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Impact of non-adherence to endocrine therapy on recurrence risk in older women with stage I breast cancer after breast-conserving surgery

  • Epidemiology
  • Published:
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Abstract

Purpose

We examined the impact of non-adherence to adjuvant endocrine therapy (ET) on the risk and site of recurrence among older women with early stage, hormone receptor positive (HR+) breast cancer (EBC).

Methods

A population-based cohort of women age ≥ 65 years with T1N0 HR + EBC who were diagnosed between 2010 and 2016 and treated with breast-conserving surgery (BCS) + ET was identified. Treatment and outcomes were ascertained through linkage with administrative databases. ET non-adherence was examined as a time-dependent covariate in multivariable cause-specific Cox regression models to evaluate its effect on the risks of ipsilateral local recurrence (LR), contralateral breast cancer, and distant metastases.

Results

The population cohort includes 2637 women; 73% (N = 1934) received radiation (RT) + ET and 27% (N = 703) received ET alone. At a median follow-up of 8.14 years, the first event was LR in 3.6% of women treated with ET alone and 1.4% for those treated with RT + ET (p < 0.001); the risk of distant metastases was < 1% in both groups. The proportion of time adherent to ET was 69.0% among those treated with RT + ET and 62.8% for those treated with ET alone. On multivariable analysis, increasing proportion of time non-adherent to ET was associated with increased risk of LR ((HR = 1.52 per 20% increase in time; 95%CI 1.25, 1.85; p < 0.001), contralateral BC (HR = 1.55; 95%CI 1.30, 1.84; p < 0.001), and distant metastases (HR = 1.44; 95%CI 1.08, 1.94; p = 0.01) but absolute risks were low.

Conclusion

Non-adherence to adjuvant ET was associated with an increased risk of recurrence, but absolute recurrence rates were low.

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Data availability

The data that support the findings of this study are available from the Institute for Clinical Evaluative Sciences, but restrictions apply to the availability of these data, which were used under license for the current study and so are not publicly available.

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Acknowledgements

This study was supported by ICES. ICES is an independent, non-profit research institute funded by an annual grant from the Ontario Ministry of Health (MOH) and the Ministry of Long-Term Care (MLTC). As a prescribed entity under Ontario’s privacy legislation, ICES is authorized to collect and use health care data for the purposes of health system analysis, evaluation and decision support. Secure access to these data is governed by policies and procedures that are approved by the Information and Privacy Commissioner of Ontario. Parts of this material are based on data and/or information compiled and provided by CIHI and the Ontario Ministry of Health. The analyses, conclusions, opinions and statements expressed herein are solely those of the authors and do not reflect those of the funding or data sources; no endorsement is intended or should be inferred. Parts of this material are based on data and information provided by Ontario Health (OH). The opinions, results, view, and conclusions reported in this paper are those of the authors and do not necessarily reflect those of OH. No endorsement by OH is intended or should be inferred. We thank IQVIA Solutions Canada Inc. for use of their Drug Information File. Parts of this material are based on data and information compiled and provided by the Ontario Ministry of Health. The analyses, conclusions, opinions and statements expressed herein are solely those of the authors and do not reflect those of the funding or data sources; no endorsement is intended or should be inferred.

Funding

E Rakovitch holds the LC Campbell Breast Cancer Research Chair.

Author information

Authors and Affiliations

  1. Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON, Canada

    Danielle Rodin & Ezra Hahn

  2. Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada

    Danielle Rodin, Ezra Hahn, Lawrence Paszat & Eileen Rakovitch

  3. Institute for Clinical Evaluative Sciences, Toronto, ON, Canada

    Rinku Sutradhar, Lena Nguyen, Cindy Fong, Lawrence Paszat & Eileen Rakovitch

  4. Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada

    Rinku Sutradhar & Lawrence Paszat

  5. Department of Medical Oncology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada

    Katarzyna J. Jerzak

  6. Division of General Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada

    Matthew Castelo

  7. Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada

    Matthew Castelo & Omolara Fatiregun

  8. Department of Medical Oncology, London Regional Cancer Program, London, ON, Canada

    Danilo Giffoni M. M. Mata

  9. Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada

    Sabina Trebinjac, Lawrence Paszat & Eileen Rakovitch

Authors
  1. Danielle Rodin
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  2. Rinku Sutradhar
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  3. Katarzyna J. Jerzak
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  4. Ezra Hahn
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  5. Lena Nguyen
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  6. Matthew Castelo
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  10. Sabina Trebinjac
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  11. Lawrence Paszat
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  12. Eileen Rakovitch
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Contributions

Data analysis was performed by LN. All authors contributed to the interpretation of the data. The first draft of the manuscript was written by DR and ER and all authors provided critical feedback. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Eileen Rakovitch.

Ethics declarations

Competing interest

E Rakovitch has received research grant funding from Genomic Health Inc. outside of the submitted work. K.J.J reports personal fees from Amgen, AstraZeneca, Apo Biologix, Eli Lilly, Esai, Genomic Health, Gilead Sciences, Knight Therapeutics, Merck, Myriad Genetics Inc, Pfizer, Roche, Seagen, Novartis, Purdue Pharma, Viatris and grants from AstraZeneca, Eli Lilly and Seagen outside the submitted work. All other authors declare no conflicts of interest.

Informed consent

This is a population-based retrospective analysis. All personal identifiers for each case in this population cohort were removed. This study was facilitated through ICES which is named as a prescribed entity in Sect.  45 of PHIPA (Regulation 329/04, Sect.  18) which allows access and utilization of administrative data for research purposes with a waived requirement for consent.

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Rodin, D., Sutradhar, R., Jerzak, K.J. et al. Impact of non-adherence to endocrine therapy on recurrence risk in older women with stage I breast cancer after breast-conserving surgery. Breast Cancer Res Treat 201, 77–87 (2023). https://doi.org/10.1007/s10549-023-06989-x

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