Breast Cancer Research and Treatment

, Volume 137, Issue 3, pp 829–836 | Cite as

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. MalyEmail author


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.


Breast cancer Hormone therapy adherence Low-income women 



This study was funded by the American Cancer Society (# TURSG-02-081), the California Breast Cancer Research Program (# 7PB-0070), and the National Cancer Institute (#R01CA119197-01A1). Dr. Maly was additionally supported by the National Cancer Institute (#R01CA140481-01A1).

Conflict of interest

The authors declare that they have no conflict of interest.


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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
    Email author
  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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