Comparative adherence to oral hormonal agents in older women with breast cancer

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• 作者：Winson Y. Cheung ; Edward Chia-Cheng Lai…
• 关键词：Adherence ; Persistence ; Self ; administration ; Oral hormonal agents ; Breast cancer
• 刊名：Breast Cancer Research and Treatment
• 出版年：2015
• 出版时间：July 2015
• 年：2015
• 卷：152
• 期：2
• 页码：419-427
• 全文大小：374 KB
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• 作者单位：Winson Y. Cheung (1) (2)
  Edward Chia-Cheng Lai (1) (2)
  Jenny Y. Ruan (1) (2)
  Jennifer T. Chang (1) (2)
  Soko Setoguchi (1) (2)
  
  1. Division of Medical Oncology, British Columbia Cancer Agency, 600 West 10th Avenue, Vancouver, BC, V5Z 4E6, Canada
  2. Duke Clinical Research Institute, Durham, NC, USA
  
• 刊物类别：Medicine
• 刊物主题：Medicine & Public Health
  Oncology
  
• 出版者：Springer Netherlands
• ISSN：1573-7217

文摘

We aim to (1) compare compliance of anastrozole, letrozole, exemestane, and tamoxifen in women and (2) identify clinical factors associated with medication non-adherence and non-persistence. Female Medicare beneficiaries who were new users of anastrozole, letrozole, exemestane, or tamoxifen between 2007 and 2010 were analyzed. Multivariate-modified Poisson and Cox regression models were constructed to compare non-adherence and non-persistence, respectively, across the different oral agents. A total of 5,150 women were included: mean age was 76.4?years, 2352 initiated anastrozole, 1401 letrozole, 248 exemestane, and 1149 tamoxifen. Non-adherence and non-persistence were 41 and 49?% respectively, with exemestane being associated with the worst non-adherence and non-persistence (RR 1.57, 95?% CI 1.37-.80, p?<?0.001; HR 1.93, 95?% CI 1.63-.30, respectively, p?<?0.001), followed by letrozole (RR 1.39, 95?% CI 1.26-.53, p?<?0.001; HR 1.47, 95?% CI 1.32-.64, respectively, p?<?0.001), and anastrozole (RR 1.16, 95?% CI 1.05-.27, p?=?0.003; HR 1.14, 95?%CI 1.03-.27, respectively, p?=?0.011), whereas tamoxifen was associated with the best compliance. Use of statins and osteoporosis medications was correlated with improved adherence (RR 0.89, 95?% CI 0.82-.96, p?=?0.002 and RR 0.84, 95?% CI 0.76-.92, p?<?0.001, respectively, for non-adherence) and persistence (HR 0.86, 95?% CI 0.79-.94, p?<?0.001 and HR 0.86, 95?% CI 0.78-.96, p?=?0.005, respectively, for non-persistence), but chronic kidney disease was correlated with worse non-persistence (HR 1.15, 95?% CI 1.04-.33, p?=?0.04). Age?≥?0?years was also associated with worse compliance. Compliance to oral hormonal therapy varied depending on the type of agent, age, and concurrent medications, highlighting specific opportunities to improve adherence and persistence in older women with breast cancer.