TY - JOUR
T1 - Endocrine Therapy Nonadherence and Discontinuation in Black and White Women
AU - Wheeler, Stephanie B.
AU - Spencer, Jennifer
AU - Pinheiro, Laura C.
AU - Murphy, Caitlin C.
AU - Earp, Jo Anne
AU - Carey, Lisa
AU - Olshan, Andrew
AU - Tse, Chiu Kit
AU - Bell, Mary E.
AU - Weinberger, Morris
AU - Reeder-Hayes, Katherine E.
N1 - Funding Information:
This research was funded by an American Cancer Society (ACS) Mentored Research Scholar Grant (MRSG-13–157-01-CPPB, Wheeler, “Improving Endocrine Therapy Utilization in Racially Diverse Populations”). This research was also funded in part by the University Cancer Research Fund of North Carolina and the National Cancer Institute Specialized Program of Research Excellence (SPORE) in Breast Cancer (NIH/NCI P50-CA58223). Additional support has been obtained from National Cancer Institute (P01CA151135) and the Susan G. Komen Foundation (CCR 15333140).
Publisher Copyright:
© The Author(s) 2018.
PY - 2019/5/1
Y1 - 2019/5/1
N2 - Background: Differential use of endocrine therapy (ET) by race may contribute to breast cancer outcome disparities, but racial differences in ET behaviors are poorly understood. Methods: Women aged 20-74 years with a first primary, stage I-III, hormone receptor-positive (HR+) breast cancer were included. At 2 years postdiagnosis, we assessed nonadherence, defined as not taking ET every day or missing more than two pills in the past 14 days, discontinuation, and a composite measure of underuse, defined as either missing pills or discontinuing completely. Using logistic regression, we evaluated the relationship between race and nonadherence, discontinuation, and overall underuse in unadjusted, clinically adjusted, and socioeconomically adjusted models. Results: A total of 1280 women were included; 43.2% self-identified as black. Compared to white women, black women more often reported nonadherence (13.7% vs 5.2%) but not discontinuation (10.0% vs 10.7%). Black women also more often reported the following: hot flashes, night sweats, breast sensitivity, and joint pain; believing that their recurrence risk would not change if they stopped ET; forgetting to take ET; and cost-related barriers. In multivariable analysis, black race remained statistically significantly associated with nonadherence after adjusting for clinical characteristics (adjusted odds ratio = 2.72, 95% confidence interval = 1.75 to 4.24) and after adding socioeconomic to clinical characteristics (adjusted odds ratio = 2.44, 95% confidence interval = 1.50 to 3.97) but was not independently associated with discontinuation after adjustment. Low recurrence risk perception and lack of a shared decision making were strongly predictive of ET underuse across races. Conclusions: Our results highlight important racial differences in ET-Adherence behaviors, perceptions of benefits/harms, and shared decision making that may be targeted with culturally tailored interventions.
AB - Background: Differential use of endocrine therapy (ET) by race may contribute to breast cancer outcome disparities, but racial differences in ET behaviors are poorly understood. Methods: Women aged 20-74 years with a first primary, stage I-III, hormone receptor-positive (HR+) breast cancer were included. At 2 years postdiagnosis, we assessed nonadherence, defined as not taking ET every day or missing more than two pills in the past 14 days, discontinuation, and a composite measure of underuse, defined as either missing pills or discontinuing completely. Using logistic regression, we evaluated the relationship between race and nonadherence, discontinuation, and overall underuse in unadjusted, clinically adjusted, and socioeconomically adjusted models. Results: A total of 1280 women were included; 43.2% self-identified as black. Compared to white women, black women more often reported nonadherence (13.7% vs 5.2%) but not discontinuation (10.0% vs 10.7%). Black women also more often reported the following: hot flashes, night sweats, breast sensitivity, and joint pain; believing that their recurrence risk would not change if they stopped ET; forgetting to take ET; and cost-related barriers. In multivariable analysis, black race remained statistically significantly associated with nonadherence after adjusting for clinical characteristics (adjusted odds ratio = 2.72, 95% confidence interval = 1.75 to 4.24) and after adding socioeconomic to clinical characteristics (adjusted odds ratio = 2.44, 95% confidence interval = 1.50 to 3.97) but was not independently associated with discontinuation after adjustment. Low recurrence risk perception and lack of a shared decision making were strongly predictive of ET underuse across races. Conclusions: Our results highlight important racial differences in ET-Adherence behaviors, perceptions of benefits/harms, and shared decision making that may be targeted with culturally tailored interventions.
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U2 - 10.1093/jnci/djy136
DO - 10.1093/jnci/djy136
M3 - Article
C2 - 30239824
AN - SCOPUS:85060329255
SN - 0027-8874
VL - 111
SP - 498
EP - 508
JO - Journal of the National Cancer Institute
JF - Journal of the National Cancer Institute
IS - 5
M1 - djy136
ER -