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Adherence and discontinuation of adjuvant hormonal therapy in breast cancer patients: a population-based study

  • Epidemiology
  • Published:
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Abstract

Adherence to long-term pharmacological treatment for chronic conditions is often less than optimal. Till date, a limited number of population-based studies have assessed adherence to adjuvant hormonal therapy in breast cancer, a therapy with proven benefits in terms of reductions of recurrence and mortality. We aimed to examine rates of adherence and early discontinuation in Sweden where prescribed medications are subsidized for all residents and made available at reduced out-of-pocket costs. Individual-level data were obtained from Regional Clinical Quality Breast Cancer Registers, the Swedish Prescribed Drug Register, and several other population-based registers. Multivariate logistic regression was used to analyze factors associated with adherence to prescribed medication for a period of 3 years. Between January 1 and December 31, 2005, 1,741 patients in central Sweden were identified with estrogen receptor positive breast cancer, and at least one prescription dispensation of either tamoxifen or an aromatase inhibitor. Of these women, 1,193 (69%) were fully adherent to therapy for 3 years (medication possession ratio of 80% or higher and a maximum of 180 days between refills). During the 3-year follow-up, 215 women (12%) had prematurely discontinued therapy. Adherence was positively associated with younger age, large tumor size, being married, and being born in the Nordic countries, while no clear association was observed with education or income. During the 3 years of follow-up, 31% of women were non-adherent to therapy. Further efforts must be undertaken to promote adherence over the entire recommended treatment period.

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Acknowledgment

The study was supported by grants from the Regional Research Council in the Uppsala-Örebro Region, the Swedish Council for Working Life and Social Research, the Swedish Cancer Society, and ALF (for clinical research in medicine in Uppsala). The authors also want to express their gratitude to all the past and the present members of the Uppsala/Örebro and Stockholm/Gotland Breast Cancer Study Groups who collected the data and maintained their quality.

Conflict of interest

The authors declare no conflicts of interest.

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Authors and Affiliations

  1. Regional Cancer Centre, Uppsala University Hospital, 751 85, Uppsala, Sweden

    Annette Wigertz, Marit Holmqvist & Mats Lambe

  2. Oncologic Centre Stockholm and Gotland, Karolinska University Hospital, Stockholm, Sweden

    Annette Wigertz & Jan Adolfsson

  3. Department of Oncology, Gävle Hospital, and Centre for Research and Development, Uppsala University, Uppsala, Sweden

    Johan Ahlgren

  4. Department of Oncology and Pathology, Karolinska Institutet, and Karolinska University Hospital, Stockholm, Sweden

    Tommy Fornander

  5. CLINTEC Department, Karolinska Institutet, Stockholm, Sweden

    Jan Adolfsson

  6. Department of Oncology, Uppsala University Hospital, Uppsala, Sweden

    Henrik Lindman

  7. Department of Surgery, Central Hospital Västerås, and Centre for Clinical Research, Uppsala University, Uppsala, Sweden

    Leif Bergkvist

  8. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden

    Mats Lambe

Authors
  1. Annette Wigertz
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  2. Johan Ahlgren
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  3. Marit Holmqvist
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  4. Tommy Fornander
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  5. Jan Adolfsson
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  6. Henrik Lindman
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  7. Leif Bergkvist
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  8. Mats Lambe
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Correspondence to Annette Wigertz.

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Wigertz, A., Ahlgren, J., Holmqvist, M. et al. Adherence and discontinuation of adjuvant hormonal therapy in breast cancer patients: a population-based study. Breast Cancer Res Treat 133, 367–373 (2012). https://doi.org/10.1007/s10549-012-1961-4

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  • DOI: https://doi.org/10.1007/s10549-012-1961-4

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