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Non-initiation of adjuvant hormonal therapy in women with hormone receptor-positive breast cancer: The Breast Cancer Quality of Care Study (BQUAL)

  • Epidemiology
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Abstract

Adjuvant hormonal therapy for non-metastatic hormone receptor (HR)-positive breast cancer decreases risk of breast cancer recurrence and increases survival. However, some women do not initiate this life-saving treatment. We used a prospective cohort design to investigate factors related to non-initiation of hormonal therapy among women with newly diagnosed, non-metastatic HR-positive breast cancer recruited from three U.S. sites. Serial interviews were conducted at baseline and during treatment to examine sociodemographic factors, tumor characteristics, and treatment decision-making factors. Multivariate modeling assessed associations between variables of interest and hormonal therapy initiation. Of 1,050 breast cancer patients recruited, 725 (69 %) had HR-positive breast cancer, of whom 87 (12.0 %) based on self-report and 122 (16.8 %) based on medical record/pharmacy fill rates did not initiate hormonal therapy. In a multivariable analysis, non-initiation of hormonal therapy, defined by medical record/pharmacy, was associated with having greater negative beliefs about efficacy of treatment (OR 1.42, 95 % CI 1.18–1.70). Non-initiation was less likely in those who found the quality of patient/physician communication to be higher (OR 0.96, 95 % CI 0.93–0.99), the hormonal therapy treatment decision an easy one to make (OR 0.45, 95 % CI 0.23–0.90) or neither easy nor difficult (OR 0.34, 95 % CI 0.20–0.58); and had more positive beliefs about hormonal therapy efficacy (OR 0.40, 95 % CI 0.34–0.62). Factors influencing non-initiation of adjuvant hormonal therapy are complex and influenced by patient beliefs regarding treatment efficacy and side effects. Educational interventions to women about the benefits of hormonal therapy may decrease negative beliefs and increase hormone therapy initiation.

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Acknowledgments

Supported by a Department of Defense Breast Cancer Center of Excellence Award (BC043120) to Dr. Neugut, a NCI R01 (CA105274), a Department of Defense Center for Biobehavioral Breast Cancer Research to Dr. Kushi, an NCI R25 fellowship (CA094601) to N. Leoce, Department of Defense (DAMD-17-01-1-0334) to Dr. Bovbjerg, a NCI R01 (CA100598) to Dr. Ambrosone, and a NCI R01 (CA124924 and 127617), U10 (CA 84131) and K05 (CA96940) to Dr. Mandelblatt. Drs. Hershman and Ambrosone are recipients of funding from the Breast Cancer Research Foundation.

Conflict of interest

The authors declare they have no conflicts of interest which may have influenced the results of this study.

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Authors and Affiliations

  1. Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY, USA

    Alfred I. Neugut, Grace Clarke Hillyer & Dawn L. Hershman

  2. Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons, Columbia University, New York, NY, USA

    Alfred I. Neugut, Wei-Yann Tsai, Judith S. Jacobson & Dawn L. Hershman

  3. Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA

    Alfred I. Neugut, Judith S. Jacobson & Dawn L. Hershman

  4. Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA

    Nicole Leoce & Wei-Yann Tsai

  5. Division of Research, Kaiser-Permanente of Northern California, Oakland, CA, USA

    Lawrence H. Kushi

  6. Department of Public Health Sciences, Henry Ford Health System, Detroit, MI, USA

    Lois Lamerato

  7. Department of Surgery, Henry Ford Health System, Detroit, MI, USA

    S. David Nathanson

  8. Department of Cancer Prevention and Control, Roswell Park Cancer Institute, Buffalo, NY, USA

    Christine B. Ambrosone

  9. Departments of Psychiatry, Psychology and Behavioral & Community Health Sciences, University of Pittsburgh, and the University of Pittsburgh Cancer Institute, Pittsburgh, PA, USA

    Dana H. Bovbjerg

  10. Department of Oncology and Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA

    Jeanne S. Mandelblatt

  11. Long Island University, Brooklyn, NY, USA

    Carol Magai

  12. Division of Medical Oncology, Columbia University Medical Center, 722 W 168th Street, Room 725, New York, NY, 10032, USA

    Alfred I. Neugut

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  1. Alfred I. Neugut
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  2. Grace Clarke Hillyer
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  3. Lawrence H. Kushi
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  8. Dana H. Bovbjerg
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  9. Jeanne S. Mandelblatt
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  13. Dawn L. Hershman
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Correspondence to Alfred I. Neugut.

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Neugut, A.I., Hillyer, G.C., Kushi, L.H. et al. Non-initiation of adjuvant hormonal therapy in women with hormone receptor-positive breast cancer: The Breast Cancer Quality of Care Study (BQUAL). Breast Cancer Res Treat 134, 419–428 (2012). https://doi.org/10.1007/s10549-012-2066-9

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  • DOI: https://doi.org/10.1007/s10549-012-2066-9

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