Breast Cancer Research and Treatment

, Volume 157, Issue 1, pp 133–143 | Cite as

Psychosocial factors related to non-persistence with adjuvant endocrine therapy among women with breast cancer: the Breast Cancer Quality of Care Study (BQUAL)

  • Dawn L. Hershman
  • Lawrence H. Kushi
  • Grace Clarke Hillyer
  • Ellie Coromilas
  • Donna Buono
  • Lois Lamerato
  • Dana H. Bovbjerg
  • Jeanne S. Mandelblatt
  • Wei-Yann Tsai
  • Xiaobo Zhong
  • Judith S. Jacobson
  • Jason D. Wright
  • Alfred I. Neugut


Non-adherence to adjuvant endocrine therapy (ET) for breast cancer (BC) is common. Our goal was to determine the associations between psychosocial factors and ET non-persistence. We recruited women with BC receiving care in an integrated healthcare system between 2006 and 2010. Using a subset of patients treated with ET, we investigated factors related to ET non-persistence (discontinuation) based on pharmacy records (≥90 days gap). Serial interviews were conducted at baseline and every 6 months. The Functional Assessment of Cancer Therapy (FACT), Medical Outcomes Survey, Treatment Satisfaction Questionnaire (TSQM), Impact of Events Scale (IES), Interpersonal Processes of Care measure, and Decision-making beliefs and concerns were measured. Multivariate models assessed factors associated with non-persistence. Of the 523 women in our final cohort who initiated ET and had a subsequent evaluation, 94 (18 %) were non-persistent over a 2-year follow-up. The cohort was primarily white (74.4 %), stage 1 (60.6 %), and on an aromatase inhibitor (68.1 %). Women in the highest income category had a lower odds of being non-persistent (OR 0.43, 95 % CI 0.23–0.81). Quality of life and attitudes toward ET at baseline were associated with non-persistence. At follow-up, the FACT, TSQM, and IES were associated with non-persistence (p < 0.001). Most women continued ET. Women who reported a better attitude toward ET, better quality of life, and more treatment satisfaction, were less likely to be non-persistent and those who reported intrusive/avoidant thoughts were more likely to be non-persistent. Interventions to enhance the psychosocial well-being of patients should be evaluated to increase adherence.


Breast cancer Adherence Quality of life Psychosocial factors 



This study was supported by the Department of Defense Breast Cancer Center of Excellence Award (BC043120) to Drs. Neugut/Hershman; the NCI R01 (CA105274) to Dr. Kushi; the Department of Defense (DAMD-17-01-1-0334) to Dr. Bovbjerg; and the NCI R01 (CA124924 and 127617) and U10 (CA 84131) to Dr. Mandelblatt. Drs. Hershman is the recipient of funding from the Breast Cancer Research Foundation.

Compliance with ethical standards

Conflict of interest

All authors report no conflicts of interest. All of the authors are responsible for the data analysis and interpretation. No additional individuals were involved in the analysis.


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Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Dawn L. Hershman
    • 1
    • 2
    • 3
  • Lawrence H. Kushi
    • 5
  • Grace Clarke Hillyer
    • 2
    • 3
  • Ellie Coromilas
    • 1
  • Donna Buono
    • 3
  • Lois Lamerato
    • 6
  • Dana H. Bovbjerg
    • 7
    • 8
  • Jeanne S. Mandelblatt
    • 9
  • Wei-Yann Tsai
    • 4
  • Xiaobo Zhong
    • 3
  • Judith S. Jacobson
    • 2
    • 3
  • Jason D. Wright
    • 2
    • 10
  • Alfred I. Neugut
    • 1
    • 2
    • 3
  1. 1.Department of MedicineColumbia UniversityNew YorkUSA
  2. 2.Herbert Irving Comprehensive Cancer Center, College of Physicians and SurgeonsColumbia UniversityNew YorkUSA
  3. 3.Department of EpidemiologyColumbia UniversityNew YorkUSA
  4. 4.Department of Biostatistics, Mailman School of Public HealthColumbia UniversityNew YorkUSA
  5. 5.Division of ResearchKaiser-Permanente of Northern CaliforniaOaklandUSA
  6. 6.Department of Public Health SciencesHenry Ford Health SystemDetroitUSA
  7. 7.Departments of Psychiatry, Psychology and Behavioral and Community Health SciencesUniversity of PittsburghPittsburghUSA
  8. 8.University of Pittsburgh Cancer InstitutePittsburghUSA
  9. 9.Department of Oncology and Lombardi Comprehensive Cancer CenterGeorgetown University Medical CenterWashingtonUSA
  10. 10.Department of Obstetrics and GynecologyColumbia UniversityNew YorkUSA

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