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Which patient- and physician-related factors are associated with guideline adherent initiation of adjuvant endocrine therapy? Results of the prospective multi-centre cohort study BRENDA II

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Abstract

Background

We analysed factors that might influence patients’ and physicians’ decisions against the initiation of guideline adherent adjuvant endocrine therapy (ET).

Methods

In a prospective multi-centre study, including four certified breast cancer centres in Germany, patients with primary breast cancer were included from 2009 to 2012. Patients completed a questionnaire prior to surgery, adjuvant therapy, and 6 months after adjuvant therapy. This questionnaire assessed health-related quality of life (QoL), psychiatric co-morbidity, demographic characteristics, and the intensity of fear for ET. Guideline adherence was classified based on an algorithm derived from international guidelines. The tumour board’s (TB) decisions against or for ET was documented. The TB was blinded regarding the guideline results.

Results

In 666 patients, adjuvant ET was indicated according to the guideline recommendations. The TB decided in 92.3 % (n = 615) of those that adjuvant ET was indicated. TB’s decision against ET was associated with the younger age of patients (OR = 0.5; 95 % CI 0.3–0.9) and poor QoL (OR = 1.7; 95 % CI 1.0–2.8). In 93 patients, ET was not indicated according to the guidelines, and the TB decided in 84 of those not to prescribe ET. The TB decided in 93.4 % of the cases according to the guidelines. Of the patients, where the TB prescribed ET, 5 % (n = 31) decided against ET. This decision was associated with fear of ET (OR = 2.2; 95 % CI 1.0–5.2) and higher age (OR 9; 95 % CI 1.0–48.1). Psychiatric co-morbidity (OR = 1.8; 95 % CI 0.7–4.2), poor QoL (OR = 0.4; 95 % CI 0.2–1.2), and education (OR = 1.2; 95 % CI 0.5–2.6) were not associated with the decision.

Discussion

Guideline adherent implementation of adjuvant ET is high. Physicians’ decision against ET is mainly associated with patients’ younger age and poor quality of life, whereas patients’ decision, once the TB decided to initiate ET and if ET is indicated by guidelines, is associated with higher age and fear of ET.

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Authors and Affiliations

  1. Department of Gynecology and Obstetrics, University Würzburg, Joseph-Schneider Str. 4, 97080, Würzburg, Germany

    Tanja Stüber, Joachim Diessner & Achim Wöckel

  2. Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Centre Mainz, Obere Zahlbacher Straße 69, 55131, Mainz, Germany

    Reyn van Ewijk, Maria Blettner & Susanne Singer

  3. Department of Gynecology and Obstetrics, Hospital Esslingen, Hirschlandstraße 97, 73730, Esslingen, Germany

    Thorsten Kühn

  4. Department of Gynecology and Obstetrics, Hospital Memmingen, Bismarkstraße 23, 87700, Memmingen, Germany

    Felix Flock

  5. Department of Gynecology and Obstetrics, Hospital Kempten, Robert-Weixler-Straße 50, 87439, Kempten, Germany

    Riccardo Felberbaum

  6. Department of Gynecology and Obstetrics, University Ulm, Prittwitzstraße 43, 89075, Ulm, Germany

    Rolf Kreienberg, Wolfgang Janni & Lukas Schwentner

  7. Department of Economics, Johannes Gutenberg University Mainz, Jakob-Welder-Weg 4, 55128, Mainz, Germany

    Reyn van Ewijk

  8. University Cancer Centre, Mainz, Germany

    Susanne Singer

Authors
  1. Tanja Stüber
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  2. Reyn van Ewijk
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  5. Felix Flock
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  7. Maria Blettner
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  8. Rolf Kreienberg
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  9. Wolfgang Janni
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  10. Achim Wöckel
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  11. Susanne Singer
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  12. Lukas Schwentner
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Corresponding author

Correspondence to Tanja Stüber.

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Conflict of interest

All authors declare that there are no potential conflicts of interest, including financial, personal, or relationship with other people or organizations that could inappropriately influence this work.

Funding source

Parts of this work were supported by the German Federal Ministry of Education and Research (BMBF-Grant-01ZP0505).

Ethical approval

This study and the BRENDA project have been approved by the ethics committee of the University of Ulm.

Additional information

For the BRENDA study group.

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Stüber, T., van Ewijk, R., Diessner, J. et al. Which patient- and physician-related factors are associated with guideline adherent initiation of adjuvant endocrine therapy? Results of the prospective multi-centre cohort study BRENDA II. Breast Cancer 24, 281–287 (2017). https://doi.org/10.1007/s12282-016-0701-8

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  • DOI: https://doi.org/10.1007/s12282-016-0701-8

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