Trajectories of adherence to adjuvant endocrine therapy for 5 years in women with breast cancer

Background

Adjuvant endocrine therapy (AET) is a daily oral medication prescribed for women with hormone-sensitive breast cancer (BC) to reduce recurrence and mortality risks. However, many women do not take AET daily or do not persist with AET for the recommended duration of at least 5 years. Our aims were to identify: 1) trajectories of AET adherence for the 5 years; 2) factors associated with these trajectories.

Methods

The French Cancer Cohort includes data on hospitalizations, ambulatory care and drug claims for all cancers diagnosed in France (SNDS database). Women diagnosed with a 1st non-metastatic BC in 2011 who had ≥ 1 AET claim within 12 months of surgery were included. For each woman, we estimated the monthly proportion of days covered (PDC) by an AET for 5 years after the first AET. Monthly PDCs were used to model AET adherence trajectories using group-based trajectory modeling. Statistical criteria were used to assess the suitability of the selected model. The factors associated with the trajectories were identified using multinomial logistic regressions.

Results

33,260 women were included. A 6-trajectory model was selected: 1) Stop of AET in the 1st year (6.6%), 2) Adherence for 1 year and stop (5.7%), 3) Adherence for 2.5y and stop (6.3%), 4) High adherence for 4.5y and stop (8.3%), 5) Sub-optimal adherence for 5y (4.3%), 6) Very high adherence for 5y (68.8%). Factors associated with non-adherence trajectories are mainly extreme age (>70y) and switch in AET.

Conclusions

About 70% of women had an optimal adherence for 5 years. Our results showed that women who changed AET during the treatment course were at higher risk of non-adherence. Among non-adherent women, the switch in AET is frequent and probably often related to the management of side effects. Interventions to detect and manage these side effects may help to support women with AET use. Effective management of these effects during all the 5 years could be needed to maintain adherence.

Key messages

About 70% of women had an optimal adherence for 5 years. Women who changed AET during the treatment course were at higher risk of non-adherence.

Financial burden from wage losses after early breast cancer: Extent and determinants among Canadian women

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Background: Wage losses after breast cancer may result in considerable financial burden. More women now participate in the workforce and breast cancer is managed using multiple treatment modalities that could lead to long work absences. We evaluated the burden from wage losses and determinants among Canadian women in the first 12 months after newly diagnosed non-metastatic breast cancer. Methods: This prospective cohort study was conducted among 800 women from 8 hospitals (participation 83%) of whom 459 were working at diagnosis. For these latter women, information on potential determinants of wage losses, work absences, compensation received and perception of financial situation was collected by 3 telephone interviews over the year. Information on medical characteristics came from medical files. The main outcome was the relative loss, namely wages lost divided by annual wages the woman would have earned had she not been absent from work. ANOVA was used to identify determinants. Results: The median relative loss in the first year after diagnosis for the 403 women reporting an absence or reduced work hours was 19% or $5,502 (Can dollars). Multivariate analysis showed that the mean relative loss was 13% for women who reported that breast cancer was not at all costly compared to 22%, 33% and 38% among women who said that breast cancer was a bit, quite or very costly, respectively (ptrend<0.0001). A higher relative loss was significantly associated with a lower level of education (difference between lowest and highest levels = 8 %, ptrend=0.0016), living =50 km from the surgery hospital (diff = 6%, p=0.0697), lower social support (diff = 8%, p=0.0119), invasive disease (diff = 6%, p=0.0861), chemotherapy (diff = 17%, p<0.0001), self-employment (diff= 17%, p<0.0001), shorter tenure in the job (diff between lowest and highest levels = 12%, ptrend<0.0001) and part-time work (diff = 10%, p=0.0003). Conclusions: Financial effects of wage losses could add to the overall burden of breast cancer. Clinicians and policy makers should be sensitized further to the fact that financial burden may be important for working women having more aggressive treatment and precarious work situations.

No significant financial relationships to disclose.

Work problems after breast cancer: an exploratory qualitative study

People treated for cancer have reported a variety of problems at work. However, there is little data on work experience after breast cancer, particularly for women treated in recent years. This exploratory qualitative study was conducted among 13 breast cancer survivors who had paid employment at diagnosis, returned to work afterwards, and mentioned work-related problems to a clinic nurse or physician. Unstructured, thematic interviews were undertaken. Qualitative thematic content analysis was conducted to identify and group themes which emerged from participants' discourse. Women in various types of jobs reported experiencing job loss, demotion, unwanted changes in tasks, problems with the employer and co-workers, personal changes in attitudes to work and diminished physical capacity. These work problems also preoccupied people treated for cancer more than two decades ago. New areas of concern also emerged: possible positive and negative effects of learning (implicitly or explicitly) about the diagnosis while at work and lack of discussion with health professionals about work and return-to-work issues, suggesting that health professionals' behaviour may influence women's work experience right from diagnosis. The identification of these new problems and confirmation of previously reported ones underlines the pertinence of determining how important and widespread these problems are in women now being treated for breast cancer.