« Pioglitazone lowers hepatic triglyceride content and raises HDL in diabetics | Home | Metformin Use May Reduce Mortality Among Patients With Type 2 Diabetes. »

Adherence to hormonal therapy for breast cancer needs improvement

By Jeremy Cockerill | July 14, 2010

Source: MedWire News

A large study of US women with early-stage breast cancer has revealed that fewer than half complete their regimen of hormone therapy according to the prescribed schedule, with younger women particularly likely to discontinue treatment.

To provide a more comprehensive understanding of the patient and clinical factors associated with discontinuation and nonadherence to hormonal therapy, Dawn Hershman (Columbia University Medical Center, New York) and colleagues examined automated pharmacy records of 8769 women diagnosed with stage I, II or III, hormone-sensitive breast cancer between 1996 and 2007.

The researchers used the records to identify hormonal therapy prescriptions and refill dates. Each woman filled at least one prescription for tamoxifen (43%), aromatase inhibitors (26%), or both (30%) within 1 year of diagnosis.

Over the 4.5-year follow-up period, 2790 (32%) patients discontinued treatment. Of the 5979 patients who continued 72% were fully adherent (medication possession ratio above 80%). This meant that overall, only 49% of patients were fully adherent to their treatment regimen.

Hershman and team found that women younger than 40 years and older than 75 years, those who had lumpectomy as opposed to mastectomy and those with comorbidities were more likely to discontinue hormonal therapy early. In contrast, Asian race, a history of chemotherapy, being married, and longer prescription refill intervals were associated with completing 4.5 years of hormonal therapy.

Women age younger than 40 years had the highest risk for discontinuation. They were 50% more likely to discontinue therapy and 40% more likely to be nonadherent than patients aged 50 to 65 years.

“It’s very disturbing that patients under 40 had the highest discontinuation and non-adherence rates, because those patients have the longest life expectancy,” said Hershman. “Perhaps we need to do a better job of making patients aware that to get the full benefit of treatment, they need to take their medications on time and for the full duration.”

The researchers conclude in the Journal of Clinical Oncology: “Ultimately, interventions need to be defined to help such patients comply with the full course of adjuvant hormonal therapy.”