PubMedGoogle Scholar
  54. 54.
    Grieco EM, Cassidy RC. Overview of race and Hispanic origin. U.S. Census Bureau, Census 2000 Brief (issued March 2001): Census 2000 Redistricting (Public Law 94-171) Summary File, Tables PL1 and PL2. U.S. Department of Commerce, Washington, D.C. http://www.census.gov/population/www/cen2000/briefs.html Accessed 9 Sept 2010
  55. 55.
    Malin JL, Schneider E, Epstein A et al (2006) Quality of care for breast cancer and colorectal cancer: results of the National Initiative for cancer Care Quality. J Clin Oncol 24:626–634PubMedCrossRefGoogle Scholar
  56. 56.
    Kahn KL, Adams JL, Weeks JC et al (2010) Adjuvant chemotherapy use and adverse events among older patients with stage III colon cancer. JAMA 303:1037–1045PubMedCrossRefGoogle Scholar
  57. 57.
    Der Wiel AB, Van Exel E, De Craen AJ et al (2002) A high response is not essential to prevent selection bias: results from the Leiden 85-plus study. J Clin Epidemiol 55(11):1119–1125CrossRefGoogle Scholar
  58. 58.
    Keeter S, Miller C, Kohut A et al (2006) Consequence of reducing nonresponse in a national telephone survey. Public Opin Q 70:759–779CrossRefGoogle Scholar
  59. 59.
    Liu Y, Diamant AL, Thind A, Maly R (2010) Validity of self-reports of breast cancer treatment in low-income medically underserved women with breast cancer. Breast Cancer Res Treat 119:745–751PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2012

Authors and Affiliations

  • Yihang Liu
    • 1
  • Jennifer L. Malin
    • 2
  • Allison L. Diamant
    • 3
  • Amardeep Thind
    • 4
  • Rose C. Maly
    • 1
  1. 1.Department of Family Medicine, David Geffen School of MedicineUniversity of CaliforniaLos AngelesUSA
  2. 2.Division of Hematology-OncologyVA Greater Los Angeles Healthcare SystemLos AngelesUSA
  3. 3.Department of Medicine, David Geffen School of MedicineUniversity of CaliforniaLos AngelesUSA
  4. 4.Department of Family Medicine and Epidemiology and BiostatisticsUniversity of Western OntarioLondonCanada

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