Adjuvant endocrine therapy for premenopausal women with breast cancer: Patient adherence and physician prescribing practices in Mexico. (October 2021)

• Record Type: Journal Article
• Authors: Villarreal-Garza, Cynthia; Mesa-Chavez, Fernanda; Ferrigno, Ana S.; De la Garza-Ramos, Cynthia; Fonseca, Alan; Villanueva-Tamez, Karen; Campos-Salgado, Jose Y.; Cruz-Ramos, Marlid; Rodriguez-Gomez, David O.; Ruiz-Cruz, Sandy; Cabrera-Galeana, Paula
• Is Part Of: Breast. Volume 59(2021)
• Page Start: 8
• Page End: 15
• Publication Date: 2021-10
• Subjects: Breast cancer -- Endocrine therapy -- Adherence -- Premenopausal -- Prescribing practices -- Mexico; Breast -- Diseases -- Periodicals; Breast -- Tumors -- Periodicals; Breast -- Periodicals; Electronic journals; Periodicals; 616
• DOI: 10.1016/j.breast.2021.05.013
• Languages: English
• ISSNs: 0960-9776

Abstract

Abstract: Background: In resource-constrained settings, data regarding breast cancer patients' adherence to endocrine therapy (ET) and physicians' prescribing practices is limited. This study aims to decrease this knowledge gap in a real-world clinical practice. Methods: Premenopausal women with stage 0-III hormone-sensitive breast cancer and receiving adjuvant ET during the past 1–5 years were identified in three Mexican referral centers. Participants' self-reported ET compliance, clinicopathologic characteristics, ET-related knowledge and beliefs, experienced adverse effects, social support, and patient-physician relationships were evaluated. Physician ET prescribing practices were compared with the gold standard according to international and national guidelines to assess clinicians' adherence to standard-of-care prescription. Results: In total, 95/132 (72%) and 35/132 (27%) participants reported complete and acceptable adherence, respectively. Incomplete adherence was mainly attributed to forgetfulness, adverse effects, and unwillingness to take ET. Being employed/studying ( p = 0.042), worrying about long-term ET use ( p = 0.031), and experiencing >7 ET-related symptoms ( p = 0.018) were associated with incomplete adherence. Guideline-endorsed regimens were prescribed in 84/132 (64%) patients, while the rest should have undergone ovarian function suppression (OFS) but instead received tamoxifen monotherapy. Conclusions: Premenopausal Mexican women self-report remarkably high rates of adequate ET adherence. However, a considerable proportion misses ≥1 doses/month, usually because of forgetfulness. Notably, only 64% receive standard-of-care ET due to suboptimal prescription of OFS. Interventions that remind patients to take their ET, refine physicians' knowledge on the importance of OFS in high-risk patients, and increase access to OFS could prove pivotal to enhance optimal ET implementation and adherence, which could translate into improved patient outcomes. Highlights: 72% of premenopausal patients had complete (100%) endocrine therapy adherence. 27% of premenopausal patients had acceptable (80-99%) endocrine therapy adherence. Incomplete adherence to endocrine therapy was mostly due to forgetfulness. Physicians prescribed guideline-endorsed endocrine therapy in 64% of cases.