title: Adherence to adjuvant hormone therapy in low-income women with breast cancer: the role of provider-patient communication.
abstract: To assess the impact of patient-provider communication on adherence to tamoxifen (TAM) and aromatase inhibitors (AIs) 36 months after breast cancer (BC) diagnosis in a low-income population of women. California statewide surveys were conducted among 921 low-income women with BC at 6, 18, and 36 months after BC diagnosis. A subset of 303 women with stage I-III BC who initiated hormone treatment after diagnosis was identified. Bivariate and multivariate logistic regression analyses were performed, and adjusted adherence rates were calculated. The main outcome measure was self-reported hormone use at 36 months after BC diagnosis and the chief independent variables were patient-centered communication after diagnosis by patient report as measured by the Consumer Assessment of Healthcare Providers and Systems (CAHPS) and patients' self-efficacy in patient-physician interactions (PEPPI). Overall adherence to TAM/AI was relatively high (88 %). Adjusted rates of adherence were 59 and 94 % for patients with the lowest versus highest scores on the CAHPS communication scale (AOR = 1.22, P = 0.006) and 72 versus 91 % for patients with the lowest and highest rating of PEPPI (AOR = 1.04, P = 0.04). Having at least one comorbid condition also increased the odds of adherence to hormonal therapy (AOR = 3.14, P = 0.03). Having no health insurance and experiencing side-effects from hormone treatment were barriers for adherence (AOR = 0.12, P = 0.001; AOR = 0.26, P = 0.003, respectively). Patient-centered communication and perceived self-efficacy in patient-physician interaction were significantly associated with patient adherence to ongoing TAM/AI therapy among low-income women with BC. Interventions on patient-provider communication may provide opportunities to improve patient outcomes in this vulnerable population.
authors.affiliation: Department of Family Medicine, David Geffen School of Medicine, University of California, 10880 Wilshire Blvd., Los Angeles, CA 90024-7087, USA.
authors.forename: Yihang
authors.initials: Y
authors.lastname: Liu
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Malin
authors.forename: Allison L
authors.initials: AL
authors.lastname: Diamant
authors.forename: Amardeep
authors.initials: A
authors.lastname: Thind
authors.forename: Rose C
authors.initials: RC
authors.lastname: Maly
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000188:drug therapy / Q000453:epidemiology*; D003142:Communication; D015981:Epidemiologic Factors; D005260:Female; D006801:Humans; D055118:Medication Adherence; D008875:Middle Aged; D010817:Physician-Patient Relations; D011203:Poverty
chemical_list: D018931:Antineoplastic Agents, Hormonal