title: Identification of subgroups of early breast cancer patients at high risk of nonadherence to adjuvant hormone therapy: results of an Italian survey.
abstract: BACKGROUND
  Adherence to adjuvant endocrine therapy (HT) is suboptimal among breast cancer patients. A high rate of nonadherence might explain differences in survival between clinical trial and clinical practice. Tailored interventions aimed at improving adherence can only be implemented if subgroups of patients at higher risk of poor adherence are identified. Because no data are available for Italy, we undertook a large survey on adherence among women taking adjuvant HT for breast cancer.
  
  
  METHODS
  Patients were recruited from 10 cancer clinics in central Italy. All patients taking HT for at least 1 year were invited, during one of their follow-up visit, to fill a confidential questionnaire. The association of sociodemographic and clinical characteristics of participants with adherence was assessed using logistic regression. The RECPAM method was used to evaluate interactions among variables and to identify subgroups of patients at different risk of nonadherence.
  
  
  RESULTS
  A total of 939 patients joined the study and 18.6% of them were classified as nonadherers. Among possible predictors, only age, working status, and switching from tamoxifen to an aromatase inhibitor were predictive of nonadherence in multivariate analysis. RECPAM analysis led to the identification of 4 classes of patients with a different likelihood of nonadherence to therapy, the lowest being observed in retired women with a low level of education, the highest in the group of unmarried, employed women, or housewives.
  
  
  CONCLUSIONS
  The identification of these subgroups of "real life" patients with a high prevalence of nonadherers might be functional in designing intervention studies aimed at improving adherence.
authors.affiliation: Department of Experimental and Clinical Sciences, University 'G. d'Annunzio,' Chieti, Italy. Electronic address: ntinari@unich.it.
authors.forename: Nicola
authors.initials: N
authors.lastname: Tinari
authors.affiliation: Laboratory of Pharmacoepidemiology, Mario Negri Sud Foundation, Santa Maria Imbaro, Italy.
authors.forename: Caterina
authors.initials: C
authors.lastname: Fanizza
authors.affiliation: Laboratory of Pharmacoepidemiology, Mario Negri Sud Foundation, Santa Maria Imbaro, Italy.
authors.forename: Marilena
authors.initials: M
authors.lastname: Romero
authors.affiliation: Department of Experimental and Clinical Sciences, University 'G. d'Annunzio,' Chieti, Italy.
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Gambale
authors.affiliation: Department of Oncology and Hematology, 'Belcolle' Hospital, Viterbo, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Moscetti
authors.affiliation: Department of Oncology, 'S.S. Trinità' Hospital, Sora, Italy.
authors.forename: Angela
authors.initials: A
authors.lastname: Vaccaro
authors.affiliation: Department of Internal Medicine, Oncology A Unit, University Sapienza, Rome, Italy.
authors.forename: Patrizia
authors.initials: P
authors.lastname: Seminara
authors.affiliation: Department of Molecular Medicine, University Sapienza, Rome, Italy.
authors.forename: Flavia
authors.initials: F
authors.lastname: Longo
authors.affiliation: Medical Oncology, 'Sacro Cuore-Don Calabria' Hospital, Negrar, Italy.
authors.forename: Stefania
authors.initials: S
authors.lastname: Gori
authors.affiliation: Division of Medical Oncology B, Regina Elena National Cancer Institute, Rome, Italy.
authors.forename: Patrizia
authors.initials: P
authors.lastname: Vici
authors.affiliation: Department of Oncology, 'S.S. Trinità' Hospital, Sora, Italy.
authors.forename: Teresa
authors.initials: T
authors.lastname: Gamucci
authors.affiliation: Department of Oncology, 'S. Giovanni-Addolorata' Hospital, Rome, Italy.
authors.forename: Mariella
authors.initials: M
authors.lastname: Mauri
authors.affiliation: Department of Oncology, 'Floraspe Renzetti' Hospital, Lanciano, Italy.
authors.forename: Lucio
authors.initials: L
authors.lastname: Laudadio
authors.affiliation: Department of Oncology, 'Floraspe Renzetti' Hospital, Lanciano, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Nuzzo
authors.affiliation: Department of Oncology and Hematology, 'Belcolle' Hospital, Viterbo, Italy.
authors.forename: Maria Agnese
authors.initials: MA
authors.lastname: Fabbri
authors.affiliation: Department of Oncology, 'A. Fiorini' Hospital, Terracina, Italy.
authors.forename: Silvia Ileana
authors.initials: SI
authors.lastname: Fattoruso
authors.affiliation: Clinical Governance Unit, 'S.S. Annunziata' Hospital, Chieti, Italy.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Mazzilli
authors.affiliation: Department of Experimental and Clinical Sciences, University 'G. d'Annunzio,' Chieti, Italy.
authors.forename: Antonino
authors.initials: A
authors.lastname: Grassadonia
authors.affiliation: Department of Experimental and Clinical Sciences, University 'G. d'Annunzio,' Chieti, Italy.
authors.forename: Ettore
authors.initials: E
authors.lastname: Cianchetti
authors.affiliation: Department of Experimental and Clinical Sciences, University 'G. d'Annunzio,' Chieti, Italy.
authors.forename: Clara
authors.initials: C
authors.lastname: Natoli
mesh_terms: D000368:Aged; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000188:drug therapy*; D017024:Chemotherapy, Adjuvant; D005260:Female; D006801:Humans; D007558:Italy; D008875:Middle Aged; D010349:Patient Compliance / Q000706:statistics & numerical data*; D012307:Risk Factors; D011795:Surveys and Questionnaires
chemical_list: D018931:Antineoplastic Agents, Hormonal
keywords: Adherence to therapy; Adjuvant endocrine therapy; Breast cancer; Oral drugs; Recursive partitioning and amalgamation analysis