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March 6, 2024
Clinical Relevance: Physicians should ficus on cost-reduction strategies and educating patients about side effects to enhance adherence to breast cancer medications and improve treatment outcomes.
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Nearly half of breast cancer patients prescribed medication following initial treatment discontinue their regimen prematurely, with some administering the medication less frequently than recommended. These startling statistics were published in the Journal of Clinical Oncology by researchers at the University of Colorado.
A new Journal of Clinical Oncology study reveals that nearly half of breast cancer patients stop their medication early or take it less often than advised. This finding suggests oncologists should re-evaluate their patient follow-up and medication adherence strategies — especially working with their patient’s on affordability concerns — to improve treatment outcomes.
It is crucial for physicians to recognize and address this non-adherence, as it may significantly compromise the effectiveness of treatment and patient outcomes. These medicines tend to help offset the chance of recurrence and improve overall survival.
Dr. Eleonora Teplinsky, head of breast medical oncology at Valley Health System, tells SurvivorNet that this study raises some serious issues given how essential drug adherence is in this population.
“Endocrine therapy has significant benefits in reducing the risk of breast cancer recurrence and improving breast cancer survival,” Dr. Teplinsky says.
“Adjuvant endocrine therapy adherence among breast cancer survivors is often suboptimal, leading to higher cancer recurrence and mortality,” researchers said in the study that included more than 375,000 women,” she adds.
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Study findings
This systematic review and meta-analysis addressed the critical issue of suboptimal adherence to adjuvant endocrine therapy (AET) among breast cancer survivors, a factor associated with increased recurrence and mortality.
The comprehensive analysis sifts through 5,045 records to pinpoint 33 studies involving 375,951 women, providing a robust evaluation of the interventions’ effectiveness. The findings reveal that educational interventions focusing on side effect management did not have a significant impact on adherence.
In contrast, policy interventions that reduced AET costs consistently improved adherence rates.
Dr. Teplinksy says that although cost was the biggest factor in women taking their recommended medication, there are benefits to helping patients cope with the side effects of endocrine therapy, which can act as a deterrent to adherence.
The utility of medication reminders, communication strategies, and psychological/coping interventions varied, indicating a nuanced landscape of effectiveness.
The meta-analysis, encompassing 25 studies with 367,873 women, underscored a statistically significant overall effect of adherence interventions when compared to control conditions. This offered a promising insight into the potential of specific interventions to mitigate adherence challenges.
Notably, the analysis did not find significant differences in intervention effectiveness based on study design, publication year, the directionality of intervention contact, or the type of intervention, suggesting a broadly applicable benefit across different settings and approaches.
This pioneering work marks a significant step forward in identifying effective strategies for promoting AET adherence — and it’s something physicians should consider in their practice. It underscores the the crucial role policy changes in medication cost can contribute and the potential of certain psychosocial and reminder-based interventions.
These insights also pave the way for tailored interventions that could be incorporated into future research, policy-making, and clinical practice to enhance AET adherence and improve outcomes for breast cancer survivors.
“Research into novel ways and methods to better manage endocrine therapy toxicity and personalization of endocrine therapy has the opportunity to increase adherence as well,” Dr. Teplinksy adds.
The authors of the study say that their knowledge, this is the first known meta-analysis to demonstrate a significant effect for interventions to promote AET adherence. They call for further research on this important issue.