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

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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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Anderson, J. N., Graff, J. C., Krukowski, R. A., Schwartzberg, L. S., Vidal, G. A., Waters, T. M., Paladino, A. J., Jones, T. N., Blue, R., Koçak, M., et al. (2020) · Health Communication · doi:10.1080/10410236.2020.1751383 · Cited by 63
“Some AET symptoms take several months to develop (Henry et al., 2012; Kahn et al., 2007), and medication adherence decreases over time (Henry et al., 2012); therefore, focus groups were also segmented by patient length of time on AET to reduce the likelihood of deference because of intragroup…”
Background
Effect of information seeking and avoidance behavior on self-rated health status among cancer survivors
Jung, M., Ramanadhan, S., & Viswanath, K. (2013) · Patient Education and Counseling · doi:10.1016/j.pec.2013.02.008 · Cited by 60
Objective Data Reveals Gender Preferences for Patients’ Primary Care Physician
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Psychosocial factors in adjuvant hormone therapy for breast cancer: an emerging context for adherence research
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A Tracking and Feedback Registry to Reduce Racial Disparities in Breast Cancer Care
Bickell, N. A., Shastri, K., Fei, K., Oluwole, S. F., Godfrey, H., Hiotis, K. L., Srinivasan, A., & Guth, A. A. (2008) · JNCI Journal of the National Cancer Institute · doi:10.1093/jnci/djn387 · Cited by 59
Class, race, ethnicity and information needs in post-treatment cancer patients
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Self-citation
Endocrine Therapy Use Among Elderly Hormone Receptor-Positive Breast Cancer Patients Enrolled in Medicare Part D
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Chemotherapy use and patient treatment preferences in advanced colorectal cancer
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BackgroundSelf-citation
Patient and Clinician Characteristics Associated with Adherence. A Cohort Study of Veterans with Incidental Pulmonary Nodules
Mosesón, E. M., Wiener, R. S., Golden, S. E., Au, D. H., Gorman, J. D., Laing, A. D., Deffebach, M. E., & Slatore, C. G. (2016) · Annals of the American Thoracic Society · doi:10.1513/annalsats.201511-745oc · Cited by 52
Barriers to and facilitative processes of endocrine therapy adherence among women with breast cancer
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The impact of medication side effects on adherence and persistence to hormone therapy in breast cancer survivors: A quantitative systematic review
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Reasons for Nonadherence to Tamoxifen and Aromatase Inhibitors for the Treatment of Breast Cancer: A Literature Review
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“A good relationship between the patient and healthcare provider was found to have a positive impact on adherence rates (Güth et al., 2008; Kahn et al., 2007; Kirk & Hudis, 2008; Partridge et al., 2003; Pellegrini et al., 2010; Sedjo & Devine, 2011).”
BackgroundInfluential
Adherence to adjuvant endocrine therapy among breast cancer survivors: a systematic review and meta-synthesis of the qualitative literature using grounded theory
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Adherence evaluation of endocrine treatment in breast cancer: methodological aspects
Oberguggenberger, A., Sztankay, M. J., Beer, B., Schubert, B., Meraner, V., Oberacher, H., Kemmler, G., Giesinger, J. M., Gamper, E., Sperner‐Unterweger, B., et al. (2012) · BMC Cancer · doi:10.1186/1471-2407-12-474 · Cited by 45
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Personal and clinical social support and adherence to adjuvant endocrine therapy among hormone receptor-positive breast cancer patients in an integrated health care system
Kroenke, C. H., Hershman, D. L., Gomez, S. L., Adams, S. R., Eldridge, E. H., Kwan, M. L., Ergas, I. J., Kubo, A., & Kushi, L. H. (2018) · Breast Cancer Research and Treatment · doi:10.1007/s10549-018-4774-2 · Cited by 44
Adherence trajectories of adjuvant endocrine therapy in the five years after its initiation among women with non-metastatic breast cancer: a cohort study using administrative databases
Lambert-Côté, L., Bouhnik, A., Bendiane, M., Bérenger, C., Mondor, M., Huiart, L., & Lauzier, S. (2020) · Breast Cancer Research and Treatment · doi:10.1007/s10549-020-05549-x · Cited by 46
“1 3 In previous studies using traditional adherence measures, receiving the right amount of support from healthcare professionals and being informed of AET side effects have been associated with AET persistence [54].”
Background
Trade-off preferences regarding adjuvant endocrine therapy among women with estrogen receptor-positive breast cancer
Wouters, H., Maatman, G. A., van Dijk, L., Bouvy, M. L., Vree, R., van Geffen, E. C. G., Nortier, J. W. R., & Stiggelbout, A. M. (2013) · Annals of Oncology · doi:10.1093/annonc/mdt195 · Cited by 39
Factors Influencing Oral Adherence: Qualitative Metasummary and Triangulation With Quantitative Evidence
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“These positive associations between PCC and adherence are true not only in the short term but also when examined longitudinally.(26,27) Some studies conceptualize adherence as a potential mediator of the relationship between PCC and clinical outcomes or satisfaction, rather than as the single and final endpoint.”
Quality of physician-patient relationships is associated with the influence of physician treatment recommendations among patients with prostate cancer who chose active surveillance
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“, hot flashes and other menopausal symptoms; joint pain) that likely influence whether women decide to initiate the medication.[24, 10, 15, 25, 26] Additionally, adherence to a daily medication that causes uncomfortable side effects to prevent recurrence—a silent health condition for which patients may feel they are n…”
The effect of complications on the patient-surgeon relationship after colorectal cancer surgery
Regenbogen, S. E., Veenstra, C. M., Hawley, S. T., Hendren, S. K., Ward, K. C., Kato, I., & Morris, A. M. (2013) · Surgery · doi:10.1016/j.surg.2013.12.011 · Cited by 36
“Scoring was inverted for the three items in the trust scale indicated with asterisks, with 1 point for “Strongly Agree,” 2 points for “Agree,” 3 points for “Neither,” 4 points for “Disagree,” and 5 points for “Strongly disagree.””
BackgroundInfluential
Symptoms and QOL as Predictors of Chemoprevention Adherence in NRG Oncology/NSABP Trial P-1
Land, S. R., Walcott, F. L., Liu, Q., Wickerham, D. L., Costantino, J. P., & Ganz, P. A. (2015) · JNCI Journal of the National Cancer Institute · doi:10.1093/jnci/djv365 · Cited by 39
Prospective investigation of social support, coping, and depressive symptoms: A model of adherence to endocrine therapy among women with breast cancer.
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Oncology providers’ perspectives on endocrine therapy prescribing and management
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“This aligns with literature associating high side effect burden with ET nonadherence.(2,13,14) Other barriers associated with ET adherence have been presented in the literature, such as minority race/ethnicity,(13) cost, poor patient–provider communication, and others.”
Oral Endocrine Therapy Nonadherence, Adverse Effects, Decisional Support, and Decisional Needs in Women With Breast Cancer
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“…traditional style of communication, is associated with a higher perceived satisfaction with, and confidence in, treatment decisions (Kane et al., 2014), greater levels of treatment adherence (Kahn et al., 2007), perceived quality of life (Hack et al., 2006) and mental health (Arora et al., 2009).”
Background
Factors influencing the process of medication (non-)adherence and (non-)persistence in breast cancer patients with adjuvant antihormonal therapy: a qualitative study
Verbrugghe, M., Verhaeghe, S. T. L., Decoene, E., Baere, S. D., Vandendorpe, B., & Hecke, A. V. (2015) · European Journal of Cancer Care · doi:10.1111/ecc.12339 · Cited by 34
“Kahn et al. (2007) also found that breast cancer patients taking tamoxifen who experienced side effects that they were not told about in advance, were less likely to continue tamoxifen in comparison to patients who did know what side effects they could expect (62% vs. 85%, P < 0.001).”
BackgroundResultInfluential
Clinical Profiles Predict Early Nonadherence to Adjuvant Endocrine Treatment in a Prospective Breast Cancer Cohort
Markkula, A., Hietala, M., Henningson, M., Ingvar, C., Rose, C., & Jernström, H. (2012) · Cancer Prevention Research · doi:10.1158/1940-6207.capr-11-0442 · Cited by 32
“The age cutoff points examined in relation to adherence were chosen in concordance with earlier publications (11, 13, 15, 23, 24).”
Method
Predicting Adherence to Aromatase Inhibitor Therapy among Breast Cancer Survivors: An Application of the Protection Motivation Theory
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Remote Monitoring App for Endocrine Therapy Adherence Among Patients With Early-Stage Breast Cancer
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Capturing patients’ experiences to change Parkinson’s disease care delivery: a multicenter study
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“Moreover, patient centeredness increases treatment adherence among chronically ill patients [8].”
Background
Adherence to Adjuvant Tamoxifen in Mexican Young Women with Breast Cancer
Martínez-Cannon, B. A., Castro‐Sánchez, A., Barragán-Carrillo, R., Pacheco, S. D. L. R., Platas, A., Fonseca, A., Vega, Y., Bojoquez-Velazquez, K., Bargalló‐Rocha, E., Mohar, A., et al. (2021) · Patient Preference and Adherence · doi:10.2147/ppa.s296747 · Cited by 30
Patients’ self-reported adherence to capecitabine on XELOX treatment in metastatic colorectal cancer: findings from a retrospective cohort analysis
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“Associated factors influencing nonadherence to oral anticancer drugs are multifactorial and interrelated.(24,25) Treatment-related side effects are the most frequently reported therapy-related factors associated with nonadherence to capecitabine,(5) and age is another predominant factor.”
Higher symptom burden is associated with lower function in women taking adjuvant endocrine therapy for breast cancer
Sitlinger, A. P., Shelby, R. A., Denburg, A. N. V., White, H. K., Edmond, S. N., Marcom, P. K., Bosworth, H. B., Keefe, F. J., & Kimmick, G. G. (2018) · Journal of Geriatric Oncology · doi:10.1016/j.jgo.2018.11.008 · Cited by 30

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: Schneider, Eric C.
Adams, John L.
Epstein, Arnold M.
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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Patient Centered Experiences in Breast Cancer: Predicting Long-Term Adherence to Tamoxifen Use

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