title: Adjuvant hormonal therapy use among women with ductal carcinoma in situ.
abstract: OBJECTIVE
  In the absence of consistent guidelines for the use of adjuvant hormonal therapy (HT) in treating ductal carcinoma in situ (DCIS), our purpose was to explore a variety of factors associated with discussion, use, and discontinuation of this therapy for DCIS, including patient, tumor, and treatment-related characteristics and physician-patient communication factors.
  
  
  METHODS
  We identified women from eight California Cancer Registry regions diagnosed with DCIS from 2002 through 2005, aged ≥18 years, of Latina or non-Latina white race/ethnicity. A total of 744 women were interviewed an average of 24 months postdiagnosis about whether they had (1) discussed with a physician, (2) used, and (3) discontinued adjuvant HT.
  
  
  RESULTS
  Although 83% of women discussed adjuvant HT with a physician, 47% used adjuvant HT, and 23% of users reported discontinuation by a median of 11 months. In multivariable adjusted analyses, Latina Spanish speakers were less likely than white women to discuss therapy (odds ratio [OR] 0.36, 95% confidence interval [CI] 0.18-0.69) and more likely to discontinue therapy (OR 2.67, 95% CI 1.05-6.81). Seeing an oncologist for follow-up care was associated with discussion (OR 5.10, 95% CI 3.14-8.28) and use of therapy (OR 4.20, 95% CI 2.05-8.61). Similarly, physician recommendation that treatment was necessary vs. optional was positively associated with use (OR 11.2, 95% CI 6.50-19.4) and inversely associated with discontinuation (OR 0.38, 95% CI 0.19-0.73).
  
  
  CONCLUSIONS
  Physician recommendation is an important factor associated with use and discontinuation of adjuvant HT for DCIS. Differences in discussion and discontinuation of therapy according to patient characteristics, particularly ethnicity/language, suggest challenges to physician-patient communication about adjuvant HT across a language barrier.
authors: Department of Health Evidence and Policy, Mount Sinai School of Medicine, New York, New York, USA.
authors: Jennifer C
authors: JC
authors: Livaudais
authors: E Shelley
authors: ES
authors: Hwang
authors: Leah
authors: L
authors: Karliner
authors: Anna
authors: A
authors: Nápoles
authors: Susan
authors: S
authors: Stewart
authors: Joan
authors: J
authors: Bloom
authors: Celia P
authors: CP
authors: Kaplan
mesh_terms: D000328:Adult; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000208:ethnology; D002140:California / Q000453:epidemiology; D018270:Carcinoma, Ductal, Breast / Q000188:drug therapy* / Q000208:ethnology; D017024:Chemotherapy, Adjuvant; D003144:Communication Barriers; D016001:Confidence Intervals; D005260:Female; D015438:Health Behavior; D054624:Health Status Disparities; D006630:Hispanic or Latino / Q000706:statistics & numerical data*; D006801:Humans; D055118:Medication Adherence / Q000208:ethnology*; D008875:Middle Aged; D016017:Odds Ratio; D010342:Patient Acceptance of Health Care / Q000208:ethnology*; D011369:Professional-Patient Relations; D044465:White People / Q000706:statistics & numerical data*; D016387:Women's Health / Q000208:ethnology
chemical_list: D018931:Antineoplastic Agents, Hormonal