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Epidemiology

Association between trajectories of adherence to endocrine therapy and risk of treated breast cancer recurrence among US nonmetastatic breast cancer survivors

British Journal of Cancer (2024)Cite this article

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Abstract

Background

Endocrine therapy is the mainstay treatment for breast cancer (BC) to reduce BC recurrence risk. During the first year of endocrine therapy use, nearly 30% of BC survivors are nonadherent, which may increase BC recurrence risk. This study is to examine the association between endocrine therapy adherence trajectories and BC recurrence risk in nonmetastatic BC survivors.

Methods

This retrospective cohort study included Medicare beneficiaries in the United States (US) with incident nonmetastatic BC followed by endocrine therapy initiation in 2010–2019 US Surveillance, Epidemiology, and End Results linked Medicare data. We calculated monthly fill-based proportion of days covered in the first year of endocrine therapy. We applied group-based trajectory models to identify distinct endocrine therapy adherence patterns. After the end of the first-year endocrine therapy trajectory measurement period, we estimated the risk of time to first treated BC recurrence within 4 years using Cox proportional hazards models.

Results

We identified 5 trajectories of adherence to endocrine therapy in BC Stages 0–I subgroup (n = 28,042) and in Stages II–III subgroup (n = 7781). A trajectory of discontinuation before 6 months accounted for 7.0% in Stages 0–I and 5.8% in Stages II–III subgroups, and this trajectory was associated with an increased treated BC recurrence risk compared to nearly perfect adherence (Stages 0–I: adjusted hazard [aHR] = 1.84, 95% CI = 1.46–2.33; Stages II–III: aHR = 1.38, 95% CI = 1.07–1.77).

Conclusions

Nearly 7% of BC survivors who discontinued before completing 6 months of treatment was associated with an increased treated BC recurrence risk compared to those with nearly perfect adherence among Medicare nonmetastatic BC survivors.

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Fig. 1
Fig. 2: The study design schematic diagram.
Fig. 3
Fig. 4: Trajectories of adherence to endocrine therapy among medicare beneficiaries with breast cancer by breast cancer stages.

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Data availability

SEER-Medicare data are not publicly available. The data that support the findings of this study are available from the National Cancer Institute, but restrictions apply to the availability of these data, which are under license for the study, and so are not publicly available.

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Acknowledgements

The collection of cancer incidence data used in this study was supported by the California Department of Public Health pursuant to California Health and Safety Code Section 103885; Centers for Disease Control and Prevention’s (CDC) National Program of Cancer Registries, under cooperative agreement 1NU58DP007156; the National Cancer Institute’s Surveillance, Epidemiology and End Results Program under contract HHSN261201800032I awarded to the University of California, San Francisco, contract HHSN261201800015I awarded to the University of Southern California, and contract HHSN261201800009I awarded to the Public Health Institute. The ideas and opinions expressed herein are those of the author(s) and do not necessarily reflect the opinions of the State of California, Department of Public Health, the National Cancer Institute, and the Centers for Disease Control and Prevention or their Contractors and Subcontractors.

Author information

Authors and Affiliations

  1. Department of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida, Gainesville, FL, 32611, USA

    Ching-Yuan Chang, Bobby L. Jones, Haesuk Park, Vakaramoko Diaby & Debbie L. Wilson

  2. Department of Epidemiology, University of North Carolina, Chapel Hill, NC, 27599, USA

    Juan M. Hincapie-Castillo

  3. Center for Drug Evaluation and Safety, College of Pharmacy, University of Florida, Gainesville, FL, 32611, USA

    Haesuk Park & Vakaramoko Diaby

  4. Department of Medicine, College of Medicine, University of Florida, Gainesville, FL, 32611, USA

    Coy D. Heldermon

  5. Division of General Internal Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, 15213, USA

    Wei-Hsuan Lo-Ciganic

  6. Center for Pharmaceutical Prescribing and Policy, University of Pittsburgh, Pittsburgh, PA, 15213, USA

    Wei-Hsuan Lo-Ciganic

  7. North Florida/South Georgia Veterans Health System; Geriatric Research Education and Clinical Center, Gainesville, FL, USA

    Wei-Hsuan Lo-Ciganic

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  1. Ching-Yuan Chang
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Contributions

Chang and Lo-Ciganic had full access to all of the data in the study and took responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: Chang, Jones, Hincapie-Castillo, Park, Heldermon, Lo-Ciganic. Acquisition of data: Chang and Lo-Ciganic. Analysis and interpretation of data: Chang, Jones, Hincapie-Castillo, Park, Heldermon, Diaby, Wilson, Lo-Ciganic. Drafting of the manuscript: Chang and Lo-Ciganic. Critical revision of the manuscript for important intellectual content: None. Statistical analysis: Chang, Jones, and Lo-Ciganic. Obtained funding: None. Administrative, technical, or material support: Jones, Wilson, and Lo-Ciganic. Study supervision: Lo-Ciganic.

Corresponding author

Correspondence to Wei-Hsuan Lo-Ciganic.

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Competing interests

W.-H.L.-C. reported receiving grants from the National Institute on Drug Abuse, the National Institute on Aging, the National Institute of Mental Health, Merck Sharp & Dohme, Bristol Myers Squibb, the Richard King Mellon Foundation at the University of Pittsburgh, the Clinical and Translational Science Institute of the University of Florida, the Pharmaceutical Research and Manufacturers of America Foundation, and the US Department of Veterans Affairs outside the submitted work; and having a patent pending for U1195.70174US00. H.P. reported receiving grants from Bristol Myers Squibb/Pfizer Alliance American Thrombosis Investigator Initiated Research Program outside the submitted work. J.M.H.-C. reported receiving grants from Merck & Co outside the submitted work. D.L.W. reported receiving grants from the National Institute on Drug Abuse, the National Institute on Aging, Merck Sharp & Dohme, and Bristol Myers Squibb outside the submitted work; and serving as an editorial board member for the Journal of Pharmacy Technology. C.-Y.C. contributions to this manuscript were made while at the University of Florida College of Pharmacy. C.-Y.C. is currently employed by Vertex Pharmaceuticals, Inc. Vertex did not fund or have any involvement in this study or publication. V.D. is currently employed by Otsuka, Inc. Otsuka did not fund or have any involvement in this study or publication. No other disclosures were reported.

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This study was approved by the institutional review board at the University of Florida, which waived the need for obtaining informed consent.

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Chang, CY., Jones, B.L., Hincapie-Castillo, J.M. et al. Association between trajectories of adherence to endocrine therapy and risk of treated breast cancer recurrence among US nonmetastatic breast cancer survivors. Br J Cancer (2024). https://doi.org/10.1038/s41416-024-02680-0

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