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Clinical Profiles Predict Early Nonadherence to Adjuvant Endocrine Treatment in a Prospective Breast Cancer Cohort

Markkula, Andrea LU ; Hietala, Maria LU ; Henningson, Maria LU ; Ingvar, Christian LU ; Rose, Carsten LU and Jernström, Helena LU (2012) In Cancer Prevention Research 5(5). p.735-745
Abstract
Nonadherence to adjuvant endocrine breast cancer treatment adversely affects disease-free and overall survival. Clinical predictors of nonadherence may allow for specific interventions to reduce nonadherence and improve survival. The aim was to investigate whether clinical characteristics predict nonadherence. Clinical characteristics and information on adherence were obtained from 417 patients with breast cancer in a population-based prospective cohort from southern Sweden using patient charts, pathology reports, and questionnaires filled out at the 1- and 2-year follow-up visits. At the 1- and 2-year follow-up visits, 36 (8.6%) and 33 (9.7%) patients were nonadherent, respectively. Thirteen of the nonadherent patients declined treatment... (More)
Nonadherence to adjuvant endocrine breast cancer treatment adversely affects disease-free and overall survival. Clinical predictors of nonadherence may allow for specific interventions to reduce nonadherence and improve survival. The aim was to investigate whether clinical characteristics predict nonadherence. Clinical characteristics and information on adherence were obtained from 417 patients with breast cancer in a population-based prospective cohort from southern Sweden using patient charts, pathology reports, and questionnaires filled out at the 1- and 2-year follow-up visits. At the 1- and 2-year follow-up visits, 36 (8.6%) and 33 (9.7%) patients were nonadherent, respectively. Thirteen of the nonadherent patients declined treatment and were never prescribed endocrine treatment. A body mass index (BMI) < 25 kg/m(2), preoperative current smoking, and drinking alcohol less often than twice a month predicted nonadherence at the 1- year [relative risk (RR), 5.24; 95% confidence interval (CI), 2.75-9.97] and the 2-year visits (RR, 4.07; 95% CI, 2.11-7.84) in patients with at least two of these clinical characteristics. When low histologic grade (I) was added to the model, having at least two of these four clinical characteristics predicted nonadherence at the 1- year (RR, 4.94; 95% CI, 2.46-10.00) and the 2-year visits (RR, 4.74; 95% CI, 2.28-9.87), the two profiles had a sensitivity ranging from 60.6% to 72.7%, whereas the specificity ranged from 68.0% to 78.4%. Nonadherence at the 1- year visit was associated with an increased risk for early breast cancer events (HR, 2.97; 95% CI, 1.08-8.15), adjusted for age and tumor characteristics. In conclusion, two clinical profiles predicted early nonadherence and may allow for targeted interventions to increase adherence if validated in an independent cohort. Cancer Prev Res; 5(5); 735-45. (c) 2012 AACR. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Cancer Prevention Research
volume
5
issue
5
pages
735 - 745
publisher
American Association for Cancer Research
external identifiers
  • wos:000308222300005
  • pmid:22401981
  • scopus:84865865696
ISSN
1940-6207
DOI
10.1158/1940-6207.CAPR-11-0442
language
English
LU publication?
yes
id
78350804-3e49-47d4-bd01-033ccab49e3d (old id 3191617)
date added to LUP
2012-12-03 07:13:07
date last changed
2017-07-09 03:07:37
@article{78350804-3e49-47d4-bd01-033ccab49e3d,
  abstract     = {Nonadherence to adjuvant endocrine breast cancer treatment adversely affects disease-free and overall survival. Clinical predictors of nonadherence may allow for specific interventions to reduce nonadherence and improve survival. The aim was to investigate whether clinical characteristics predict nonadherence. Clinical characteristics and information on adherence were obtained from 417 patients with breast cancer in a population-based prospective cohort from southern Sweden using patient charts, pathology reports, and questionnaires filled out at the 1- and 2-year follow-up visits. At the 1- and 2-year follow-up visits, 36 (8.6%) and 33 (9.7%) patients were nonadherent, respectively. Thirteen of the nonadherent patients declined treatment and were never prescribed endocrine treatment. A body mass index (BMI) &lt; 25 kg/m(2), preoperative current smoking, and drinking alcohol less often than twice a month predicted nonadherence at the 1- year [relative risk (RR), 5.24; 95% confidence interval (CI), 2.75-9.97] and the 2-year visits (RR, 4.07; 95% CI, 2.11-7.84) in patients with at least two of these clinical characteristics. When low histologic grade (I) was added to the model, having at least two of these four clinical characteristics predicted nonadherence at the 1- year (RR, 4.94; 95% CI, 2.46-10.00) and the 2-year visits (RR, 4.74; 95% CI, 2.28-9.87), the two profiles had a sensitivity ranging from 60.6% to 72.7%, whereas the specificity ranged from 68.0% to 78.4%. Nonadherence at the 1- year visit was associated with an increased risk for early breast cancer events (HR, 2.97; 95% CI, 1.08-8.15), adjusted for age and tumor characteristics. In conclusion, two clinical profiles predicted early nonadherence and may allow for targeted interventions to increase adherence if validated in an independent cohort. Cancer Prev Res; 5(5); 735-45. (c) 2012 AACR.},
  author       = {Markkula, Andrea and Hietala, Maria and Henningson, Maria and Ingvar, Christian and Rose, Carsten and Jernström, Helena},
  issn         = {1940-6207},
  language     = {eng},
  number       = {5},
  pages        = {735--745},
  publisher    = {American Association for Cancer Research},
  series       = {Cancer Prevention Research},
  title        = {Clinical Profiles Predict Early Nonadherence to Adjuvant Endocrine Treatment in a Prospective Breast Cancer Cohort},
  url          = {http://dx.doi.org/10.1158/1940-6207.CAPR-11-0442},
  volume       = {5},
  year         = {2012},
}