Influence of patient and treatment factors on adherence to adjuvant endocrine therapy in breast cancer.
OBJECTIVE
To comprehensively assess the patient and illness or treatment factors that may predict nonadherence to adjuvant endocrine therapy and to explore whether an interaction occurs between these factors in women with breast cancer.


METHODS
Repeated-measures design.


METHODS
The Outpatient Services of the Women's Cancer Program at the University of Pittsburgh Cancer Institute and participants' homes.


METHODS
91 women with early-stage breast cancer who received endocrine therapy.


METHODS
Adherence was assessed continuously for the first 18 months of endocrine therapy. Patient and illness or treatment factors were assessed at four time points (Time 1 to Time 4). Time 1 (baseline) was within two weeks prior to the initiation of endocrine therapy. Times 2-4 occurred at six-month intervals, as many as 18 months after Time 1.


METHODS
Adherence, patient factors, and illness or treatment factors.


RESULTS
Adherence to endocrine therapy declined significantly during the first 18 months of treatment in women with breast cancer. The presence of negative mood and symptoms before starting treatment predicted nonadherence to endocrine therapy over time. Perceptions of financial hardship, symptoms, disease stage, and more complex medication regimens intensified the effect of negative mood on adherence over time.


CONCLUSIONS
Women with breast cancer may be at risk for nonadherence to prescribed endocrine therapy if they experience depression or anxiety and symptoms prior to initiating therapy.


CONCLUSIONS
Oncology nurses should be alert to women with breast cancer who are depressed or anxious or who are experiencing symptoms. Management of negative mood and symptoms may result in better adherence.
Clinical and Translational Science Institute.
Catherine M
CM
Bender
Department of Health and Community Systems, School of Medicine.
Amanda L
AL
Gentry
Division of Hematology/Oncology, School of Medicine.
Adam M
AM
Brufsky
Department of Acute and Tertiary Care, Office of Community Partnerships.
Frances E
FE
Casillo
Department of Acute and Tertiary Care, Office of Community Partnerships.
Susan M
SM
Cohen
Department of Acute and Tertiary Care, Office of Community Partnerships.
Meredith M
MM
Dailey
Department of Acute and Tertiary Care, Office of Community Partnerships.
Heidi S
HS
Donovan
School of Nursing.
Jacqueline
J
Dunbar-Jacob
University of Pittsburgh Cancer Institute.
Rachel C
RC
Jankowitz
Acute Care Nurse Practitioner Program, University of Pittsburgh in Pennsylvania.
Margaret Q
MQ
Rosenzweig
Department of Acute and Tertiary Care at the School of Nursing, University of Pittsburgh in Pennsylvania.
Paula R
PR
Sherwood
Center for Research and Evaluation, University of Pittsburgh in Pennsylvania.
Susan M
SM
Sereika
D000293:Adolescent; D000328:Adult; D000339:Affect; D000368:Aged; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000453:epidemiology / Q000532:radiotherapy*; D017024:Chemotherapy, Adjuvant / Q000523:psychology*; D015897:Comorbidity; D003863:Depression / Q000453:epidemiology / Q000523:psychology*; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D006801:Humans; D008875:Middle Aged; D010349:Patient Compliance / Q000523:psychology*; D010414:Pennsylvania / Q000453:epidemiology; D012959:Socioeconomic Factors; D013629:Tamoxifen / Q000627:therapeutic use*; D013997:Time Factors; D055815:Young Adult
D018931:Antineoplastic Agents, Hormonal; D013629:Tamoxifen
adherence; breast cancer; financial hardship; mood; symptoms