Factors Associated with Endocrine Therapy Non‐Adherence in Breast Cancer Survivors. Issue 4 (11th February 2020)

• Record Type: Journal Article
• Authors: Spencer, Jennifer C.; Reeve, Bryce B.; Troester, Melissa A.; Wheeler, Stephanie B.
• Is Part Of: Psycho-oncology. Volume 29:Issue 4(2020)
• Page Start: 647
• Page End: 654
• Publication Date: 2020-02-11
• Subjects: Cancer -- Oncology -- Breast Cancer -- Endocrine Therapy -- Medication Adherence -- Cancer Disparities -- Cancer Equity -- Factor Analysis; Cancer -- Psychological aspects -- Periodicals; Cancer -- Social aspects -- Periodicals; Neoplasms -- psychology -- Periodicals; 616.9940019
• DOI: 10.1002/pon.5289
• Languages: English
• ISSNs: 1057-9249

Abstract

Abstract: Background: For women with hormone receptor positive breast cancer, long‐term endocrine therapy (ET) can greatly reduce the risk of recurrence, yet adherence is low‐ particularly among traditionally underserved populations. Methods: The Carolina Breast Cancer Study oversampled Black and young women (<50 years of age). Participants answered an ET‐specific medication adherence questionnaire assessing reasons for non‐adherence. We used principal factor analysis to identify latent factors describing ET non‐adherence. We then performed multivariable regression to determine clinical and demographic characteristics associated with each ET non‐adherence factor. Results: 1, 231 women were included in analysis, 59% reported at least one barrier to ET adherence. We identified three latent factors which we defined as: habit ‐ challenges developing medication‐taking behavior; tradeoffs ‐ high perceived side effect burden and medication safety concerns; and resource barriers ‐ challenges related to cost or accessibility. Older age (50+) was associated with less reporting of habit (Adjusted Risk Ratio (aRR) 0.54[95% CI: 0.43‐0.69] and resource barriers (aRR 0.66[0.43‐0.997]), but was not associated with tradeoff barriers. Medicaid‐insured women were more likely than privately‐insured to report tradeoff (aRR:1.53 [1.10‐2.13]) or resource barriers (aRR:4.43[2.49‐6.57]). Black race was associated with increased reporting of all factors (habit: aRR 1.29[1.09‐1.53]; tradeoffs: 1.32[1.09‐1.60], resources: 1.65[1.18‐2.30]). Conclusion: Barriers to ET adherence were described by three distinct factors, and strongly associated with sociodemographic characteristics. Barriers to ET adherence appear inadequately addressed for younger, Black, and publicly‐insured breast cancer survivors. These findings underscore the importance of developing multi‐faceted, patient‐centered interventions that address a diverse range of barriers to ET adherence.