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- Title
Patient-Reported Outcomes and Long-Term Nonadherence to Aromatase Inhibitors.
- Authors
Hershman, Dawn L; Neugut, Alfred I; Moseley, Anna; Arnold, Kathryn B; Gralow, Julie R; Henry, N Lynn; Hillyer, Grace Clarke; Ramsey, Scott D; Unger, Joseph M
- Abstract
<bold>Background: </bold>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.<bold>Methods: </bold>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.<bold>Results: </bold>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).<bold>Conclusions: </bold>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.
- Subjects
CANCER relapse; AROMATASE inhibitors; PATIENT satisfaction; BREAST cancer; BRIEF Pain Inventory; DISEASE risk factors; RESEARCH; RESEARCH methodology; EVALUATION research; COMPARATIVE studies; PSYCHOLOGICAL tests; DRUGS; RESEARCH funding; QUESTIONNAIRES; PATIENT compliance; BREAST tumors
- Publication
JNCI: Journal of the National Cancer Institute, 2021, Vol 113, Issue 8, p989
- ISSN
0027-8874
- Publication type
journal article
- DOI
10.1093/jnci/djab022