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The results indicated that 49% of women in the study population did not take the hormone therapy for the full duration of the treatment.

Women with early stage breast cancer, especially those aged younger than 40 years, had significant rates of nonadherence for prescribed hormonal therapy, which has been proven to reduce breast cancer recurrence and increase survival among these patients.

The results, published in the Journal of Clinical Oncology, indicated that 49% of women in the study population did not take the hormone therapy for the full duration of the treatment.

“This new study reaffirms some worrisome trends for women completing hormonal therapy, and brings up the larger issue of noncompliance for cancer therapies in general,” Jennifer Obel, MD, a member of ASCO’s Cancer Communications Committee, said in a statement.

“As we increasingly move treatments out of the clinic and into the home — we now have more than 50 oral chemotherapy medications — compliance has become a significant problem that hasn’t been addressed very well. Patients tend to underestimate side effects and under-report events that happen between clinic visits. We need to identify reasons why patients don’t take their drugs before we can find ways to reverse this trend,” she said.

Recurrence prevention

In the study, Dawn L. Hershman, MD, associate professor of medicine and epidemiology at Columbia University Medical Center, and colleagues examined pharmacy records for 8,769 women diagnosed with stage I, II or III hormone-sensitive breast cancer between 1996 and 2007. All of the women were enrolled in Kaiser Permanente of Northern California health system and had filled a prescription for tamoxifen or an aromatase inhibitor within 1 year of diagnosis. These agents are normally prescribed for a period of 5 years.

After 4.5 years, 32% of women had discontinued therapy; of those who did not discontinue, 28% were nonadherent (taking medication less than 80% of the time). This rate of discontinuation or nonadherence was similar to that identified in earlier research; however, in this study, the researchers identified several factors associated with discontinuation or nonadherence.

Treatment noncompliance

The highest rate of noncompliance was among the 202 patients who were aged younger than 40 years. These women were 50% more likely to discontinue therapy and 40% more likely to be nonadherent (P<.001), according to the researchers.

In addition, older women (older than age 65 years), those who had undergone lumpectomy vs. mastectomy, and women with more comorbidities were more likely to discontinue hormone therapy. In contrast, women of Asian/Pacific Islander ethnicity, married women, and women with longer prescription refill intervals were more likely to complete the 4.5 years of hormone therapy.

“Physicians are often unaware of patient compliance, and this is becoming an increasingly important issue in cancer,” Hershman said in a press release. “It’s disturbing that patients under 40 had the highest discontinuation and nonadherence rates because those patients have the longest life expectancy. If we can better understand the issues surrounding compliance with hormonal therapy, this might help us understand why patients don’t adhere to other treatments that are moving out of the clinic and into the home, such as oral chemotherapy, as often as we would like.”

Source: HemOnc Today