Nonadherence to adjuvant tamoxifen therapy in women with primary breast cancer
Abstract
Purpose: Although clinical trials have clearly demonstrated the benefits of tamoxifen in women with primary breast cancer, little is known about how this drug is actually used in the general population. We sought to estimate adherence and predictors of nonadherence in women starting tamoxifen as adjuvant breast cancer therapy. Patients and Methods: Subjects were age 18 years or older initiating tamoxifen for primary breast cancer and enrolled in New Jersey’s Medicaid or Pharmaceutical Assistance to the Aged and Disabled programs during the study period, from 1990 to 1996 (N = 2,378). Main outcome measures were number of days covered by filled prescriptions for tamoxifen in the first year of therapy with the 4 years after tamoxifen initiation for a subset; predictors of good versus poor adherence. Results: Twenty-three percent of patients missed taking tamoxifen on more than one fifth of days studied, although on average, patients filled prescriptions for tamoxifen for 87% of their first year of treatment. The youngest, oldest, nonwhite, and mastectomy patients had significantly lower rates of adherence; patients who had seen an oncologist before taking tamoxifen had significantly higher rates of adherence. Overall adherence decreased to 50% by year 4 of therapy. Conclusion: The mean level of adherence to tamoxifen is high compared with other chronic medications. However, nearly one fourth of patients may be at risk for inadequate clinical response because of poor adherence. Because of the efficacy of tamoxifen therapy in preventing recurrence and death in women with early-stage breast cancer, further efforts are necessary to identify and prevent suboptimal adherence.
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Only one study was conducted in the US.
“Only one was conducted in the US.”
From Behavioral interventions to enhance adherence to hormone therapy in breast cancer survivors: a systematic literature review (2016) · cites this paper as [28]
All interventions were patient-focused and included educational and reminder components.
“All the interventions were patient-focused (rather than physician-focused or patient-provider communication focused) and comprised of an educational and a reminder component.14, 24-26, 28”
From Behavioral interventions to enhance adherence to hormone therapy in breast cancer survivors: a systematic literature review (2016) · cites this paper as [28]
Only 40% (2/5) of interventions were theory driven.
“Only 40% of the interventions (n=2) presented were theory driven.26, 28”
From Behavioral interventions to enhance adherence to hormone therapy in breast cancer survivors: a systematic literature review (2016) · cites this paper as [28]
Ell and colleagues' intervention focused predominantly on Latina breast cancer survivors in a public safety net medical center in the US.
“Notably, Ell and colleagues' intervention focused predominantly on Latina breast cancer survivors in a public safety net medical center in the US.”
From Behavioral interventions to enhance adherence to hormone therapy in breast cancer survivors: a systematic literature review (2016) · cites this paper as [28]
Only one study included survivors taking tamoxifen.
“Only one study included survivors taking tamoxifen.28”
From Behavioral interventions to enhance adherence to hormone therapy in breast cancer survivors: a systematic literature review (2016) · cites this paper as [28]
In IMPAACT, among 44 patients who obtained tamoxifen or anastrozole, 59% were adherent and there was no significant difference in hormonal therapy adherence between arms.
“From the 44 patients that obtained tamoxifen or anastrozole, 59% were adherent and there was no significant difference in hormonal therapy adherence between the two arms.”
From Behavioral interventions to enhance adherence to hormone therapy in breast cancer survivors: a systematic literature review (2016) · cites this paper as [28]
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- Authors
- Partridge, A. H., Wang, P. S., Winer, E. P., & Avorn, J.
- Affiliations
- Brigham and Women's Hospital (US)
- Venue
- Journal of Clinical Oncology
- Published
- 2003-02-15
- Volume
- 21
- Issue
- 4
- Pages
- 602-606
- ISSN
- 0732-183X (ISSN-L)
- 1527-7755
- OpenAlex
- W1996337195
- Cited by
- 676
- References
- 47
- Citations by year
- 2026: 14 · 2025: 18 · 2024: 20 · 2023: 19 · 2022: 35 · 2021: 33 · 2020: 28 · 2019: 23 · 2018: 30 · 2017: 44 · 2016: 45 · 2015: 46 · 2014: 36 · 2013: 57 · 2012: 56
- FWCI
- 8.35
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Clinical Oncology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (1r03ag018395-01)
- National Institute on Aging (R03-AG18395)
- Topics
- Health Sciences › Medicine › Family Practice › Medication Adherence and Compliance
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Cancer Research › Breast Cancer Treatment Studies
- Health Sciences › Medicine › Oncology › Cancer survivorship and care
- Keywords
- tamoxifen, medication adherence, non-compliance, primary breast cancer, predictors of adherence, prescription filling, Medicaid, older women, mastectomy, early breast cancer, recurrence prevention
- MeSH terms
- Adult, Aged, Aged, 80 and over, Breast Neoplasms, Female, Humans, Mastectomy, Medicaid, Middle Aged, New Jersey, Tamoxifen, United States, Treatment Refusal, Chemotherapy, Adjuvant, Antineoplastic Agents, Hormonal
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
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