Patient-Reported Outcomes and Long-Term Nonadherence to Aromatase Inhibitors.

Abstract

BACKGROUND:

Nonadherence to aromatase inhibitors (AIs) is common and increases risk of breast cancer (BC) recurrence. We analyzed factors associated with nonadherence among patients enrolled in S1105, a randomized trial of text messaging.

METHODS:

At enrollment, patients were required to have been on an adjuvant AI for at least 30 days and were asked about financial, medication, and demographic factors. They completed patient-reported outcomes (PROs) representing pain (Brief Pain Inventory), endocrine symptoms (Functional Assessment of Cancer Therapy-Endocrine Symptoms), and beliefs about medications (Treatment Satisfaction Questionnaire for Medicine; Brief Medication Questionnaire). Our primary endpoint was AI nonadherence at 36 months, defined as urine AI metabolite assay of less than 10 ng/mL or no submitted specimen. We evaluated the association between individual baseline characteristics and nonadherence with logistic regression. A composite risk score reflecting the number of statistically significant baseline characteristics was examined.

RESULTS:

We analyzed data from 702 patients; median age was 60.9 years. Overall, 35.9% patients were nonadherent at 36 months. Younger patients (younger than age 65 years) were more nonadherent (38.8% vs 28.6%, odds ratio [OR] = 1.51, 95% confidence interval [CI] = 1.05 to 2.16; P = .02). Fourteen baseline PRO scales were each statistically significantly associated with nonadherence. In a composite risk model categorized into quartile levels, each increase in risk level was associated with a 46.5% increase in the odds of nonadherence (OR = 1.47, 95% CI =1.26 to 1.70; P < .001). The highest-risk patients were more than 3 times more likely to be nonadherent than the lowest-risk patients (OR = 3.14, 95% CI = 1.97 to 5.02; P < .001).

CONCLUSIONS:

The presence of multiple baseline PRO-specified risk factors was statistically significantly associated with AI nonadherence. The use of these assessments can help identify patients for targeted interventions to improve adherence.

• Authors: Dawn L Hershman, Alfred I Neugut, Anna Moseley, Kathryn B Arnold, Julie R Gralow, N Lynn Henry, Grace Clarke Hillyer, Scott D Ramsey, Joseph M Unger
• Journal: Journal of the National Cancer Institute (J Natl Cancer Inst) Vol. 113 Issue 8 Pg. 989-996 (08 02 2021) ISSN: 1460-2105 [Electronic] United States
• PMID: 33629114 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)
• Copyright: © The Author(s) 2021. Published by Oxford University Press. All rights reserved. For permissions, please email: [email protected].

Chemical References

• Aromatase Inhibitors

Topics

• Aged
• Aromatase Inhibitors (therapeutic use)
• Breast Neoplasms (drug therapy, metabolism)
• Female
• Humans
• Medication Adherence
• Middle Aged
• Neoplasm Recurrence, Local (drug therapy)
• Patient Reported Outcome Measures