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Breast Cancer Research and Treatment

, Volume 145, Issue 2, pp 525–534 | Cite as

Contributors to nonadherence and nonpersistence with endocrine therapy in breast cancer survivors recruited from an online research registry

  • Annette L. StantonEmail author
  • Keith J. Petrie
  • Ann H. Partridge
Epidemiology

Abstract

Rates of adherence and persistence with endocrine therapy regimens (i.e., tamoxifen, aromatase inhibitors) by breast cancer survivors are suboptimal, with negative implications for prognosis. This study identified potential contributors to nonadherence and nonpersistence. From an online breast cancer research registry (Army of Women) including approximately 51,000 breast cancer survivors, we recruited 1,371 women who currently were taking endocrine therapy and 94 nonpersisters (i.e., diagnosed during the prior 5 years and on endocrine therapy within the prior 12 months, but no longer taking it). Participants completed an online questionnaire assessing demographic/medical characteristics, general and cancer-related psychosocial variables (i.e., depressive symptoms, anxiety, patient–oncologist relationship quality, cancer recurrence worry, general symptoms), and endocrine therapy-specific variables (i.e., endocrine therapy-related symptoms, perceived endocrine therapy necessity, long-term therapy use concern, endocrine therapy-related emotions). Two weeks later, current users were re-contacted to complete an endocrine therapy adherence measure. In a final regression model, patient-reported nonadherence among current users was significantly associated with lower financial status, a prior switch in endocrine therapies, a poorer relationship with the oncologist, and lower perceived need for and more negative emotions regarding endocrine therapy (adjusted R 2 = 0.15, P < 0.001). In a final logistic regression model, endocrine therapy nonpersisters were significantly more likely than current users to report depressive symptoms, as well as more negative emotions and lower positive emotions related to endocrine therapy (adjusted R 2 = 0.10, P < 0.001). In addition to demographic/medical variables, several potentially modifiable psychosocial characteristics are likely to contribute to endocrine therapy nonadherence and nonpersistence.

Keywords

Breast cancer Adherence Tamoxifen Aromatase inhibitor Compliance 

Notes

Acknowledgments

This research was supported by funding from the Breast Cancer Research Foundation (Stanton).

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Burstein HJ, Prestrud AA, Seidenfeld J et al (2010) American Society of Clinical Oncology clinical practice guideline: update on adjuvant endocrine therapy for women with hormone receptor-positive breast cancer. J Clin Oncol 28:3784–3796PubMedCrossRefGoogle Scholar
  2. 2.
    Murphy CC, Bartholomew LK, Carpentier MY, Bluethmann SM, Vernon SW (2012) Adherence to adjuvant hormonal therapy among breast cancer survivors in clinical practice: a systematic review. Breast Cancer Res Treat 134:459–478PubMedCentralPubMedCrossRefGoogle Scholar
  3. 3.
    McCowan 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 99:1763–1768PubMedCentralPubMedCrossRefGoogle Scholar
  4. 4.
    Makubate B, Donnan PT, Dewar JA, Thompson AM, McCowan C (2013) Cohort study of adherence to adjuvant endocrine therapy, breast cancer recurrence and mortality. Br J Cancer 108:1515–1524PubMedCentralPubMedCrossRefGoogle Scholar
  5. 5.
    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 126:529–537PubMedCentralPubMedCrossRefGoogle Scholar
  6. 6.
    Weaver KE, Camacho F, Hwang W, Anderson R, Kimmick G (2013) Adherence to adjuvant hormonal therapy and its relationship to breast cancer recurrence and survival in low income women. Am J Clin Oncol 36:181–187PubMedCentralPubMedCrossRefGoogle Scholar
  7. 7.
    Haynes RB, Sackett DL (1979) Compliance in health care. Johns Hopkins University Press, Baltimore, MDGoogle Scholar
  8. 8.
    Liu Y, Malin JL, Diamant AL, Thind A, Maly RC (2013) Adherence to adjuvant hormone therapy in low-income women with breast cancer: the role of provider-patient communication. Breast Cancer Res Treat 137:829–836PubMedCentralPubMedCrossRefGoogle Scholar
  9. 9.
    DiMatteo MR, Lepper HS, Croghan TW (2000) Depression is a risk factor for noncompliance with medical treatment: a meta-analysis of the effects of anxiety and depression on patient adherence. Arch Intern Med 160:2101–2107PubMedCrossRefGoogle Scholar
  10. 10.
    Grenard JL, Munjas BA, Adams JL, Suttorp M, Maglione M, McGlynn EA, Gellad WF (2011) Depression and medication adherence in the treatment of chronic diseases in the United States: a meta-analysis. J Gen Intern Med 26:1175–1182PubMedCentralPubMedCrossRefGoogle Scholar
  11. 11.
    Gonzalez JS, Batchelder AW, Psaros C, Safren SA (2011) Depression and HIV/AIDS treatment adherence: a review and meta-analysis. J Acquir Immun Defic Syndr 58:181–187Google Scholar
  12. 12.
    Hay JL, McCaul KD, Magnan RE (2006) Does worry about breast cancer predict screening behaviors? A meta-analysis of the prospective evidence. Prev Med 42:401–408PubMedCrossRefGoogle Scholar
  13. 13.
    Demissie S, Silliman RA, Lash TL (2001) Adjuvant tamoxifen: predictors of use, side effects, and discontinuation in older women. J Clin Oncol 19:322–328PubMedGoogle Scholar
  14. 14.
    Grunfeld EA, Hunter MS, Sikka P, Mittal S (2005) Adherence beliefs among breast cancer patients taking tamoxifen. Patient Educ Counsel 59:97–102CrossRefGoogle Scholar
  15. 15.
    Lash TL, Fox MP, Westrup LJ, Fink AK, Silliman RA (2006) Adherence to tamoxifen over the five-year course. Breast Cancer Res Treat 99:215–220PubMedCrossRefGoogle Scholar
  16. 16.
    Owusu C, Buist DS, Field TS et al (2008) Predictors of tamoxifen discontinuation among older women with estrogen receptor-positive breast cancer. J Clin Oncol 26:549–555PubMedCrossRefGoogle Scholar
  17. 17.
    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 22:3309–3315PubMedCrossRefGoogle Scholar
  18. 18.
    Ziller V, Kalder M, Albert U-S, Holzhauer W, Ziller M, Wagner U, Hadji P (2009) Adherence to adjuvant endocrine therapy in postmenopausal women with breast cancer. Annals Oncol 20:431–436CrossRefGoogle Scholar
  19. 19.
    Horne R, Weinman J (1999) Patients’ beliefs about prescribed medicines and their role in adherence to treatment in chronic physical illness. J Psychosom Res 47:555–567PubMedCrossRefGoogle Scholar
  20. 20.
    Gierisch JM, Earp JA, Brewer NT, Rimer BK (2010) Longitudinal predictors of nonadherence to maintenance of mammography. Cancer Epidemiol Biomarkers Prev 19:1103–1111PubMedCentralPubMedCrossRefGoogle Scholar
  21. 21.
    Zigmond AS, Snaith RP (1983) The Hospital Anxiety and Depression Scale. Acta Psychiatr Scand 67:361–370PubMedCrossRefGoogle Scholar
  22. 22.
    Vodermaier A, Linden W, Siu C (2009) Screening for emotional distress in cancer patients: a systematic review of assessment instruments. J Natl Cancer Inst 101:1464–1488PubMedCentralPubMedCrossRefGoogle Scholar
  23. 23.
    Tracey TJ, Kokotovic AM (1989) Factor structure of the working alliance inventory. Psychol Assess 1:207–210CrossRefGoogle Scholar
  24. 24.
    Busseri MA, Tyler JD (2003) Interchangeability of the working alliance inventory and working alliance inventory, short form. Psychol Assess 15:193–197PubMedCrossRefGoogle Scholar
  25. 25.
    Horvath AO, Greenberg LS (1989) Development and validation of the working alliance inventory. J Counseling Psychol 36:223–233CrossRefGoogle Scholar
  26. 26.
    Stanton AL, Bernaards CA, Ganz PA (2005) The BCPT Symptom Scales: a measure of physical symptoms for women diagnosed with or at risk for breast cancer. J Natl Cancer Inst 97:448–456PubMedCrossRefGoogle Scholar
  27. 27.
    Zivian MT, Salgado B (2008) Side effects revisited: women’s experiences with aromatase inhibitors. Breast Cancer Action. http://archive.bcaction.org/uploads/PDF/AIReport.pdf
  28. 28.
    Crites SL, Fabrigar LR, Petty RE (1994) Measuring the affective and cognitive properties of attitudes: conceptual and methodological issues. Pers Soc Psychol Bull 20:619–634CrossRefGoogle Scholar
  29. 29.
    Morisky DE, Green LW, Levine DM (1986) Concurrent and predictive validity of a self-reported measure of medication adherence. Med Care 24:67–74PubMedCrossRefGoogle Scholar
  30. 30.
    Lavsa SM, Holzworth A, Ansani NT (2011) Selection of a validated scale for measuring medication adherence. J Am Pharm Assoc 51:90–94CrossRefGoogle Scholar
  31. 31.
    Horne R, Weinman J (2002) Self-regulation and self-management in asthma: exploring the role of illness perceptions and treatment beliefs in explaining non-adherence to preventer medication. Psychol Health 17:17–32CrossRefGoogle Scholar
  32. 32.
    ATAC Trialists’ Group (2005) Results of the ATAC (Arimidex, Tamoxifen, Alone or in Combination) trial after completion of 5 years’ adjuvant treatment for breast cancer. Lancet 365:60–62CrossRefGoogle Scholar
  33. 33.
    Lin JH, Zhang SM, Manson JE (2011) Predicting adherence to tamoxifen for breast cancer adjuvant therapy and prevention. Cancer Prev Res 4:1360–1365CrossRefGoogle Scholar
  34. 34.
    Sedjo RL, Devine S (2011) Predictors of non-adherence to aromatase inhibitors among commercially insured women with breast cancer. Breast Cancer Res Treat 125:191–200PubMedCrossRefGoogle Scholar
  35. 35.
    Wigertz A, Ahlgren J, Holmqvist M, Fornander T, Adolfsson J, Lindman H, Bergkvist L, Lambe M (2012) Adherence and discontinuation of adjuvant hormonal therapy in breast cancer patients: a population-based study. Breast Cancer Res Treat 133:367–373PubMedCrossRefGoogle Scholar
  36. 36.
    Hart SL, Hoyt MA, Diefenbach M, Anderson DR, Kilbourn KM, Craft LL, Steel JL, Cuijpers P, Mohr DC, Berendsen M, Spring B, Stanton AL (2012) Meta-analysis of efficacy of interventions for elevated depressive symptoms in adults diagnosed with cancer. J Natl Cancer Inst 104:990–1004PubMedCentralPubMedCrossRefGoogle Scholar
  37. 37.
    Schneider S, Moyer A, Knapp-Oliver S, Sohl S, Cannella D, Targhetta V (2010) Pre-intervention distress moderates the efficacy of psychosocial treatment for cancer patients: a meta-analysis. J Behav Med 33:1–14PubMedCentralPubMedCrossRefGoogle Scholar
  38. 38.
    Haskard-Zolnierek KB, DiMatteo MR (2009) Physician communication and patient adherence to treatment: a meta-analysis. Med Care 47:826–834PubMedCentralCrossRefGoogle Scholar
  39. 39.
    McCorkle R, Ercolano E, Lazenby M, Schulman-Green D, Schilling LS, Lorig K, Wagner EH (2011) Self-management: enabling and empowering patients living with cancer as a chronic illness. CA Cancer J Clin 61:50–62PubMedCentralPubMedCrossRefGoogle Scholar
  40. 40.
    Partridge AH, Wang PS, Winer EP, Avorn J (2003) Nonadherence to adjuvant tamoxifen therapy in women with primary breast cancer. J Clin Oncol 15:602–606CrossRefGoogle Scholar
  41. 41.
    Garber MC, Nau DP, Erickson SR, Aikens JE, Lawrence JB (2004) The concordance of self-report with other measures of medication adherence: a summary of the literature. Med Care 42:649–652PubMedCrossRefGoogle Scholar
  42. 42.
    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
  43. 43.
    Simoni JM, Kurth AE, Pearson CR, Pantalone DW, Merrill JO, Frick PA (2006) Self-report measures of antiretroviral therapy adherence: a review with recommendations for HIV research and clinical management. AIDS Behav 10:227–245PubMedCrossRefGoogle Scholar
  44. 44.
    Phillips KA, Milne RL, Buys S, Friedlander ML, Ward JH, McCredie MR, Giles GG, Hopper JL (2005) Agreement between self-reported breast cancer treatment and medical records in a population-based Breast Cancer Family Registry. J Clin Oncol 23:4679–4686PubMedCrossRefGoogle Scholar
  45. 45.
    Bjorner JB, Rose M, Gandek B, Stone AA, Junghaenel DU, Ware JE (2014) Method of administration of PROMIS scales did not significantly impact score level, reliability, or validity. J Clin Epidemiol 67:108–113PubMedCrossRefGoogle Scholar
  46. 46.
    DiMatteo MR (2004) Social support and patient adherence to medical treatment: a meta-analysis. Health Psychol 23:207–218PubMedCrossRefGoogle Scholar
  47. 47.
    Haynes RB, Ackloo E, Sahota N, McDonald HP, Yao X (2008) Interventions for enhancing medication adherence. Cochrane Database Syst Rev, Issue 2. Art. No.: CD000011. doi: 10.1002/14651858.CD000011.pub3
  48. 48.
    Roter DL, Hall JA, Merisca R, Nordstrom B, Cretin D, Svarstad B (1998) Effectiveness of interventions to improve patient compliance: a meta-analysis. Med Care 36:1138–1161PubMedCrossRefGoogle Scholar
  49. 49.
    Hadji P, Blettner M, Harbeck N, Jackisch C, Lück HJ, Windemuth-Kieselbach C, Zaun S, Kreienberg R (2013) The Patient’s Anastrozole Compliance to Therapy (PACT) program: a randomized, in-practice study on the impact of a standardized information program on persistence and compliance to adjuvant endocrine therapy in postmenopausal women with early breast cancer. Ann Oncol 24:1505–1512PubMedCrossRefGoogle Scholar
  50. 50.
    Ziller V, Kyvernitakis I, Knöll D, Storch A, Hars O, Hadji P (2013) Influence of a patient information program on adherence and persistence with an aromatase inhibitor in breast cancer treatment—the COMPAS study. BMC Cancer 13:407. doi: 10.1186/1471-2407-13-407 PubMedCentralPubMedCrossRefGoogle Scholar
  51. 51.
    Duijts SF, van Beurden M, Oldenburg HS et al (2012) Efficacy of cognitive behavioral therapy and physical exercise in alleviating treatment-induced menopausal symptoms in patients with breast cancer: results of a randomized, controlled, multicenter trial. J Clin Oncol 30:4124–4133PubMedCrossRefGoogle Scholar
  52. 52.
    Ruddy K, Mayer E, Partridge A (2009) Patient adherence and persistence with oral anticancer treatment. CA Cancer J Clin 59:56–66PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Annette L. Stanton
    • 1
    Email author
  • Keith J. Petrie
    • 2
  • Ann H. Partridge
    • 3
  1. 1.Departments of Psychology and Psychiatry/Biobehavioral Sciences, Center for Cancer Prevention and Control Research, Jonsson Comprehensive Cancer CenterUniversity of California, Los AngelesLos AngelesUSA
  2. 2.Department of Psychological MedicineUniversity of AucklandAucklandNew Zealand
  3. 3.Dana-Farber Cancer Institute, Brigham and Women’s HospitalHarvard Medical SchoolBostonUSA

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