Compliance to adjuvant therapy in breast cancer patients

During recent years a continuous reduction of mortality from breast cancer has taken place in the Western countries. We wanted to verify whether the actual therapy for our own cases deviates from our recommendations, although the surgeon, radiotherapist and gynaecological oncologist are on the same premises. We sent out questionnaires to all newly diagnosed breast cancer patients in the last seven years regarding their adjuvant therapy. Comparing these answers to our own recommendation showed a very good compliance regarding chemotherapy and radiation therapy. Adjuvant endocrine therapy showed a very poor compliance with an adherence of 77%. Overall we can conclude that endocrine therapy causes many side-effects that seem to burden the patients. In combination with the duration of the therapy this causes a severe reduction in compliance and length of the therapy.

Compliance; Breast cancer; Adjuvant therapy; Endocrine therapy

[1] Gesellschaft der epidemiologischen Krebsregister in Deutschland e.V. und das RKI. Krebs in Deutschland. 5. überarbeitete, aktualisierte Ausgabe. Saarbrücken 2006.

[2] Jemal A., Siegel R., Ward E., Hao Y., Xu J., Murray T., Thun M.J. et al.: “Cancer Statistics 2008”. CA Cancer J. Clin., 2008, 58, 71.

[3] Sant M., Capocaccia R., Verdecchia A., Esteve J., Gatta G., Micheli A. et al.: “Survival of women with breast cancer in Europe:variation with age, year of diagnosis and country. The EUROCARE Working Group”. Int. J. Cancer, 1998, 77, 679.

[4] Early Breast Cancer Trialists’ Collaborative Group (EBCTCG), Clarke M., Coates A.S., Darby S.C., Davies C., Gelber R.D., Godwin J. et al.: “Adjuvant chemotherapy in oestrogen-receptor-poor breast cancer: patient-level meta-analysis of randomised trials”. Lancet, 2008, 5, 29.

[5] Hadji P., Ziller V., Kalder M., Torode J., Jacklsch C.: “Non-compliance in der adjuvanten endokrinen therapie des mammakarzinoms”. Frauenarzt, 2007, 27, 146.

[6] Ziller V., Kalder M., Albert U.S., Holzhauer W., Ziller M., Wagner U., Hadji P.: “Adherence to adjuvant endocrine therapy in postmenopausal women with breast cancer”. Ann. Oncol., 2009, 20, 431.

[7] Varga D., Wischnewsky M., Atassi Z., Wolters R., Geyer V., Strunz K. et al.: “Does guideline-adherent therapy improve the outcome for early-onset breast cancer patients?”. Oncology, 2010, 78, 189.

[8] Yood M.U., Owusu C., Buist D.S., Geiger A.M., Field T.S., Thwin S.S. et al.: “Mortality impact of less-than-standard therapy in older breast cancer patients”. J. Am. Coll. Surg., 2008, 206, 66.

[9] Cella D., Fallowfield L.J.: “Recognition and management of treatment-related side effects for breast cancer patients receiving adjuvant endocrine therapy”. Breast Cancer Res. Treat., 2008, 107, 167.

[10] McCowan C., Shearer J., Donnan P.T., Dewar J.A., Crilly M., Thompson A.M., Fahey T.P. et al.: “Cohort study examining tamoxifen adherence and its relationship to mortality in women with breast cancer”. Br. J. Cancer, 2008, 99, 1763.

[11] Fink A.K., Gurwitz J., Rakowski W., Guadagnoli E., Silliman R.A.: “Patient beliefs and tamoxifen discontinuance in older women with estrogen receptor-positive breast cancer”. J. Clin. Oncol., 2004, 22, 3309.

[12] Hadji P.: “Improving compliance and persistence to adjuvant tamoxifen and aromatase inhibitor therapy”. Crit. Rev. Oncol. Hematol., 2010, 73, 156.

[13] Güth U., Huang D.J., Schötzau A., Zanetti-Dällenbach R., Holzgreve W., Bitzer J., Wight E.: “Target and reality of adjuvant endocrine therapy in postmenopausal patients with invasive breast cancer.” Br. J. Cancer, 2008, 99, 428.

[14] Haynes R.B., McDonald H., Garg A.X., Montague P.: “Interventions for helping patients to follow prescriptions for medications”. Cochrane Database Sys. Rev., 2002 CD000011.

[15] WHO. Adherence Project. WHO 2003.