Medication use trajectories of postmenopausal breast cancer survivors and matched cancer-free controls
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While adverse medical sequelae are associated with breast cancer therapies, information on breast cancer impact on medication use is limited. Therefore, we compared medication use before and after diagnosis of early stage breast cancer to medication use in matched, cancer-free controls. Of 68,132 Women’s Health Initiative participants, 3726 were diagnosed with breast cancer and, after exclusions, in 1731 breast cancer cases, medication use before and >3 years after diagnosis (mean 5.3 ± 2.1 SD) was compared to use in 1731 cancer-free matched controls on similar inventory dates. The medication category number at follow-up inventory was the primary study outcome. Medication category use (n, mean, SD) was comparable at baseline and significantly increased at follow-up in both cases (2.48 ± 1.66 vs. 4.15 ± 2.13, baseline vs follow-up, respectively, P < .0001) and controls (2.44 ± 1.67 vs. 3.95 ± 2.13, respectively, P < .0001), with clinically marginal but statistically significant additional medication category use by cases (0.20 ± 2.40, P < .0001). Tamoxifen users used somewhat more selected medication categories at follow-up assessment (mean 3.40 ± 1.89 vs. 3.21 ± 1.99, respectively, P = 0.05), while aromatase inhibitor users used more medication categories (mean 4.85 ± 2.10 vs. 4.44 ± 1.94, respectively, P = 0.02). No increase in medication category was seen in cases who were not current endocrine therapy users. Breast cancer survivors having only a clinically marginal increase in medication use compared to cancer-free controls. These findings highlight the importance of incorporation of control populations in studies of cancer survivorship.
KeywordsBreast cancer Medication Survivorship Control group Women’s Health Initiative Comorbidity
The WHI program is reported by the National Heart, Lung and Blood Institute, National Institutes of Health, Department of Health and Human Services through contracts N01WH22110, 24152, 32100-2, 32105-6, 32108-9, 32111-13, 32115, 32118-32119, 32122, 42107-26, 42129-32, and 44221.
Role of the sponsor
The WHI Project Office at the US National Heart, Lung, and Blood Institute (NHLBI) reviewed and approved the final manuscript but had no other role in the preparation of this report.
KP and RTC wrote the analysis proposal and initial draft of the report. KP and RTC had full access to the data in the study and take full responsibility for the integrity of the data and the accuracy of the data analysis. RR undertook the statistical analysis. RTC, JEM, MLS, MSS, KCJ, JW, MJO, and RLP collected the data and obtained study funding. Additional contributions: We thank the Women’s Health Initiative investigators, staff, and the trial participants for their outstanding dedication and commitment.
Women’s Health Initiative investigators
Program office (National Heart, Lung, and Blood Institute, Bethesda, MD) Jacques Roscoe, Shari Ludlum, Dale Burden, Joan McGowan, Leslie Ford, and Nancy Geller. Clinical coordinating center (Fred Hutchinson Cancer Research Center, Seattle, WA) Garnet Anderson, Ross Prentice, Andrea LaCroix, and Charles Kooperberg. Investigators and academic centers (Brigham and Women’s Hospital, Harvard Medical School, Boston, MA) JoAnn E, Manson; (MedStar Health Research Institute/Howard University, Washington, DC) Barbara V Howard; (Stanford Prevention Research Center, Stanford, CA) Marcia L. Stefanick; (The Ohio State University, Columbus, OH) Rebecca Jackson; (University of Arizona, Tucson/Phoenix, AZ) Cynthia A. Thompson; (University at Buffalo, Buffalo, NY) Jean Wactawski-Wende; (University of Florida, Gainesville/Jacksonville, FL) Marian Limacher; (University of Iowa, Iowa City/Davenport, IA) Robert Wallace; (University of Pittsburgh, Pittsburgh, PA) Lewis Kuller; (Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA) Rowan T. Chlebowski; (Wake Forest University School of Medicine, Winston Salem, NC) Sally Shumaker. Women’s Health Initiative memory study (Wake Forest University School of Medicine, Winston Salem, NC) Sally Shumaker. Additional information A full list of all the investigators who have contributed to Women’s Health Initiative science appears at https://www.whi.org/researchers/Documents%20%20Write%20a%20Paper/WHI%20Investigator%20Long%20List.pdf.
Compliance with ethical standards
Conflict of interest
All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Dr. Chlebowski reported being a consultant for AstraZenea, Novartis, Amgen, Genomic Health and Novo Nordisk, receiving funding support from Amgen, and serving on the speaker’s bureau for Novartis and Genentech.
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