Adjuvant endocrine therapy initiation and persistence in a diverse sample of patients with breast cancer


Adjuvant endocrine therapy for breast cancer reduces recurrence and improves survival rates. Many patients never start treatment or discontinue prematurely. A better understanding of factors associated with endocrine therapy initiation and persistence could inform practitioners how to support patients. We analyzed data from a longitudinal study of 2,268 women diagnosed with breast cancer and reported to the Metropolitan Detroit and Los Angeles SEER cancer registries in 2005–2007. Patients were surveyed approximately both 9 months and 4 years after diagnosis. At the 4-year mark, patients were asked if they had initiated endocrine therapy, terminated therapy, or were currently taking therapy (defined as persistence). Multivariable logistic regression models examined factors associated with initiation and persistence. Of the 743 patients eligible for endocrine therapy, 80 (10.8 %) never initiated therapy, 112 (15.1 %) started therapy but discontinued prematurely, and 551 (74.2 %) continued use at the second time point. Compared with whites, Latinas (OR 2.80, 95 % CI 1.08–7.23) and black women (OR 3.63, 95 % CI 1.22–10.78) were more likely to initiate therapy. Other factors associated with initiation included worry about recurrence (OR 3.54, 95 % CI 1.31–9.56) and inadequate information about side effects (OR 0.24, 95 % CI 0.10–0.55). Factors associated with persistence included two or more medications taken weekly (OR 4.19, 95 % CI 2.28–7.68) and increased age (OR 0.98, 95 % CI 0.95–0.99). Enhanced patient education about potential side effects and the effectiveness of adjuvant endocrine therapy in improving outcomes may improve initiation and persistence rates and optimize breast cancer survival.

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This work was funded by Grants R01 CA109696 and R01 CA088370 from the National Cancer Institute to the University of Michigan. Dr. Friese was supported by a Pathway to Independence Award from the National Institute for Nursing Research (R00NR01570). Dr. Katz was supported by an Established Investigator Award in Cancer Prevention, Control, Behavioral, and Population Sciences Research from the National Cancer Institute (K05CA111340). Dr. Jagsi was supported by a Mentored Research Scholar Grant from the American Cancer Society (MRSG-09-145-01). The collection of Los Angeles County cancer incidence data was supported by the California Department of Public Health as part of the statewide cancer reporting program mandated by California Health and Safety Code §103885. The National Cancer Institute’s Surveillance, Epidemiology, and End Results Program under contract N01-PC-35139 was awarded to the University of Southern California. Contract N01-PC-54404 and agreement 1U58DP00807-01 were awarded to the Public Health Institute. The collection of metropolitan Detroit cancer incidence data was supported by the National Cancer Institute’s Surveillance, Epidemiology, and End Results Program under contract N01-PC-35145.

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The authors declare they have no conflict of interest.

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Institutional Review Boards of the University of Michigan, the University of Southern California, and Wayne State University approved the study described in this work.

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Correspondence to Christopher R. Friese.

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Friese, C.R., Pini, T.M., Li, Y. et al. Adjuvant endocrine therapy initiation and persistence in a diverse sample of patients with breast cancer. Breast Cancer Res Treat 138, 931–939 (2013).

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  • Breast neoplasms
  • Aromatase inhibitors
  • Selective estrogen receptor modulators
  • Medication taking
  • Health services research