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Cited by 245Patient-Provider Communication in HealthcareCancer survivorship and careBreast Cancer Treatment Studies

Patient Centered Experiences in Breast Cancer: Predicting Long-Term Adherence to Tamoxifen Use

Kahn, Katherine L., Schneider, Eric C., Malin, Jennifer L., Adams, John L., Epstein, Arnold M.·2007·Medical Care
DOI 10.1097/01.mlr.0000257193.10760.7f
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Abstract

BACKGROUND: Among breast cancer patients, tamoxifen use is associated with reduced risk of disease relapse and death, but it is often difficult for women to sustain therapy during the 5 years required to obtain maximum benefit. OBJECTIVES: We sought to examine the influence of patient-centered care activities on ongoing tamoxifen use 4 years after initiation, we examined key components of patient-centered care and rates of ongoing tamoxifen. METHODS: Using a prospective cohort study that included observational data from the National Initiative for Cancer Care Quality (NICCQ), we studied 881 patients with stage I-III breast cancer who were registered with an initial diagnosis in 1998 by an American College of Surgeons-approved hospital cancer registry in 1 of 5 metropolitan areas, who initiated tamoxifen treatment. A patient survey and medical record abstraction were used as measurements. RESULTS: Among women who initiated tamoxifen, 79% were still taking it 4 years later. Other than older age and the severity of side effects, other demographic, clinical and cancer characteristics, and treatments did not predict ongoing tamoxifen use. In contrast, after adjusting for these factors, the proportion of patients with ongoing tamoxifen use was lower for patients reporting less support than needed (82% vs. 69%, P = 0.0051), less than wanted role in decision-making (80% vs. 70%, P = 0.0486), decision-making about tamoxifen without doctor input (79% vs. 64%, P = 0.0182), and for patients who weren't told about side effects in advance (82% vs. 72%, P = 0.0016). CONCLUSIONS: Although age and the severity of side-effects remain important, patient-centered care was a primary mediator of patient adherence to ongoing cancer treatment with tamoxifen.

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  • Patient variables, social support, patient-provider communication, and healthcare factors such as cost are associated with adherence to systemic therapies in breast cancer survivors.

    “Patient variables (e.g., age), social support, patient-provider communication, and healthcare factors (e.g., cost) have been associated with breast cancer survivor adherence to systemic therapies.6, 16-18”

    From Behavioral interventions to enhance adherence to hormone therapy in breast cancer survivors: a systematic literature review (2016) · cites this paper as [16]

  • Survivors who reported lack of understandable information, not being told about side effects in advance, limited opportunity to ask questions at diagnosis, and never being asked about difficulties taking adjuvant hormonal therapy had lower adherence rates.

    “There is also evidence that survivors who reported (1) lack of understandable information about treatment, (2) not being told about side effects in advance, (3) having limited opportunity to ask questions at the time of diagnosis, and (4) never having been asked about the difficulties of taking adjuvant hormonal therapy, exhibited lower rates of adherence to hormonal treatment.16-18”

    From Behavioral interventions to enhance adherence to hormone therapy in breast cancer survivors: a systematic literature review (2016) · cites this paper as [16]

  • Social support is associated with higher adherence in a meta-analysis with various medical conditions and in several adjuvant hormonal therapy studies with breast cancer survivors.

    “Social support has also been associated with higher adherence in a meta-analysis with various medical conditions46 and in several adjuvant hormonal therapy studies with breast cancer survivors.16, 17, 47”

    From Behavioral interventions to enhance adherence to hormone therapy in breast cancer survivors: a systematic literature review (2016) · cites this paper as [16]

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Authors
Kahn, K. L., Schneider, E. C., Malin, J. L., Adams, J. L., & Epstein, A. M.
Affiliations
  • RAND Corporation (US)
  • Brigham and Women's Hospital (US)
  • Amgen (United States) (US)
Corresponding author
  • Kahn, Katherine L.
  • Adams, John L.
ORCID
Venue
Medical Care
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2007-05
Volume
45
Issue
5
Pages
431-439
ISSN
0025-7079 (ISSN-L)
DOI
10.1097/01.mlr.0000257193.10760.7f
OpenAlex
W1979710912
Cited by
245
References
44
Citations by year
2026: 3 · 2025: 11 · 2024: 6 · 2023: 11 · 2022: 9 · 2021: 20 · 2020: 13 · 2019: 10 · 2018: 17 · 2017: 18 · 2016: 16 · 2015: 17 · 2014: 16 · 2013: 29 · 2012: 14
FWCI
12.51
Type
journal article
Language
en
Open access
closed
Locations
  • Medical Care (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Health Professions › General Health Professions › Patient-Provider Communication in Healthcare
  • Health Sciences › Medicine › Oncology › Cancer survivorship and care
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Cancer Research › Breast Cancer Treatment Studies
Keywords
breast cancer, tamoxifen, patient-centered care, medication adherence, patient support, shared decision-making, treatment side effects
MeSH terms
Adult, Aged, Aged, 80 and over, Breast Neoplasms, Female, Humans, Medical Audit, Middle Aged, Neoplasm Staging, Patient Compliance, Patient Participation, Prospective Studies, Tamoxifen, Time Factors, United States, Cohort Studies, Patient-Centered Care, Health Care Surveys

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