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Personal and clinical social support and adherence to adjuvant endocrine therapy among hormone receptor-positive breast cancer patients in an integrated health care system

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

Abstract

Purpose

We evaluated associations between personal and clinical social support and non-adherence to adjuvant endocrine therapy (AET) in a large, Northern California breast cancer (BC) cohort from an integrated healthcare network.

Methods

This study included 3382 women from the Pathways Study diagnosed from 2005 to 2013 with stages I–III hormone receptor-positive BC and who responded to the Medical Outcomes Study Social Support and Interpersonal Processes of Care surveys, approximately 2 months post-diagnosis. We used logistic regression to evaluate associations between tertiles of social support and non-initiation (< 2 consecutive prescription fills within a year after diagnosis). Among those who initiated treatment, we used proportional hazards regression to evaluate associations with discontinuation (≥ 90 day gap) and non-adherence (< 80% medical possession ratio).

Results

Of those who initiated AET (79%), approximately one-fourth either discontinued AET or were non-adherent. AET non-initiation was more likely in women with moderate (adjusted OR 1.18, 95% CI 0.96–1.46) or low (OR 1.30, 95% CI 1.05–1.62) versus high personal social support (P trend = 0.02). Women with moderate (HR 1.20, 95% CI 0.99–1.45) or low (HR 1.32, 95% CI 1.09–1.60) personal social support were also more likely to discontinue treatment (P trend = 0.01). Furthermore, women with moderate (HR 1.25, 95% CI 1.02–1.53) or low (HR 1.38, 95% CI 1.12–1.70) personal social support had higher non-adherence (P trend = 0.007). Associations with clinical social support and outcomes were similar. Notably, high clinical social support mitigated the risk of discontinuation when patients’ personal support was moderate or low (P value = 0.04).

Conclusions

Women with low personal or clinical social support had higher AET non-adherence. Clinician teams may need to fill support gaps that compromise treatment adherence.

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Acknowledgements

This work was supported by the National Institutes of Health, National Cancer Institute Grant K07 CA187403 (PI: C. Kroenke), R01 CA105274 (PI: L Kushi), and U01 CA195565 (mPI: L Kushi, C. Ambrosone).

Author information

Authors and Affiliations

  1. Division of Research, Kaiser Permanente Northern California, 2000 Broadway, 5th floor, Oakland, CA, USA

    Candyce H. Kroenke, Sara R. Adams, Elizabeth H. Eldridge, Marilyn L. Kwan, Isaac J. Ergas, Ai Kubo & Lawrence H. Kushi

  2. Columbia University Medical Center, New York, NY, USA

    Dawn L. Hershman

  3. University of California, San Francisco, CA, USA

    Scarlett L. Gomez

  4. Cancer Prevention Institute of California, Fremont, CA, USA

    Scarlett L. Gomez

  5. Stanford Cancer Institute, Stanford, CA, USA

    Scarlett L. Gomez

Authors
  1. Candyce H. Kroenke
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  2. Dawn L. Hershman
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  3. Scarlett L. Gomez
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  4. Sara R. Adams
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  5. Elizabeth H. Eldridge
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  6. Marilyn L. Kwan
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  7. Isaac J. Ergas
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  8. Ai Kubo
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  9. Lawrence H. Kushi
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Contributions

CHK contributed to conceptualization and design of the study, analysis, writing, and interpretation. DLH contributed to interpretation and editing. SLG contributed to data collection, interpretation, and editing. SRA and EHE contributed to analysis, writing, and editing. MLK contributed to data collection and editing. IJE contributed to analysis. AK contributed to editing. LHK contributed to data collection and editing. All authors of this research paper have approved the final version submitted.

Corresponding author

Correspondence to Candyce H. Kroenke.

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The authors report no conflicts of interest.

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Kroenke, C.H., Hershman, D.L., Gomez, S.L. et al. Personal and clinical social support and adherence to adjuvant endocrine therapy among hormone receptor-positive breast cancer patients in an integrated health care system. Breast Cancer Res Treat 170, 623–631 (2018). https://doi.org/10.1007/s10549-018-4774-2

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  • DOI: https://doi.org/10.1007/s10549-018-4774-2

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