Patient Preference and Adherence (Sep 2021)
Assessing Predictors of Tamoxifen Nonadherence in Patients with Early Breast Cancer
Abstract
Emilia Montagna,1 Paola Zagami,1,2 Marianna Masiero,3,4 Ketti Mazzocco,3,4 Gabriella Pravettoni,3,4 Elisabetta Munzone1 1Division of Medical Senology, IEO European Institute of Oncology IRCCS, Milan, Italy; 2Division of Early Drug Development for Innovative Therapies, IEO European Institute of Oncology IRCCS, Milan, Italy; 3Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy; 4Applied Research Division for Cognitive and Psychological Science, IEO European Institute of Oncology IRCCS, Milan, 20141, ItalyCorrespondence: Emilia MontagnaDivision of Medical Senology, European Institute of Oncology, IRCCS, Via Ripamonti 435, Milan, 20141, ItalyTel +39 02 57489439Fax +39 02 574829212Email [email protected]: Adjuvant endocrine therapy (AET) is generally proposed to all patients with hormone receptor-positive breast cancer to reduce the risk of recurrence and death. Adherence to therapy is crucial. However, non-adherence to AET is common, with estimates of up to 50% of patients not successfully completing a five-year course of treatment, and it is significantly associated with lower survival rates and a higher risk of recurrence. Currently, no gold standard is available to assess adherence. Several studies, most of them retrospective in nature, have used both direct and indirect methods to monitor the adherence to therapy in breast cancer. The indirect method is more widely used, and it is based on pharmacy prescription refills and patient administered questionnaires. On the other hand, direct methods such as a measurement of the level of the drug or its metabolites in blood or urine are much more precise, but more expensive and not routinely implemented. In this review, we analyzed the results of the major studies focused on the adherence to tamoxifen in breast cancer patients. We identified several factors associated with poor adherence, such as the side effects of therapy, the lack of shared decision-making between the physician and patient, the context in which the discussion takes place, and whether the patients are enrolled in a clinical trial. Moreover, we discussed possible methods to improve adherence to adjuvant therapy in breast cancer.Keywords: adherence, adjuvant endocrine therapy, tamoxifen, breast cancer
