Factors influencing the use of extended adjuvant endocrine therapy

  • Kunal C. Kadakia
  • Kelley M. Kidwell
  • Debra L. Barton
  • Anne F. Schott
  • Daniel F. Hayes
  • Jennifer J. Griggs
  • N. Lynn HenryEmail author
Clinical trial



Extending adjuvant endocrine therapy (ET) beyond 5 years has been shown to improve outcomes in breast cancer; however, limited data are available about if and why women pursue extended ET. The primary objective was to estimate the proportion of women who were willing to receive extended ET if recommended by their physician and secondarily, to determine what factors were associated with this decision.


This descriptive cross-sectional study surveyed 131 women with AJCC 7th Edition stages I–III breast cancer who had been taking adjuvant ET for 3–5 years. The survey inquired about the willingness to continue ET, quality of life (FACT-ES), and beliefs about medications (BMQ). Logistic regression was used to test for associations between clinical and disease factors, FACT-ES, BMQ, and the primary outcome.


One hundred and twelve (85%) patients reported “moderate” (n = 30, 23%), “quite a bit” (n = 41, 31%), or “extreme” (n = 41, 31%) willingness to pursue extended ET; 19 (14%) patients were “not at all” or were “unlikely” to be willing to take extended ET. On univariate analysis, lower total and social well-being FACT-ES scores, and lower perceived necessity and higher concerns on BMQ were associated with lower willingness to pursue extended ET. On multivariable analysis, greater patient perception of necessity of ET was the only factor associated with willingness to pursue extended ET (OR 1.34, 95% CI 1.15–1.57, p = 0.0005).


Most women who have taken ET for multiple years report being willing to pursue extended ET if recommended. When discussing extended ET, the data from this study support exploring patients’ belief of medication necessity.


Aromatase inhibitors Tamoxifen Quality of life Decision making Surveys and questionnaires Drug-related side effects and adverse reactions 


Author contributions

KCK: Conceptualization, data curation, formal analysis, investigation, methodology, validation, visualization, writing—original draft, review, and editing. KMK: Data curation, formal analysis, methodology, software, and writing—review and editing. DLB: Conceptualization, supervision, and writing—review and editing. JG: Conceptualization, supervision, and writing—review and editing. AFS: Writing—review and editing. DFH: Writing—review and editing. NLH: Conceptualization, data curation, funding acquisition, investigation, project administration, resources, supervision, writing—original draft, review, and editing.


This study was funded by NLH who was a Damon Runyon-Lilly Clinical Investigator supported (in part) by the Damon Runyon Cancer Research Foundation (Grant Number CI-53-10) and by an American Cancer Society Research Scholar Grant (124654-RSG-13-240-01-PCSM).

Compliance with ethical standards

Conflict of interest

All authors report no conflicts of interest specific to the content of the submitted manuscript. NLH and DFH have conflicts of interest not related to the current manuscript which are documented on the signed Conflict of Interest Disclosure Forms submitted with the manuscript. All authors report no conflicts of interest to disclose.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Supplementary material

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Supplementary material 1 (DOCX 14 KB)
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Supplementary material 2 (DOCX 18 KB)
10549_2019_5145_MOESM3_ESM.docx (32 kb)
Supplementary material 3 (DOCX 32 KB)


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Kunal C. Kadakia
    • 1
  • Kelley M. Kidwell
    • 2
  • Debra L. Barton
    • 3
  • Anne F. Schott
    • 4
  • Daniel F. Hayes
    • 4
  • Jennifer J. Griggs
    • 4
  • N. Lynn Henry
    • 5
    Email author
  1. 1.Department of Solid Tumor Oncology, Levine Cancer InstituteAtrium HealthCharlotteUSA
  2. 2.Department of BiostatisticsUniversity of Michigan School of Public HealthAnn ArborUSA
  3. 3.School of NursingUniversity of MichiganAnn ArborUSA
  4. 4.Breast Oncology ProgramUniversity of Michigan Rogel Cancer CenterAnn ArborUSA
  5. 5.Division of Oncology, Huntsman Cancer InstituteUniversity of UtahSalt Lake CityUSA

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