Predictors of tamoxifen discontinuation among older women with estrogen receptor-positive breast cancer

Five years of adjuvant tamoxifen therapy for estrogen receptor (ER) -positive breast cancer is more effective than 2 years of use. However, information on tamoxifen discontinuation is scanty. We sought to identify predictors of tamoxifen discontinuation among older women with breast cancer. Within s...

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Published in:	Journal of clinical oncology Vol. 26; no. 4; p. 549
Main Authors:	Owusu, Cynthia, Buist, Diana S M, Field, Terry S, Lash, Timothy L, Thwin, Soe Soe, Geiger, Ann M, Quinn, Virginia P, Frost, Floyd, Prout, Marianne, Yood, Marianne Ulcickas, Wei, Feifei, Silliman, Rebecca A
Format:	Journal Article
Language:	English
Published:	United States 01.02.2008
Subjects:	Aged Aged, 80 and over Breast Neoplasms - drug therapy Breast Neoplasms - metabolism Breast Neoplasms - pathology Female Humans Life Tables Lymphatic Metastasis Medical Records - standards Neoplasm Recurrence, Local - prevention & control Neoplasm Staging Patient Compliance - statistics & numerical data Receptors, Estrogen - metabolism Selective Estrogen Receptor Modulators - administration & dosage Tamoxifen - administration & dosage Treatment Outcome
ISSN:	1527-7755, 1527-7755
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Abstract	Five years of adjuvant tamoxifen therapy for estrogen receptor (ER) -positive breast cancer is more effective than 2 years of use. However, information on tamoxifen discontinuation is scanty. We sought to identify predictors of tamoxifen discontinuation among older women with breast cancer. Within six health care delivery systems, we identified women >or= 65 years old diagnosed with stage I to IIB ER-positive or indeterminant breast cancer between 1990 and 1994 who had filled a prescription for adjuvant tamoxifen. We observed them for 5 years after initial tamoxifen prescription. We used automated pharmacy records to validate tamoxifen prescription information abstracted from medical records. The primary end point was tamoxifen discontinuation, operationalized as ever discontinuing tamoxifen during 5 years of follow-up. We used Cox proportional hazards to identify predictors of tamoxifen discontinuation. Of 961 women who were prescribed tamoxifen, 49% discontinued tamoxifen before the completion of 5 years. Discontinuers were more likely to be aged 75 to less than 80 years (v < 70 years; hazard ratio [HR] = 1.41; 95% CI, 1.06 to 1.87), be aged >or= 80 years (HR = 2.02; 95% CI, 1.53 to 2.66), have an increase in Charlson Comorbidity Index at 3 years from diagnosis (HR = 1.52; 95% CI, 1.18 to 1.95), have an increase in the number of cardiopulmonary comorbidities at 3 years (HR = 1.75; 95% CI, 1.34 to 2.28), have indeterminant ER status (v ER-positive status; HR = 1.36; 95% CI, 1.00 to 1.85), and have received breast-conserving surgery (BCS) without radiotherapy (v mastectomy; HR = 1.62; 95% CI, 1.18 to 2.22). Attention to nonadherence among older women at risk of discontinuation, particularly those receiving BCS without radiotherapy, might improve breast cancer outcomes for these women.
AbstractList	Five years of adjuvant tamoxifen therapy for estrogen receptor (ER) -positive breast cancer is more effective than 2 years of use. However, information on tamoxifen discontinuation is scanty. We sought to identify predictors of tamoxifen discontinuation among older women with breast cancer.PURPOSEFive years of adjuvant tamoxifen therapy for estrogen receptor (ER) -positive breast cancer is more effective than 2 years of use. However, information on tamoxifen discontinuation is scanty. We sought to identify predictors of tamoxifen discontinuation among older women with breast cancer.Within six health care delivery systems, we identified women >or= 65 years old diagnosed with stage I to IIB ER-positive or indeterminant breast cancer between 1990 and 1994 who had filled a prescription for adjuvant tamoxifen. We observed them for 5 years after initial tamoxifen prescription. We used automated pharmacy records to validate tamoxifen prescription information abstracted from medical records. The primary end point was tamoxifen discontinuation, operationalized as ever discontinuing tamoxifen during 5 years of follow-up. We used Cox proportional hazards to identify predictors of tamoxifen discontinuation.PATIENTS AND METHODSWithin six health care delivery systems, we identified women >or= 65 years old diagnosed with stage I to IIB ER-positive or indeterminant breast cancer between 1990 and 1994 who had filled a prescription for adjuvant tamoxifen. We observed them for 5 years after initial tamoxifen prescription. We used automated pharmacy records to validate tamoxifen prescription information abstracted from medical records. The primary end point was tamoxifen discontinuation, operationalized as ever discontinuing tamoxifen during 5 years of follow-up. We used Cox proportional hazards to identify predictors of tamoxifen discontinuation.Of 961 women who were prescribed tamoxifen, 49% discontinued tamoxifen before the completion of 5 years. Discontinuers were more likely to be aged 75 to less than 80 years (v < 70 years; hazard ratio [HR] = 1.41; 95% CI, 1.06 to 1.87), be aged >or= 80 years (HR = 2.02; 95% CI, 1.53 to 2.66), have an increase in Charlson Comorbidity Index at 3 years from diagnosis (HR = 1.52; 95% CI, 1.18 to 1.95), have an increase in the number of cardiopulmonary comorbidities at 3 years (HR = 1.75; 95% CI, 1.34 to 2.28), have indeterminant ER status (v ER-positive status; HR = 1.36; 95% CI, 1.00 to 1.85), and have received breast-conserving surgery (BCS) without radiotherapy (v mastectomy; HR = 1.62; 95% CI, 1.18 to 2.22).RESULTSOf 961 women who were prescribed tamoxifen, 49% discontinued tamoxifen before the completion of 5 years. Discontinuers were more likely to be aged 75 to less than 80 years (v < 70 years; hazard ratio [HR] = 1.41; 95% CI, 1.06 to 1.87), be aged >or= 80 years (HR = 2.02; 95% CI, 1.53 to 2.66), have an increase in Charlson Comorbidity Index at 3 years from diagnosis (HR = 1.52; 95% CI, 1.18 to 1.95), have an increase in the number of cardiopulmonary comorbidities at 3 years (HR = 1.75; 95% CI, 1.34 to 2.28), have indeterminant ER status (v ER-positive status; HR = 1.36; 95% CI, 1.00 to 1.85), and have received breast-conserving surgery (BCS) without radiotherapy (v mastectomy; HR = 1.62; 95% CI, 1.18 to 2.22).Attention to nonadherence among older women at risk of discontinuation, particularly those receiving BCS without radiotherapy, might improve breast cancer outcomes for these women.CONCLUSIONAttention to nonadherence among older women at risk of discontinuation, particularly those receiving BCS without radiotherapy, might improve breast cancer outcomes for these women. Five years of adjuvant tamoxifen therapy for estrogen receptor (ER) -positive breast cancer is more effective than 2 years of use. However, information on tamoxifen discontinuation is scanty. We sought to identify predictors of tamoxifen discontinuation among older women with breast cancer. Within six health care delivery systems, we identified women >or= 65 years old diagnosed with stage I to IIB ER-positive or indeterminant breast cancer between 1990 and 1994 who had filled a prescription for adjuvant tamoxifen. We observed them for 5 years after initial tamoxifen prescription. We used automated pharmacy records to validate tamoxifen prescription information abstracted from medical records. The primary end point was tamoxifen discontinuation, operationalized as ever discontinuing tamoxifen during 5 years of follow-up. We used Cox proportional hazards to identify predictors of tamoxifen discontinuation. Of 961 women who were prescribed tamoxifen, 49% discontinued tamoxifen before the completion of 5 years. Discontinuers were more likely to be aged 75 to less than 80 years (v < 70 years; hazard ratio [HR] = 1.41; 95% CI, 1.06 to 1.87), be aged >or= 80 years (HR = 2.02; 95% CI, 1.53 to 2.66), have an increase in Charlson Comorbidity Index at 3 years from diagnosis (HR = 1.52; 95% CI, 1.18 to 1.95), have an increase in the number of cardiopulmonary comorbidities at 3 years (HR = 1.75; 95% CI, 1.34 to 2.28), have indeterminant ER status (v ER-positive status; HR = 1.36; 95% CI, 1.00 to 1.85), and have received breast-conserving surgery (BCS) without radiotherapy (v mastectomy; HR = 1.62; 95% CI, 1.18 to 2.22). Attention to nonadherence among older women at risk of discontinuation, particularly those receiving BCS without radiotherapy, might improve breast cancer outcomes for these women.
Author	Geiger, Ann M Thwin, Soe Soe Field, Terry S Buist, Diana S M Prout, Marianne Lash, Timothy L Silliman, Rebecca A Yood, Marianne Ulcickas Wei, Feifei Owusu, Cynthia Quinn, Virginia P Frost, Floyd
Author_xml	– sequence: 1 givenname: Cynthia surname: Owusu fullname: Owusu, Cynthia email: cynthia.owusu@case.edu organization: Division of Hematology/Oncology, Case Western Reserve University, University Hospitals Health System Ireland Cancer Center-BHC 5055, 11100 Euclid Ave, Cleveland, OH 44106-5055, USA. cynthia.owusu@case.edu – sequence: 2 givenname: Diana S M surname: Buist fullname: Buist, Diana S M – sequence: 3 givenname: Terry S surname: Field fullname: Field, Terry S – sequence: 4 givenname: Timothy L surname: Lash fullname: Lash, Timothy L – sequence: 5 givenname: Soe Soe surname: Thwin fullname: Thwin, Soe Soe – sequence: 6 givenname: Ann M surname: Geiger fullname: Geiger, Ann M – sequence: 7 givenname: Virginia P surname: Quinn fullname: Quinn, Virginia P – sequence: 8 givenname: Floyd surname: Frost fullname: Frost, Floyd – sequence: 9 givenname: Marianne surname: Prout fullname: Prout, Marianne – sequence: 10 givenname: Marianne Ulcickas surname: Yood fullname: Yood, Marianne Ulcickas – sequence: 11 givenname: Feifei surname: Wei fullname: Wei, Feifei – sequence: 12 givenname: Rebecca A surname: Silliman fullname: Silliman, Rebecca A
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Snippet	Five years of adjuvant tamoxifen therapy for estrogen receptor (ER) -positive breast cancer is more effective than 2 years of use. However, information on...
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StartPage	549
SubjectTerms	Aged Aged, 80 and over Breast Neoplasms - drug therapy Breast Neoplasms - metabolism Breast Neoplasms - pathology Female Humans Life Tables Lymphatic Metastasis Medical Records - standards Neoplasm Recurrence, Local - prevention & control Neoplasm Staging Patient Compliance - statistics & numerical data Receptors, Estrogen - metabolism Selective Estrogen Receptor Modulators - administration & dosage Tamoxifen - administration & dosage Treatment Outcome
Title	Predictors of tamoxifen discontinuation among older women with estrogen receptor-positive breast cancer
URI	https://www.ncbi.nlm.nih.gov/pubmed/18071188 https://www.proquest.com/docview/70252777
Volume	26
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