Adherence to adjuvant antihormonal treatment in patients with breast cancer
Abstract
Adherence to medical treatment is of relevance in all clinical specialities. If a patient does not take a prescribed medication, whether intentionally or unintentionally, the outcome for that patient is likely to be negatively affected. As clinicians we believe that the medications we prescribe will benefit our patients. More knowledge regarding adherence to medical treatments is needed. To overcome the obstacles of poor adherence, increased awareness both among health care professionals and patients, is important. Good communication is paramount; comprehensible information about why the treatment is given, dosage, possible side effects and expected benefit is necessary. Close follow-up of the patients is also important. This is especially true for antihormonal treatment where side effects are often the reason for non-adherence. Prescribing treatments to overcome bothersome side effects might help improve adherence rates. Differentiating between primary non-adherence and secondary non-adherence is of importance as the former group will largely benefit from good communication and close follow-up. Patients in the latter group have frequently become nonadherent due to troublesome side effects. Being able to predict who will become nonadherent is important.
In the first study, we show that the young and the elderly are at increased risk of nonadherence to antihormonal treatment. As most discontinue the therapy in the initial part of the treatment period, this is the time when close follow-up will be most important. Patients with the most severe breast cancers are more often adherent to antihormonal treatment. We also show that primary non-adherent (PNA) patients tend to have a better prognosis than the rest of the study population.
In the second study, we examine the effect of adherence to adjuvant antihormonal therapy on survival in the same series of breast cancer patients. Secondary non-adherent patients have poorer survival compared to the rest of the study population. The PNA-patients did better than anticipated. This can probably be explained by their favourable prognostic profile. We suggest that in the future, a more individualized antihormonal treatment regimen based on biomarker profiling will become the preferred way of selecting patients for antihormonal treatment.
In the third study, we wanted to investigate why the omission of the sentinel lymph node biopsy (SLNB) procedure in low-risk elderly patients with breast cancer has not been widely implemented despite guidelines stating that it is safe to do so. We suspected that the presence of axillary lymph node metastases and poor adherence would be factors contributing to the reluctance amongst clinicians to omit the SLNB-procedure. We show that about one third of these patients had axillary metastases as confirmed on the postoperative pathology report. Furthermore, we show that about one third of these low-risk, elderly patients are nonadherent to the antihormonal treatment they were prescribed. We suggest that these factors, at least partly, explain the rather unsuccessful implementation of the omission of the SLNBprocedure. In the future, we believe that the selection of patients eligible for the omission of SLNB will be more personalised based on biomarker profiling and assessment of comorbidities.
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Paper 1: Dragvoll, Ida; Bofin, Anna M.; Søiland, Håvard; Taraldsen, Gunnar; Engstrøm, Monica J. Predictors of adherence and the role of primary non-adherence in antihormonal treatment of breast cancer. BMC Cancer 2022 ;Volum 22. https://doi.org/10.1186/s12885-022-10362-4 This article is licensed under a Creative Commons Attribution 4.0 CC BYPaper 2: Adjuvant antihormonal treatment in breast cancer. Understanding how poor adherence affects survival. https://doi.org/10.21203/rs.3.rs-3071927/v - This work is licensed under a Creative Commons Attribution 4.0 International License. CC BY
Paper 3: Dragvoll, Ida Maria; Bofin, Anna M.; Søiland, Håvard; Engstrøm, Monica Jernberg. How to Optimize Deimplementation of Sentinel Lymph Node Biopsy?. The Breast Journal 2024 ;Volum 2024. https://doi.org/10.1155/2024/7623194 - This is an open access article distributed under the Creative Commons Attribution License CC BY