Skip to main content

Advertisement

SpringerLink
Log in

Half of breast cancer patients discontinue tamoxifen and any endocrine treatment before the end of the recommended treatment period of 5 years: a population-based analysis

  • Epidemiology
  • Published:
Breast Cancer Research and Treatment Aims and scope Submit manuscript

Abstract

Observational studies on long-term endocrine treatment among breast cancer patients have presented discontinuation rates on tamoxifen, but lack information on the continuance of any endocrine treatment [both tamoxifen and aromatase inhibitors (AIs)] within the same cohort. In this study we determined switching rates from tamoxifen to AIs, discontinuation rates of tamoxifen only, discontinuation rates of any endocrine treatment and determinants of first treatment switch and treatment discontinuation. Patients with early stage breast cancer (stage I–IIIa) starting on tamoxifen were selected from the linked Eindhoven Cancer Registry-PHARMO RLS cohort in the period 1998–2006. Continuous use (allowing a 60 days gap between refills) of tamoxifen only and any endocrine treatment were determined after various follow-up periods: 1, 2, 3, 4, and 5 years. Time to first switch from tamoxifen to an AI was assessed. Cox regression was used to identify determinants of first treatment switch, discontinuation of tamoxifen, and discontinuation of any endocrine treatment. A total of 1,451 new early stage breast cancer patients started on tamoxifen. Of those, 380 had a treatment switch to an AI during follow-up. Of the patients followed for 5 years, 40% continuously used tamoxifen, which was 49% for any endocrine treatment. Older age (older than 70 versus 50–69 years) was independently associated with increased discontinuation of tamoxifen and any endocrine therapy. Patients with two or more concomitant diseases (versus no comorbidity) showed an increased likelihood to stop any endocrine treatment or switch treatment from tamoxifen to an AI. In conclusion, up to half of the breast cancer patients starting tamoxifen continued 5 years of endocrine treatment. Identification of patients at risk of discontinuation will assist in the development of interventions to improve treatment continuation comparable to that of patients included in clinical trials.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. 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(9472):1687–1717

    Article  Google Scholar 

  2. Winer EP, Hudis C, Burstein HJ, Wolff AC, Pritchard KI, Ingle JN, Chlebowski RT, Gelber R, Edge SB, Gralow J et al (2005) American Society of Clinical Oncology technology assessment on the use of aromatase inhibitors as adjuvant therapy for postmenopausal women with hormone receptor-positive breast cancer: status report 2004. J Clin Oncol 23(3):619–629

    Article  CAS  PubMed  Google Scholar 

  3. Waterhouse DM, Calzone KA, Mele C, Brenner DE (1993) Adherence to oral tamoxifen: a comparison of patient self-report, pill counts, and microelectronic monitoring. J Clin Oncol 11(6):1189–1197

    CAS  PubMed  Google Scholar 

  4. Barron TI, Connolly R, Bennett K, Feely J, Kennedy MJ (2007) Early discontinuation of tamoxifen: a lesson for oncologists. Cancer 109:832–839

    Article  CAS  PubMed  Google Scholar 

  5. McCowan C, Shearer J, Donnan PT, Dewar JA, Crilly M, Thompson AM, Fahey TP (2008) Cohort study examining tamoxifen adherence and its relationship to mortality in women with breast cancer. Br J Cancer 99(11):1763–1768

    Article  CAS  PubMed  Google Scholar 

  6. 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(4):549–555

    Article  PubMed  Google Scholar 

  7. 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(21):3445–3451

    Article  PubMed  Google Scholar 

  8. Schwartzberg LS, Cobb P, Senecal F, Henry D, Kulig K, Walker MS, Houts AC, Stepanski EJ (2009) Initial treatment and changes in adjuvant endocrine therapy for early stage breast cancer. Breast 18(2):78–83

    Article  PubMed  Google Scholar 

  9. van Herk-Sukel MP, van de Poll-Franse LV, Lemmens VE, Vreugdenhil G, Pruijt JF, Coebergh JW, Herings RM (2010) New opportunities for drug outcomes research in cancer patients: the linkage of the Eindhoven Cancer Registry and the PHARMO Record Linkage System. Eur J Cancer 46(2):395–404

    Article  Google Scholar 

  10. Rutgers EJ, Nortier JW, Tuut MK, van Tienhoven G, Struikmans H, Bontenbal M, von Meyenfeldt MF, Vreugdenhil G, Benraadt T, Garssen B et al (2002) Dutch Institute for Healthcare Improvement guideline, ‘Treatment of breast cancer’. Ned Tijdschr Geneeskd 146(45):2144–2151

    PubMed  Google Scholar 

  11. Kwaliteitsinstituut voor de Gezondheidszorg CBO (2004) Guideline ‘Treatment of breast cancer’. Utrecht, the Netherlands

  12. Andrade SE, Kahler KH, Frech F, Chan KA (2006) Methods for evaluation of medication adherence and persistence using automated databases. Pharmacoepidemiol Drug Saf 15(8):565–574 (discussion 575-567)

    Article  PubMed  Google Scholar 

  13. Cramer JA, Roy A, Burrell A, Fairchild CJ, Fuldeore MJ, Ollendorf DA, Wong PK (2008) Medication compliance and persistence: terminology and definitions. Value Health 11(1):44–47

    PubMed  Google Scholar 

  14. Catalan V, Lelorier J (2000) Predictors of long-term persistence on statins in a subsidized clinical population. Value Health 3(6):417–426

    Article  CAS  PubMed  Google Scholar 

  15. Atkins L, Fallowfield L (2006) Intentional and non-intentional non-adherence to medication amongst breast cancer patients. Eur J Cancer 42(14):2271–2276

    Article  PubMed  Google Scholar 

  16. Kahn KL, Schneider EC, Malin JL, Adams JL, Epstein AM (2007) Patient centered experiences in breast cancer: predicting long-term adherence to tamoxifen use. Med Care 45(5):431–439

    Article  PubMed  Google Scholar 

  17. Partridge AH, Wang PS, Winer EP, Avorn J (2003) Nonadherence to adjuvant tamoxifen therapy in women with primary breast cancer. J Clin Oncol 21(4):602–606

    Article  CAS  PubMed  Google Scholar 

  18. Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40(5):373–383

    Article  CAS  PubMed  Google Scholar 

  19. van de Velde CJ, Verma S, van Nes JG, Masterman C, Pritchard KI (2009) Switching from tamoxifen to aromatase inhibitors for adjuvant endocrine therapy in postmenopausal patients with early breast cancer. Cancer Treat Rev. doi:10.1016/j.ctrv.2009.10.003

  20. Verma S, Sehdev S, Joy A, Madarnas Y, Younus J, Roy JA (2009) An updated review on the efficacy of adjuvant endocrine therapies in hormone receptor-positive early breast cancer. Curr Oncol 16(Supplement 2):S1–S13

    CAS  PubMed  Google Scholar 

  21. Grunfeld EA, Hunter MS, Sikka P, Mittal S (2005) Adherence beliefs among breast cancer patients taking tamoxifen. Patient Educ Couns 59(1):97–102

    Article  PubMed  Google Scholar 

  22. Murthy V, Bharia G, Sarin R (2002) Tamoxifen non-compliance: does it matter? Lancet Oncol 3(11):654

    Article  PubMed  Google Scholar 

  23. Demissie S, Silliman RA, Lash TL (2001) Adjuvant tamoxifen: predictors of use, side effects, and discontinuation in older women. J Clin Oncol 19(2):322–328

    CAS  PubMed  Google Scholar 

  24. 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(16):3309–3315

    Article  PubMed  Google Scholar 

  25. Lash TL, Fox MP, Westrup JL, Fink AK, Silliman RA (2006) Adherence to tamoxifen over the five-year course. Breast Cancer Res Treat 99(2):215–220

    Article  PubMed  Google Scholar 

  26. Partridge AH, LaFountain A, Mayer E, Taylor BS, Winer E, Asnis-Alibozek A (2008) Adherence to initial adjuvant anastrozole therapy among women with early-stage breast cancer. J Clin Oncol 26(4):556–562

    Article  CAS  PubMed  Google Scholar 

  27. Ziller V, Kalder M, Albert US, Holzhauer W, Ziller M, Wagner U, Hadji P (2009) Adherence to adjuvant endocrine therapy in postmenopausal women with breast cancer. Ann Oncol 20(3):431–436

    Article  CAS  PubMed  Google Scholar 

  28. van Nes JG, Seynaeve C, Maartense E, Roumen RM, de Jong RS, Beex LV, Meershoek-Klein Kranenbarg WM, Putter H, Nortier JW, van de Velde CJ (2009) Patterns of care in Dutch postmenopausal patients with hormone-sensitive early breast cancer participating in the Tamoxifen Exemestane Adjuvant Multinational (TEAM) trial. Ann Oncol. doi:10.1093/annonc/mdp419

Download references

Acknowledgment

This work was partially supported by the Netherlands organization for health research and development (ZonMw 80-82500-98-8227).

Conflict of interest statement

No conflict of interest declared for the authors Dr. L. V. van de Poll-Franse, Dr. A. C. Voogd, Dr. G. A. P. Nieuwenhuijzen, Prof. Dr. J. W. W. Coebergh. Mrs. M. P. P. van Herk-Sukel and Dr. R. M. C. Herings are employees of the PHARMO Institute for Drug Outcomes Research. This research institute performs financially supported studies for several pharmaceutical companies.

Author information

Authors and Affiliations

  1. PHARMO Institute for Drug Outcomes Research, P.O. Box 85222, 3508 AE, Utrecht, The Netherlands

    Myrthe P. P. van Herk-Sukel & Ron M. C. Herings

  2. Eindhoven Cancer Registry, Comprehensive Cancer Center South, Eindhoven, The Netherlands

    Lonneke V. van de Poll-Franse, Adri C. Voogd & Jan Willem W. Coebergh

  3. Center of Research on Psychology in Somatic Diseases (CoRPS), Tilburg University, Tilburg, The Netherlands

    Lonneke V. van de Poll-Franse

  4. Department of Epidemiology, Maastricht University, Maastricht, The Netherlands

    Adri C. Voogd

  5. Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands

    Grard A. P. Nieuwenhuijzen

  6. Department of Public Health, Erasmus University Medical Centre, Rotterdam, The Netherlands

    Jan Willem W. Coebergh

  7. Department of Health Policy & Management, Erasmus University Medical Centre, Rotterdam, The Netherlands

    Ron M. C. Herings

Authors
  1. Myrthe P. P. van Herk-Sukel
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Lonneke V. van de Poll-Franse
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Adri C. Voogd
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Grard A. P. Nieuwenhuijzen
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jan Willem W. Coebergh
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ron M. C. Herings
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Myrthe P. P. van Herk-Sukel.

Additional information

This study was performed as part of the Ph.D. programme of Mrs. M. P. P. van Herk-Sukel.

Rights and permissions

Reprints and permissions

About this article

Cite this article

van Herk-Sukel, M.P.P., van de Poll-Franse, L.V., Voogd, A.C. et al. Half of breast cancer patients discontinue tamoxifen and any endocrine treatment before the end of the recommended treatment period of 5 years: a population-based analysis. Breast Cancer Res Treat 122, 843–851 (2010). https://doi.org/10.1007/s10549-009-0724-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10549-009-0724-3

Keywords

Search

Navigation