title: Complementary or alternative medicine as possible determinant of decreased persistence to aromatase inhibitor therapy among older women with non-metastatic breast cancer.
abstract: OBJECTIVE
  Aromatase inhibitor therapy (AI) significantly improves survival in breast cancer patients. Little is known about adherence and persistence to aromatase inhibitors and about the causes of treatment discontinuation among older women.
  
  
  METHODS
  We constituted a cohort of women over 65 receiving a first AI therapy for breast cancer between 2006 and 2008, and followed them until June 2011. Women were selected in the population-based French National Health Insurance databases, and data was collected on the basis of pharmacy refills, medical records and face-to-face interviews. Non-persistence to treatment was defined as the first treatment discontinuation lasting more than 3 consecutive months. Time to treatment discontinuation was studied using survival analysis techniques.
  
  
  RESULTS
  Overall among the 382 selected women, non-persistence to treatment went from 8.7% (95%CI: 6.2-12.1) at 1 year, to 15.6% (95%CI: 12.2-19.8) at 2 years, 20.8% (95%CI: 16.7-25.6) at 3 years, and 24.7% (95%CI: 19.5-31.0) at 4 years. In the multivariate analysis on a sub-sample of 233 women with available data, women using complementary or alternative medicine (CAM) (HR = 3.2; 95%CI: 1.5-6.9) or suffering from comorbidities (HR = 2.2; 95%CI: 1.0-4.8) were more likely to discontinue their treatment, whereas women with polypharmacy (HR = 0.4; 95%CI: 0.2-0.91) were less likely to discontinue. In addition, 13% of the women with positive hormonal receptor status did not fill any prescription for anti-hormonal therapy.
  
  
  CONCLUSIONS
  AI therapy is discontinued prematurely in a substantial portion of older patients. Some patients may use CAM not as a complementary treatment, but as an alternative to conventional medicine. Improving patient-physician communication on the use of CAM may improve hormonal therapy adherence.
authors.affiliation: Unité de Soutien Méthodologique, CHU La Réunion, Saint-Denis, France ; U912 (SESSTIM), INSERM, Marseille, France ; Université Aix Marseille, IRD, UMR-S912, Marseille, France.
authors.forename: Laetitia
authors.initials: L
authors.lastname: Huiart
authors.affiliation: U912 (SESSTIM), INSERM, Marseille, France ; Université Aix Marseille, IRD, UMR-S912, Marseille, France.
authors.forename: Anne-Deborah
authors.initials: AD
authors.lastname: Bouhnik
authors.affiliation: U912 (SESSTIM), INSERM, Marseille, France ; Université Aix Marseille, IRD, UMR-S912, Marseille, France ; ORS PACA, Observatoire Régional de la Santé Provence Alpes Côte d'Azur, Marseille, France.
authors.forename: Dominique
authors.initials: D
authors.lastname: Rey
authors.affiliation: Medical Oncology Department, Institut Paoli-Calmettes, Marseille, France.
authors.forename: Frédérique
authors.initials: F
authors.lastname: Rousseau
authors.affiliation: Centre Gérontologique Départemental, Marseille, France.
authors.forename: Frédérique
authors.initials: F
authors.lastname: Retornaz
authors.affiliation: U912 (SESSTIM), INSERM, Marseille, France ; Université Aix Marseille, IRD, UMR-S912, Marseille, France.
authors.forename: Mégane
authors.initials: M
authors.lastname: Meresse
authors.affiliation: U912 (SESSTIM), INSERM, Marseille, France ; Université Aix Marseille, IRD, UMR-S912, Marseille, France ; ORS PACA, Observatoire Régional de la Santé Provence Alpes Côte d'Azur, Marseille, France.
authors.forename: Marc Karim
authors.initials: MK
authors.lastname: Bendiane
authors.affiliation: Medical Oncology Department, Institut Paoli-Calmettes, Marseille, France ; Université Aix Marseille, Centre de Recherche en Cancérologie de Marseille, INSERM U891, Marseille, France.
authors.forename: Patrice
authors.initials: P
authors.lastname: Viens
authors.affiliation: U912 (SESSTIM), INSERM, Marseille, France ; Université Aix Marseille, IRD, UMR-S912, Marseille, France ; Service Biostatistique et Technologies de l'Information et de la Communication, Hôpital de la Timone, Assistance Publique - Hopitaux de Marseille, Marseille, France.
authors.forename: Roch
authors.initials: R
authors.lastname: Giorgi
mesh_terms: D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use; D047072:Aromatase Inhibitors / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000188:drug therapy*; D015331:Cohort Studies; D000529:Complementary Therapies / Q000379:methods*; D005260:Female; D006801:Humans
chemical_list: D018931:Antineoplastic Agents, Hormonal; D047072:Aromatase Inhibitors