Age-related differences in persistence in women with breast cancer treated with tamoxifen or aromatase inhibitors in Germany.
To study age-related persistence in postmenopausal women with endocrine-responsive breast cancer treated with tamoxifen (TAM) and aromatase inhibitors (AI).



Data on 29,245 patients diagnosed with metastatic or non-metastatic breast cancer (BC) and initially treated with TAM or AI between 2004 and 2013 were included. The primary outcome measure was the age-dependent rate of discontinuation of endocrine treatment within 5years after initiation. Discontinuation of therapy was defined as a period of at least 90days without treatment. A multivariate Cox regression model was created to determine the influence of age on the risk of discontinuation. Health insurance type (private/statutory), type of care (gynecological/general), region (West/East Germany), concomitant diagnoses (depression, osteoporosis, and diabetes), and Charlson Comorbidity Score were included as covariates.



The mean ages of the women in the <70 and ≥70 groups were 55.9 (SD: 9.7) and 77.4 (SD: 5.4) years, respectively. Within 5years after treatment initiation, 88.8% of women <70 of age and 82% of women ≥70 years of age had terminated treatment (p-value<0.001). Patients aged ≥70 exhibited a lower risk of treatment discontinuation than patients aged <70 (HR=0.75, 95% CI: 0.66-0.85). Furthermore, gynecological practices, disease management programs, and high Charlson scores increased persistence.



Overall, the present study indicates that persistence rates are low in both women with BC aged <70 and those aged ≥70 years. We also found that younger women with BC are at a higher risk of treatment discontinuation than older women.
Department of Biology, École Normale Supérieure de Lyon, Lyon, France.
Louis
L
Jacob
Nordwest Hospital Frankfurt, Frankfurt am Main, Germany.
Peyman
P
Hadji
IMS Health, Epidemiology, Frankfurt, Germany. Electronic address: kkostev@de.imshealth.com.
Karel
K
Kostev
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use*; D047072:Aromatase Inhibitors / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000453:epidemiology; D015897:Comorbidity; D003863:Depression / Q000453:epidemiology; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D005858:Germany; D006801:Humans; D007348:Insurance, Health; D053208:Kaplan-Meier Estimate; D008495:Medical Oncology; D008875:Middle Aged; D015999:Multivariate Analysis; D010024:Osteoporosis / Q000453:epidemiology; D016016:Proportional Hazards Models; D013629:Tamoxifen / Q000627:therapeutic use*; D016903:Drug Monitoring
D018931:Antineoplastic Agents, Hormonal; D047072:Aromatase Inhibitors; D013629:Tamoxifen
Aromatase inhibitors; Breast cancer; Persistence; Tamoxifen