Persistence to 5-year hormonal breast cancer therapy: a French national population-based study.
Non-persistence to oral hormonal therapy (HT) in breast cancer (BC) is an emerging health issue, and estimations vary according to the population selected and/or the statistical method applied. This study aimed to estimate non-persistence over 5 years to HT in an unselected sample of women with BC using a French national population-based database and accounting for competing risks.



A retrospective cohort of 600 women initiating a HT between 2006 and 2007 was constituted using a representative sample of the French national healthcare insurance system database. The Cumulative Incidence Function method was used to estimate the probability of first treatment discontinuation of at least 90 days accounting for competing risk of death from any cause over the theoretical 5-year period of treatment.



Thirty one percent of patients who initiated a HT were identified as non-persistent at the fifth year of follow-up. Patients who switched to another HT (HR 3.10, 95% CI (2.20; 4.36)) or had metastatic BC (HR 3.07, 95% CI (1.73; 5.46)) were more likely to be non-persistent. Women who initiated aromatase inhibitors as compared with tamoxifen (HR 0.62, 95% CI (0.46; 0.83)), had administrative registration for BC (HR 0.21, 95% CI (0.13; 0.32)), or had received an adjuvant chemotherapy (HR 0.65, 95% CI (0.48; 0.89)) were less likely to discontinue.



The estimate of long-term non-persistence in an unselected sample of women treated in France by oral hormonal therapy is substantial, even accounting for competing risks.
INSERM, U1219, Univ. Bordeaux, Population Health Research Center, Pharmacoepidemiology and Population Impact of Drugs Team, F-33000 Bordeaux, France.|CIC Bordeaux CIC1401, F-33000 Bordeaux, France.|CHU de Bordeaux, Department of Medical Pharmacology, F-33000 Bordeaux, France.
Pauline
P
Bosco-Lévy
CIC Bordeaux CIC1401, F-33000 Bordeaux, France.
Jeremy
J
Jové
CIC Bordeaux CIC1401, F-33000 Bordeaux, France.
Philip
P
Robinson
INSERM, U1219, Univ. Bordeaux, Population Health Research Center, Pharmacoepidemiology and Population Impact of Drugs Team, F-33000 Bordeaux, France.|CIC Bordeaux CIC1401, F-33000 Bordeaux, France.|CHU de Bordeaux, Department of Medical Pharmacology, F-33000 Bordeaux, France.
Nicholas
N
Moore
INSERM, U1219, Univ. Bordeaux, Population Health Research Center, Pharmacoepidemiology and Population Impact of Drugs Team, F-33000 Bordeaux, France.|CIC Bordeaux CIC1401, F-33000 Bordeaux, France.|CHU de Bordeaux, Department of Medical Pharmacology, F-33000 Bordeaux, France.
Annie
A
Fourrier-Réglat
INSERM, U1219, Univ. Bordeaux, Population Health Research Center, Pharmacoepidemiology and Population Impact of Drugs Team, F-33000 Bordeaux, France.|CIC Bordeaux CIC1401, F-33000 Bordeaux, France.|CHU de Bordeaux, Department of Medical Pharmacology, F-33000 Bordeaux, France.
Julien
J
Bezin
D000368:Aged; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D047072:Aromatase Inhibitors / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000401:mortality; D002423:Cause of Death; D017024:Chemotherapy, Adjuvant; D016208:Databases, Factual; D057915:Drug Substitution; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D007349:Insurance, Health, Reimbursement / Q000706:statistics & numerical data; D008875:Middle Aged; D010352:Patient Dropouts / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors; D012494:Sampling Studies; D013629:Tamoxifen / Q000627:therapeutic use
D018931:Antineoplastic Agents, Hormonal; D047072:Aromatase Inhibitors; D013629:Tamoxifen