A prospective cohort study of early discontinuation of adjuvant chemotherapy in women with breast cancer: the breast cancer quality of care study (BQUAL).
For many women with non-metastatic breast cancer, adjuvant chemotherapy prevents recurrence and extends survival. Women who discontinue chemotherapy early may reduce those benefits, but little is known about what predicts early discontinuation. We sought to determine prospectively the rate and reasons for early discontinuation of adjuvant chemotherapy in women with breast cancer. We conducted a prospective cohort study among three U.S. health care organizations. Of 1158 women with newly diagnosed non-metastatic breast cancer, 2006-2010, we analyzed 445 (38.4 %) patients who initiated standard adjuvant chemotherapy as defined by accepted guidelines. We interviewed patients at baseline and twice during treatment regarding sociodemographic/psychosocial factors and treatment decision-making and collected clinical data. They were categorized according to the number of cycles required by the chemotherapy regimen they had initiated. The outcome was early discontinuation (<80 % of planned cycles). Of patients analyzed, 392 (88.1 %) completed the prescribed therapy. The strongest predictor was receipt of a regimen entailing >4 cycles of therapy (18.1 % for longer regimens, 7.4 % for 4 cycles) (odds ratio [OR] 2.59, 95 % CI 1.32-5.08), controlling for race, age, stage, hormone receptor status, social support, optimism, spirituality, stress, and physical symptoms. Higher levels of psychological symptoms on the Memorial symptom assessment scale also increased the odds of early discontinuation (OR 1.92, 95 % CI 0.998-3.68). The large majority of patients who initiated adjuvant chemotherapy for breast cancer completed their prescribed regimens, but early discontinuation was associated with lengthier regimens and, with borderline statistical significance, for those with psychological side effects.
Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY, USA. ain1@columbia.edu.|Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons, Columbia University, New York, NY, USA. ain1@columbia.edu.|Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA. ain1@columbia.edu.|Columbia University Medical Center, 722 W 168th Street, Room 725, New York, NY, 10032, USA. ain1@columbia.edu.
Alfred I
AI
Neugut
Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons, Columbia University, New York, NY, USA.|Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.
Grace Clarke
GC
Hillyer
Division of Research, Kaiser Permanente of Northern California, Oakland, CA, USA.
Lawrence H
LH
Kushi
Department of Public Health Sciences, Henry Ford Health System, Detroit, MI, USA.
Lois
L
Lamerato
Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.
Donna L
DL
Buono
Department of Surgery, Henry Ford Health System, Detroit, MI, USA.
S David
SD
Nathanson
Departments of Psychiatry, Psychology and Behavioral & Community Health Sciences, University of Pittsburgh, University of Pittsburgh Cancer Institute, Pittsburgh, PA, USA.
Dana H
DH
Bovbjerg
Department of Oncology and Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA.
Jeanne S
JS
Mandelblatt
Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons, Columbia University, New York, NY, USA.|Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA.
Wei-Yann
WY
Tsai
Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons, Columbia University, New York, NY, USA.|Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.
Judith S
JS
Jacobson
Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY, USA.|Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons, Columbia University, New York, NY, USA.|Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.
Dawn L
DL
Hershman
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000523:psychology; D017024:Chemotherapy, Adjuvant / Q000379:methods*; D005260:Female; D006801:Humans; D008875:Middle Aged; D016017:Odds Ratio; D010349:Patient Compliance / Q000523:psychology*; D011446:Prospective Studies; D057566:Self Report; D016896:Treatment Outcome
Adherence; Adjuvant chemotherapy; Breast cancer; Early discontinuation; Non-persistence; Toxicity