title: Early discontinuation and nonadherence to adjuvant hormonal therapy in a cohort of 8,769 early-stage breast cancer patients.
abstract: OBJECTIVE
  While studies have found that adjuvant hormonal therapy for hormone-sensitive breast cancer (BC) dramatically reduces recurrence and mortality, adherence to medications is suboptimal. We investigated the rates and predictors of early discontinuation and nonadherence to hormonal therapy in patients enrolled in Kaiser Permanente of Northern California health system.
  
  
  METHODS
  We identified women diagnosed with hormone-sensitive stage I-III BC from 1996 to 2007 and used automated pharmacy records to identify hormonal therapy prescriptions and dates of refill. We used Cox proportional hazards regression models to analyze factors associated with early discontinuation and nonadherence (medication possession ratio < 80%) of hormonal therapy.
  
  
  RESULTS
  We identified 8,769 patients with BC who met our eligibility criteria and who filled at least one prescription for tamoxifen (43%), aromatase inhibitors (26%), or both (30%) within 1 year of diagnosis. Younger or older age, lumpectomy (v mastectomy), and comorbidities were associated with earlier discontinuation, while Asian race, being married, earlier year at diagnosis, receipt of chemotherapy or radiotherapy, and longer prescription refill interval were associated with completion of 4.5 years of therapy. Of those who continued therapy, similar factors were associated with full adherence. Women age younger than 40 years had the highest risk of discontinuation (hazard ratio, 1.51; 95% CI, 1.23 to 1.85). By 4.5 years, 32% discontinued therapy, and of those who continued, 72% were fully adherent.
  
  
  CONCLUSIONS
  Only 49% of patients with BC took adjuvant hormonal therapy for the full duration at the optimal schedule. Younger women are at high risk of nonadherence. Interventions to improve adherence and continuation of hormonal therapy are needed, especially for younger women.
authors.affiliation: Mailman School of Public Health, Columbia University Medical Center, 161 Fort Washington Ave, New York, NY 10032, USA. dlh23@columbia.edu
authors.forename: Dawn L
authors.initials: DL
authors.lastname: Hershman
authors.forename: Lawrence H
authors.initials: LH
authors.lastname: Kushi
authors.forename: Theresa
authors.initials: T
authors.lastname: Shao
authors.forename: Donna
authors.initials: D
authors.lastname: Buono
authors.forename: Aaron
authors.initials: A
authors.lastname: Kershenbaum
authors.forename: Wei-Yann
authors.initials: WY
authors.lastname: Tsai
authors.forename: Louis
authors.initials: L
authors.lastname: Fehrenbacher
authors.forename: Scarlett Lin
authors.initials: SL
authors.lastname: Gomez
authors.forename: Sunita
authors.initials: S
authors.lastname: Miles
authors.forename: Alfred I
authors.initials: AI
authors.lastname: Neugut
mesh_terms: D000367:Age Factors; D000368:Aged; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use*; D047072:Aromatase Inhibitors / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000473:pathology; D002140:California; D017024:Chemotherapy, Adjuvant; D015331:Cohort Studies; D011307:Drug Prescriptions; D005260:Female; D006279:Health Maintenance Organizations; D006801:Humans; D007356:Insurance, Pharmaceutical Services; D053208:Kaplan-Meier Estimate; D055118:Medication Adherence; D008875:Middle Aged; D009367:Neoplasm Staging; D016016:Proportional Hazards Models; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D013629:Tamoxifen / Q000627:therapeutic use*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D018931:Antineoplastic Agents, Hormonal; D047072:Aromatase Inhibitors; D013629:Tamoxifen