Early discontinuation and non-adherence to adjuvant hormonal therapy are associated with increased mortality in women with breast cancer
Open accessAbstract
Despite the benefit of adjuvant hormonal therapy (HT) on mortality among women with breast cancer (BC), many women are non-adherent with its use. We investigated the effects of early discontinuation and non-adherence to HT on mortality in women enrolled in Kaiser Permanente of Northern California (KPNC). We identified women diagnosed with hormone-sensitive stage I-III BC, 1996-2007, and used automated pharmacy records to identify prescriptions and dates of refill. We categorized patients as having discontinued HT early if 180 days elapsed from the prior prescription. For those who continued, we categorized patients as adherent if the medication possession ratio was ≥80%. We used Cox proportional hazards models to estimate the association between discontinuation and non-adherence with all-cause mortality. Among 8,769 women who filled at least one prescription for HT, 2,761 (31%) discontinued therapy. Of those who continued HT, 1,684 (28%) were non-adherent. During a median follow-up of 4.4 years, 813 women died. Estimated survival at 10 years was 80.7% for women who continued HT versus 73.6% for those who discontinued (P < 0.001). Of those who continued, survival at 10 years was 81.7 and 77.8% in women who adhered and non-adhered, respectively (P < 0.001). Adjusting for clinical and demographic variables, both early discontinuation (HR 1.26, 95% CI 1.09-1.46) and non-adherence (HR 1.49, 95% CI 1.23-1.81), among those who continued, were independent predictors of mortality. Both early discontinuation and non-adherence to HT were common and associated with increased mortality. Interventions to improve continuation of and adherence to HT may be critical to improve BC survival.
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Taking the full course of adjuvant hormonal therapy (daily for at least five years) is necessary to obtain its full benefits.
“Adherence to the full course of treatment (one pill every day for at least 5 years) is necessary to obtain the full benefits of hormonal treatment.4, 5”
From Behavioral interventions to enhance adherence to hormone therapy in breast cancer survivors: a systematic literature review (2016) · cites this paper as [5]
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- Authors
- Hershman, D. L., Shao, T., Kushi, L. H., Buono, D., Tsai, W. Y., Fehrenbacher, L., Kwan, M., Gomez, S. L., & Neugut, A. I.
- Affiliations
- NewYork–Presbyterian Hospital (US)
- Columbia University Irving Medical Center (US)
- Kaiser Permanente (US)
- Columbia University (US)
- Cancer Prevention Institute of California (US)
- Corresponding author
- Hershman, Dawn L.
- ORCID
- Venue
- Breast Cancer Research and Treatment
- Published
- 2010-08-28
- Volume
- 126
- Issue
- 2
- Pages
- 529-537
- ISSN
- 0167-6806 (ISSN-L)
- 1573-7217
- PMC
- PMC3462663
- OpenAlex
- W2071003201
- Cited by
- 870
- References
- 42
- Citations by year
- 2026: 38 · 2025: 61 · 2024: 62 · 2023: 64 · 2022: 73 · 2021: 63 · 2020: 63 · 2019: 55 · 2018: 56 · 2017: 66 · 2016: 59 · 2015: 59 · 2014: 46 · 2013: 48 · 2012: 38
- FWCI
- 10.47
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Breast Cancer Research and Treatment (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- U.S. Department of Defense
- American Cancer Society
- National Institutes of Health (n01pc35136-24-0-2)
- National Cancer Institute (N01PC35136, R01CA105274, N01 PC035136, U24CA171524)
- Topics
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Cancer Research › Breast Cancer Treatment Studies
- Health Sciences › Medicine › Family Practice › Medication Adherence and Compliance
- Health Sciences › Medicine › Oncology › Global Cancer Incidence and Screening
- Keywords
- breast cancer, adjuvant endocrine therapy, treatment discontinuation, medication adherence, all-cause mortality, survival, medication possession ratio, hormone receptor-positive breast cancer, Kaiser Permanente
- MeSH terms
- Aged, Breast Neoplasms, Female, Humans, Lymphatic Metastasis, Middle Aged, Patient Compliance, Tamoxifen, Proportional Hazards Models, Chemotherapy, Adjuvant, Antineoplastic Agents, Hormonal, Aromatase Inhibitors, Tumor Burden, Kaplan-Meier Estimate
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