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Breast Cancer Research and Treatment

, Volume 163, Issue 2, pp 311–319 | Cite as

Identifying socio-demographic and clinical characteristics associated with medication beliefs about aromatase inhibitors among postmenopausal women with breast cancer

  • Teresa M. SalgadoEmail author
  • Emily J. Davis
  • Karen B. Farris
  • Souhiela Fawaz
  • Peter Batra
  • N. Lynn Henry
Epidemiology

Abstract

Purpose

Non-adherence/persistence to adjuvant endocrine therapy can negatively impact survival. Beliefs about medicines are known to affect adherence. This study aims to identify socio-demographic and clinical characteristics associated with medication beliefs among women taking aromatase inhibitors (AIs).

Methods

Women completed an online survey on beliefs about AI therapy [Beliefs about Medicines Questionnaire (BMQ)], beliefs about breast cancer [Assessment of Survivor Concerns scale (ASC)], and depression [Personal Health Questionnaire depression scale (PHQ-8)]. Socio-demographic and clinical characteristics were collected. Bivariate analyses and linear regression models were performed to investigate relationships between variables.

Results

A total of 224 women reported currently taking AI therapy and were included in the analysis. Significantly higher concern beliefs were found among women who had at least mild depression, experienced side effects from AIs, and previously stopped therapy with another AI. Significant correlations were found between concern and necessity beliefs and cancer and health worry. Women age 70 and older displayed less fear of cancer recurrence and health worry, and a trend towards lower necessity and concern beliefs. No differences were found for other variables. In the regression model, greater necessity beliefs were found with increases in the number of current prescription medications (B = 1.06, 95% CI 0.31–1.81, p = 0.006) and shorter duration of current AI therapy (B = −0.65, 95% CI −1.23 to −0.07, p = 0.029), whereas greater concern beliefs were associated with higher depression scores (B = 1.19, 95% CI 0.35–2.03, p = 0.006).

Conclusions

Medication necessity and concern beliefs were associated with a definable subset of patients who may be at higher risk for non-persistence.

Keywords

Medication adherence Adjuvant endocrine therapy Aromatase inhibitor Beliefs about medicines Socio-demographic characteristics Persistence 

Notes

Funding

Dr. Henry was supported, in part, by a Damon Runyon-Lilly Clinical Investigator Award supported by the Damon Runyon Cancer Research Foundation (#CI-53-10).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This study was approved by the University of Michigan (UM) Institutional Review Board (IRBMED). Written informed consent was obtained from all individuals before completing the survey.

References

  1. 1.
    DeSantis CE, Fedewa SA, Goding Sauer A, Kramer JL, Smith RA, Jemal A (2016) Breast cancer statistics, 2015: convergence of incidence rates between black and white women. CA Cancer J Clin 66:31–42CrossRefPubMedGoogle Scholar
  2. 2.
    Burstein HJ, Temin S, Anderson H, Buchholz TA, Davidson NE, Gelmon KE, Giordano SH, Hudis CA, Rowden D, Solky AJ et al (2014) Adjuvant endocrine therapy for women with hormone receptor-positive breast cancer: american society of clinical oncology clinical practice guideline focused update. J Clin Oncol 32:2255–2269CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Dowsett M, Cuzick J, Ingle J, Coates A, Forbes J, Bliss J, Buyse M, Baum M, Buzdar A, Colleoni M et al (2010) Meta-analysis of breast cancer outcomes in adjuvant trials of aromatase inhibitors versus tamoxifen. J Clin Oncol 28:509–518CrossRefPubMedGoogle Scholar
  4. 4.
    Goss PE, Ingle JN, Pritchard KI, Robert NJ, Muss H, Gralow J, Gelmon K, Whelan T, Strasser-Weippl K, Rubin S et al (2016) Extending aromatase-inhibitor adjuvant therapy to 10 years. N Engl J Med 375:209–219CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Dowsett M, Forbes JF, Bradley R, Ingle J, Aihara T, Bliss J, Boccardo F, Coates A, Coombes RC, Cuzick J et al (2015) Aromatase inhibitors versus tamoxifen in early breast cancer: patient-level meta-analysis of the randomised trials. Lancet 386:1341–1352CrossRefPubMedGoogle Scholar
  6. 6.
    Early Breast Cancer Trialists’ Collaborative Group (EBCTCG) (2005) Effects of chemotherapy and hormonal therapy for early breast cancer on recurrence and 15-year survival: an overview of the randomised trials. Lancet 365:1687–1717CrossRefGoogle Scholar
  7. 7.
    Chirgwin JH, Giobbie-Hurder A, Coates AS, Price KN, Ejlertsen B, Debled M, Gelber RD, Goldhirsch A, Smith I, Rabaglio M et al (2016) Treatment adherence and its impact on disease-free survival in the breast international group 1-98 trial of tamoxifen and letrozole, alone and in sequence. J Clin Oncol 34:2452–2459CrossRefPubMedGoogle Scholar
  8. 8.
    Hershman DL, Shao T, Kushi LH, Buono D, Tsai WY, Fehrenbacher L, Kwan M, Gomez SL, Neugut AI (2011) Early discontinuation and non-adherence to adjuvant hormonal therapy are associated with increased mortality in women with breast cancer. Breast Cancer Res Treat 126:529–537CrossRefPubMedGoogle Scholar
  9. 9.
    Barron TI, Cahir C, Sharp L, Bennett K (2013) A nested case-control study of adjuvant hormonal therapy persistence and compliance, and early breast cancer recurrence in women with stage I-III breast cancer. Br J Cancer 109:1513–1521CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    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 134:459–478CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    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 133:367–373CrossRefPubMedGoogle Scholar
  12. 12.
    Owusu C, Buist DS, Field TS, Lash TL, Thwin SS, Geiger AM, Quinn VP, Frost F, Prout M, Yood MU et al (2008) Predictors of tamoxifen discontinuation among older women with estrogen receptor-positive breast cancer. J Clin Oncol 26:549–555CrossRefPubMedGoogle Scholar
  13. 13.
    Sedjo RL, Devine S (2011) Predictors of non-adherence to aromatase inhibitors among commercially insured women with breast cancer. Breast Cancer Res Treat 125:191–200CrossRefPubMedGoogle Scholar
  14. 14.
    Wang X, Du XL (2015) Socio-demographic and geographic variations in the utilization of hormone therapy in older women with breast cancer after medicare Part-D coverage. Med Oncol 32:154CrossRefPubMedGoogle Scholar
  15. 15.
    Andersson Sundell K, Jonsson AK (2016) Beliefs about medicines are strongly associated with medicine-use patterns among the general population. Int J Clin Pract 70:277–285CrossRefPubMedGoogle Scholar
  16. 16.
    Kumar K, Raza K, Nightingale P, Horne R, Chapman S, Greenfield S, Gill P (2015) Determinants of adherence to disease modifying anti-rheumatic drugs in White British and South Asian patients with rheumatoid arthritis: a cross sectional study. BMC Musculoskelet Disord 16:396CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Horne R, Weinman J (1999) Patients’ beliefs about prescribed medicines and their role in adherence to treatment in chronic physical illness. J Psychosom Res 47:555–567CrossRefPubMedGoogle Scholar
  18. 18.
    Horne R, Chapman SC, Parham R, Freemantle N, Forbes A, Cooper V (2013) Understanding patients’ adherence-related beliefs about medicines prescribed for long-term conditions: a meta-analytic review of the necessity-concerns framework. PLoS ONE 8:e80633CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Kimmick G, Anderson R, Camacho F, Bhosle M, Hwang W, Balkrishnan R (2009) Adjuvant hormonal therapy use among insured, low-income women with breast cancer. J Clin Oncol 27:3445–3451CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    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 22:3309–3315CrossRefPubMedGoogle Scholar
  21. 21.
    Grunfeld EA, Hunter MS, Sikka P, Mittal S (2005) Adherence beliefs among breast cancer patients taking tamoxifen. Patient Educ Couns 59:97–102CrossRefPubMedGoogle Scholar
  22. 22.
    Harrow A, Dryden R, McCowan C, Radley A, Parsons M, Thompson AM, Wells M (2014) A hard pill to swallow: a qualitative study of women’s experiences of adjuvant endocrine therapy for breast cancer. BMJ Open 4:e005285CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Partridge AH, Fasse K, Stanton AL, Jones A, Bright E, Petrie KJ (2015) What goes through your mind when you think about your medication? Thoughts about endocrine medication and treatment adherence (Publication Number: P5-12-13). San Antonio Breast Cancer Symposium: 2015 San Antonio, TXGoogle Scholar
  24. 24.
    Brier MJ, Chambless DL, Gross R, Chen J, Mao JJ (2017) Perceived barriers to treatment predict adherence to aromatase inhibitors among breast cancer survivors. Cancer 123:169–176CrossRefPubMedGoogle Scholar
  25. 25.
    Corter AL, Findlay M, Broom R, Porter D, Petrie KJ (2013) Beliefs about medicine and illness are associated with fear of cancer recurrence in women taking adjuvant endocrine therapy for breast cancer. Br J Health Psychol 18:168–181CrossRefPubMedGoogle Scholar
  26. 26.
    Simon R, Latreille J, Matte C, Desjardins P, Bergeron E (2014) Adherence to adjuvant endocrine therapy in estrogen receptor-positive breast cancer patients with regular follow-up. Can J Surg 57:26–32CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Neugut AI, Hillyer GC, Kushi LH, Lamerato L, Leoce N, Nathanson SD, Ambrosone CB, Bovbjerg DH, Mandelblatt JS, Magai C et al (2012) Non-initiation of adjuvant hormonal therapy in women with hormone receptor-positive breast cancer: the breast cancer quality of care study (BQUAL). Breast Cancer Res Treat 134:419–428CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Wouters H, Stiggelbout AM, Bouvy ML, Maatman GA, Van Geffen EC, Vree R, Nortier JW, Van Dijk L (2014) Endocrine therapy for breast cancer: assessing an array of women’s treatment experiences and perceptions, their perceived self-efficacy and non adherence. Clin Breast Cancer 14(460–467):e462Google Scholar
  29. 29.
    Heisig SR, Shedden-Mora MC, von Blanckenburg P, Rief W, Witzel I, Albert US, Nestoriuc Y (2016) What do women with breast cancer expect from their treatment? Correlates of negative treatment expectations about endocrine therapy. Psychooncology 25:1485–1492CrossRefPubMedGoogle Scholar
  30. 30.
    Barr JT, Conley M, Sluboski K, Griffith J (2015) Beliefs about medicines in an urban community health center hypertension population. Value Health 18:A397CrossRefPubMedGoogle Scholar
  31. 31.
    Kumar K, Gordon C, Toescu V, Buckley CD, Horne R, Nightingale PG, Raza K (2008) Beliefs about medicines in patients with rheumatoid arthritis and systemic lupus erythematosus: a comparison between patients of South Asian and White British origin. Rheumatology (Oxford) 47:690–697CrossRefGoogle Scholar
  32. 32.
    Horne R, Graupner L, Frost S, Weinman J, Wright SM, Hankins M (2004) Medicine in a multi-cultural society: the effect of cultural background on beliefs about medications. Soc Sci Med 59:1307–1313CrossRefPubMedGoogle Scholar
  33. 33.
    Horne R, Weinman J, Hankins M (1999) The beliefs about medicines questionnaire: the development and evaluation of a new method for assessing the cognitive representation of medication. Psychol Health 14:1–24CrossRefGoogle Scholar
  34. 34.
    Gotay CC, Pagano IS (2007) Assessment of Survivor Concerns (ASC): a newly proposed brief questionnaire. Health Qual Life Outcomes 5:15CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Kroenke K, Strine TW, Spitzer RL, Williams JB, Berry JT, Mokdad AH (2009) The PHQ-8 as a measure of current depression in the general population. J Affect Disord 114:163–173CrossRefPubMedGoogle Scholar
  36. 36.
    De Smedt RH, Denig P, van der Meer K, Haaijer-Ruskamp FM, Jaarsma T (2011) Self-reported adverse drug events and the role of illness perception and medication beliefs in ambulatory heart failure patients: a cross-sectional survey. Int J Nurs Stud 48:1540–1550CrossRefPubMedGoogle Scholar
  37. 37.
    Allen LaPointe NM, Ou FS, Calvert SB, Melloni C, Stafford JA, Harding T, Alexander KP, Peterson ED (2010) Changes in beliefs about medications during long-term care for ischemic heart disease. Am Heart J 159:561–569CrossRefPubMedGoogle Scholar
  38. 38.
    Llewellyn CD, McGurk M, Weinman J (2006) Head and neck cancer: to what extent can psychological factors explain differences between health-related quality of life and individual quality of life? Br J Oral Maxillofac Surg 44:351–357CrossRefPubMedGoogle Scholar
  39. 39.
    Trachtenberg FL, Mednick L, Kwiatkowski JL, Neufeld EJ, Haines D, Pakbaz Z, Thompson AA, Quinn CT, Grady R, Sobota A et al (2012) Beliefs about chelation among thalassemia patients. Health Qual Life Outcomes 10:148CrossRefPubMedPubMedCentralGoogle Scholar
  40. 40.
    Cheruvu VK, Oancea SC (2016) Current depression as a potential barrier to health care utilization in adult cancer survivors. Cancer Epidemiol 44:132–137CrossRefPubMedGoogle Scholar
  41. 41.
    Grassi L, Meggiolaro E, Berardi MA, Sirgo A, Colistro MC, Andritsch E, Montesi A, Bertelli T, Farkas C, Caruso R et al (2017) Beliefs about medicines, doctor-patient relationship, and coping among European patients with cancer. Psychooncology 26:282–285CrossRefPubMedGoogle Scholar
  42. 42.
    Myrick ME, Schmid SM, Kilic N, Guth U (2012) Eligibility, compliance and persistence of extended adjuvant endocrine therapy for breast cancer. Acta Oncol 51:247–253CrossRefPubMedGoogle Scholar
  43. 43.
    Nekhlyudov L, Li L, Ross-Degnan D, Wagner AK (2011) Five-year patterns of adjuvant hormonal therapy use, persistence, and adherence among insured women with early-stage breast cancer. Breast Cancer Res Treat 130:681–689CrossRefPubMedGoogle Scholar
  44. 44.
    Lash TL, Fox MP, Westrup JL, Fink AK, Silliman RA (2006) Adherence to tamoxifen over the five-year course. Breast Cancer Res Treat 99:215–220CrossRefPubMedGoogle Scholar
  45. 45.
    Neugut AI, Zhong X, Wright JD, Accordino M, Yang J, Hershman DL (2016) Nonadherence to medications for chronic conditions and nonadherence to adjuvant hormonal therapy in women with breast cancer. JAMA Oncol 2:1326–1332CrossRefPubMedGoogle Scholar
  46. 46.
    Greenlee H, Neugut AI, Falci L, Hillyer GC, Buono D, Roh JM, Ergas IJ, Kwan ML, Lee M, Tsai WY et al (2015) Complementary and alternative medicine use and breast cancer chemotherapy initiation: The BQUAL study (Publication Number: PD4-05). San Antonio Breast Cancer Symposium: 2015 San Antonio, TXGoogle Scholar
  47. 47.
    Huiart L, Bouhnik AD, Rey D, Rousseau F, Retornaz F, Meresse M, Bendiane MK, Viens P, Giorgi R (2013) Complementary or alternative medicine as possible determinant of decreased persistence to aromatase inhibitor therapy among older women with non-metastatic breast cancer. PLoS ONE 8:e81677CrossRefPubMedPubMedCentralGoogle Scholar
  48. 48.
    Hadji P, Blettner M, Harbeck N, Jackisch C, Luck 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 24:1505–1512CrossRefPubMedGoogle Scholar
  49. 49.
    Markopoulos C, Neven P, Tanner M, Marty M, Kreienberg R, Atkins L, Franquet A, Gnant M, Neciosup S, Tesarova P et al (2015) Does patient education work in breast cancer? Final results from the global CARIATIDE study. Future Oncol 11:205–217CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  • Teresa M. Salgado
    • 1
    Email author
  • Emily J. Davis
    • 2
  • Karen B. Farris
    • 3
  • Souhiela Fawaz
    • 4
  • Peter Batra
    • 5
  • N. Lynn Henry
    • 6
  1. 1.Department of Pharmacotherapy & Outcomes ScienceVirginia Commonwealth University School of PharmacyRichmondUSA
  2. 2.University of Michigan College of PharmacyAnn ArborUSA
  3. 3.Department of Clinical PharmacyUniversity of Michigan College of PharmacyAnn ArborUSA
  4. 4.Department of Biomedical and Pharmaceutical SciencesChapman University School of PharmacyIrvineUSA
  5. 5.Survey Research Center, Institute for Social ResearchUniversity of MichiganAnn ArborUSA
  6. 6.Huntsman Cancer InstituteUniversity of UtahSalt Lake CityUSA

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