Factors influencing 5-year persistence to adjuvant endocrine therapy in young women with breast cancer
Eleonora Pagan,
Monica Ruggeri,
Nadia Bianco,
Eraldo Oreste Bucci,
Rossella Graffeo,
Markus Borner,
Monica Giordano,
Lorenzo Gianni,
Manuela Rabaglio,
Andrea Freschi,
Elisabetta Cretella,
Elena Seles,
Alberto Farolfi,
Edda Simoncini,
Mariangela Ciccarese,
Daniel Rauch,
Adolfo Favaretto,
Friedemann Honecker,
Rossana Berardi,
Alessandra Franzetti-Pellanda,
Shari Gelber,
Ann H. Partridge,
Aron Goldhirsch,
Vincenzo Bagnardi,
Olivia Pagani,
Karin Ribi
Affiliations
Eleonora Pagan
Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
Monica Ruggeri
Program for Young Patients, International Breast Cancer Study Group, a Division of ETOP IBCSG Partners Foundation, Bern, Switzerland
Nadia Bianco
Division of Medical Senology, IEO, European Institute of Oncology IRCCS, Milan, Italy
Eraldo Oreste Bucci
Breast Cancer Unit, Ospedale MultiMedica, Castellanza, VA, Italy
Rossella Graffeo
Oncology Institute of Southern Switzerland, EOC, Bellinzona, Switzerland
Markus Borner
Division of Oncology (Oncocare), Klinik Engeried, Lindenhofgruppe, Bern, Switzerland
Monica Giordano
ASST-Lariana, Como, Italy
Lorenzo Gianni
Department of Medical Oncology, Ospedale Infermi, Rimini, AUSL Della Romagna, Italy
Manuela Rabaglio
Department of Medical Oncology, Inselspital, Bern University Hospital, University of Bern, Switzerland
Andrea Freschi
Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, 33081, Aviano, Italy
Elisabetta Cretella
Department of Medical Oncology, Azienda Sanitaria Dell'Alto Adige, Bolzano, Italy
Elena Seles
Department of Medical Oncology, Ospedale Degli Infermi, Biella, Italy
Alberto Farolfi
Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio Dei Tumori (IRST) ''Dino Amadori'', Meldola, Italy
Edda Simoncini
Breast Unit, ASST Spedali Civili di Brescia, Brescia, Italy
Mariangela Ciccarese
Regional Agency for Social and Health Development (AReSS Puglia), Bari, Italy
Daniel Rauch
Onko-Netz, Thun, Switzerland
Adolfo Favaretto
Medical Oncology Unit, Azienda ULSS2, Marca Trevigiana, Treviso, Italy
Friedemann Honecker
Tumor- and Breast Eastern Switzerland, St. Gallen, Switzerland
Rossana Berardi
Department of Medical Oncology, Università Politecnica Delle Marche, A.O.U. Delle Marche, Ancona, Italy
Alessandra Franzetti-Pellanda
Radiotherapy Service, Gruppo Ospedaliero Moncucco, Clinica Moncucco, Lugano, Switzerland
Shari Gelber
Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
Ann H. Partridge
Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA; Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
Aron Goldhirsch
International Breast Cancer Study Group, IEO European Institute of Oncology, IRCCS, Milan, Italy
Vincenzo Bagnardi
Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
Olivia Pagani
Geneva University Hospitals, Lugano University, Swiss Group for Clinical Cancer Research (SAKK), Switzerland
Karin Ribi
Quality of Life Office, International Breast Cancer Study Group, a division of ETOP IBCSG Partners Foundation, Bern, Switzerland; Careum School of Health, Part of the Kalaidos University of Applied Sciences, Zurich, Switzerland; Corresponding author. International Breast Cancer Study Group, a division of ETOP IBCSG Partners Foundation, Effingerstr. 33, 3008, Bern, Switzerland.
Purpose: Although younger age has been negatively associated with persistence to adjuvant endocrine therapy (ET), factors contributing to non-persistence remain poorly understood. We assessed factors associated with non-persistence to ET and described the 5-year trajectories of quality of life (QoL) and symptoms in young women (≤40 years) with hormone receptor-positive breast cancer (BC). Methods: We retrieved data on clinical characteristics and non-persistence from the medical annual records in the European cohort of the “Helping Ourselves, Helping Others: The Young Women's BC Study” (IBCSG 43-09 HOHO). Women completed surveys at baseline, biannually for three years, and annually for another seven years. Data collection included sociodemographic information, QoL aspects assessed by the Cancer Rehabilitation Evaluation System-Short Form and symptoms assessed by the Breast Cancer Prevention Trial symptom scales. Cox regression models were applied to identify factors associated with non-persistence. Results: The cumulative risk of interrupting ET within 5 years was 27.7 % (95 % CI, 21.5–35.2). The QoL subscale scores remained stable over 5 years, with slight improvements in the physical subscale. Hot flashes decreased (p < 0.001), while vaginal problems intensified (p < 0.001) over time. Being married without children and having difficulties interacting and communicating with the medical team were significantly associated with non-persistence. Conclusions: Discussing the desire to conceive with partnered childless women and establishing a good relationship with the medical team may be important in addressing the non-persistence in young BC survivors. As recent data suggests the safety of pausing ET to conceive, this approach may be a reasonable future option to limit non-persistence.
