title: Psychosocial factors related to non-persistence with adjuvant endocrine therapy among women with breast cancer: the Breast Cancer Quality of Care Study (BQUAL).
abstract: Non-adherence to adjuvant endocrine therapy (ET) for breast cancer (BC) is common. Our goal was to determine the associations between psychosocial factors and ET non-persistence. We recruited women with BC receiving care in an integrated healthcare system between 2006 and 2010. Using a subset of patients treated with ET, we investigated factors related to ET non-persistence (discontinuation) based on pharmacy records (≥90 days gap). Serial interviews were conducted at baseline and every 6 months. The Functional Assessment of Cancer Therapy (FACT), Medical Outcomes Survey, Treatment Satisfaction Questionnaire (TSQM), Impact of Events Scale (IES), Interpersonal Processes of Care measure, and Decision-making beliefs and concerns were measured. Multivariate models assessed factors associated with non-persistence. Of the 523 women in our final cohort who initiated ET and had a subsequent evaluation, 94 (18 %) were non-persistent over a 2-year follow-up. The cohort was primarily white (74.4 %), stage 1 (60.6 %), and on an aromatase inhibitor (68.1 %). Women in the highest income category had a lower odds of being non-persistent (OR 0.43, 95 % CI 0.23-0.81). Quality of life and attitudes toward ET at baseline were associated with non-persistence. At follow-up, the FACT, TSQM, and IES were associated with non-persistence (p < 0.001). Most women continued ET. Women who reported a better attitude toward ET, better quality of life, and more treatment satisfaction, were less likely to be non-persistent and those who reported intrusive/avoidant thoughts were more likely to be non-persistent. Interventions to enhance the psychosocial well-being of patients should be evaluated to increase adherence.
authors.affiliation: Department of Medicine, Columbia University, 161 Ft Washington, Room 1068, New York, NY, 10032, USA. dlh23@columbia.edu.|Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons, Columbia University, New York, NY, USA. dlh23@columbia.edu.|Department of Epidemiology, Columbia University, New York, NY, USA. dlh23@columbia.edu.
authors.forename: Dawn L
authors.initials: DL
authors.lastname: Hershman
authors.affiliation: Division of Research, Kaiser-Permanente of Northern California, Oakland, CA, USA.
authors.forename: Lawrence H
authors.initials: LH
authors.lastname: Kushi
authors.affiliation: Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons, Columbia University, New York, NY, USA.|Department of Epidemiology, Columbia University, New York, NY, USA.
authors.forename: Grace Clarke
authors.initials: GC
authors.lastname: Hillyer
authors.affiliation: Department of Medicine, Columbia University, 161 Ft Washington, Room 1068, New York, NY, 10032, USA.
authors.forename: Ellie
authors.initials: E
authors.lastname: Coromilas
authors.affiliation: Department of Epidemiology, Columbia University, New York, NY, USA.
authors.forename: Donna
authors.initials: D
authors.lastname: Buono
authors.affiliation: Department of Public Health Sciences, Henry Ford Health System, Detroit, MI, USA.
authors.forename: Lois
authors.initials: L
authors.lastname: Lamerato
authors.affiliation: Departments of Psychiatry, Psychology and Behavioral and Community Health Sciences, University of Pittsburgh, Pittsburgh, PA, USA.|University of Pittsburgh Cancer Institute, Pittsburgh, PA, USA.
authors.forename: Dana H
authors.initials: DH
authors.lastname: Bovbjerg
authors.affiliation: Department of Oncology and Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA.
authors.forename: Jeanne S
authors.initials: JS
authors.lastname: Mandelblatt
authors.affiliation: Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA.
authors.forename: Wei-Yann
authors.initials: WY
authors.lastname: Tsai
authors.affiliation: Department of Epidemiology, Columbia University, New York, NY, USA.
authors.forename: Xiaobo
authors.initials: X
authors.lastname: Zhong
authors.affiliation: Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons, Columbia University, New York, NY, USA.|Department of Epidemiology, Columbia University, New York, NY, USA.
authors.forename: Judith S
authors.initials: JS
authors.lastname: Jacobson
authors.affiliation: Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons, Columbia University, New York, NY, USA.|Department of Obstetrics and Gynecology, Columbia University, 161 Ft Washington, Room 1068, New York, NY, 10032, USA.
authors.forename: Jason D
authors.initials: JD
authors.lastname: Wright
authors.affiliation: Department of Medicine, Columbia University, 161 Ft Washington, Room 1068, New York, NY, 10032, USA.|Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons, Columbia University, New York, NY, USA.|Department of Epidemiology, Columbia University, New York, NY, USA.
authors.forename: Alfred I
authors.initials: AI
authors.lastname: Neugut
mesh_terms: D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use; D047072:Aromatase Inhibitors / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000523:psychology; D017024:Chemotherapy, Adjuvant; D005260:Female; D006801:Humans; D055118:Medication Adherence / Q000208:ethnology / Q000523:psychology*; D011788:Quality of Life / Q000523:psychology*; D012307:Risk Factors
chemical_list: D018931:Antineoplastic Agents, Hormonal; D047072:Aromatase Inhibitors
keywords: Adherence; Breast cancer; Psychosocial factors; Quality of life