Impact of non-adherence to endocrine therapy on recurrence risk in older women with stage I breast cancer after breast-conserving surgery
Purpose We examined the impact of non-adherence to adjuvant endocrine therapy (ET) on the risk and site of recurrence among older women with early stage, hormone receptor positive (HR+) breast cancer (EBC). Methods A population-based cohort of women age ≥ 65 years with T1N0 HR + EBC who were diagnos...
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| Veröffentlicht in: | Breast cancer research and treatment 2023-08, Vol.201 (1), p.77-87 |
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| creator | Rodin, Danielle Sutradhar, Rinku Jerzak, Katarzyna J. Hahn, Ezra Nguyen, Lena Castelo, Matthew Fatiregun, Omolara Fong, Cindy Mata, Danilo Giffoni M. M. Trebinjac, Sabina Paszat, Lawrence Rakovitch, Eileen |
| description | Purpose
We examined the impact of non-adherence to adjuvant endocrine therapy (ET) on the risk and site of recurrence among older women with early stage, hormone receptor positive (HR+) breast cancer (EBC).
Methods
A population-based cohort of women age ≥ 65 years with T1N0 HR + EBC who were diagnosed between 2010 and 2016 and treated with breast-conserving surgery (BCS) + ET was identified. Treatment and outcomes were ascertained through linkage with administrative databases. ET non-adherence was examined as a time-dependent covariate in multivariable cause-specific Cox regression models to evaluate its effect on the risks of ipsilateral local recurrence (LR), contralateral breast cancer, and distant metastases.
Results
The population cohort includes 2637 women; 73% (
N
= 1934) received radiation (RT) + ET and 27% (
N
= 703) received ET alone. At a median follow-up of 8.14 years, the first event was LR in 3.6% of women treated with ET alone and 1.4% for those treated with RT + ET (
p
|
| doi_str_mv | 10.1007/s10549-023-06989-x |
| format | Article |
| fullrecord | <record><control><sourceid>gale_proqu</sourceid><recordid>TN_cdi_proquest_miscellaneous_2827255663</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><galeid>A754967663</galeid><sourcerecordid>A754967663</sourcerecordid><originalsourceid>FETCH-LOGICAL-c473t-cdd4f96fd2dfb8691a62d869dfec70124d32184c1414a3bd1cae520789fc25013</originalsourceid><addsrcrecordid>eNp9kl1vFCEUhonR2Fr9A14YEhPjzVQ-ZmDmsmn82KSJN3pNWDjsUmdgBabt_gT_tWynWmuMIYFweN4TzjkvQi8pOaWEyHeZkq4dGsJ4Q8TQD83NI3RMO8kbyah8jI4JFbIRPRFH6FnOl4SQQZLhKTrikjMhRXeMfqymnTYFR4dDDI22W0gQDOASMQQbTfKhXmpU7_Y4BpzAzGlBks_fsA84jhYSvo4TBHztyxbnojeAV3idQOeCja50wtqVui-xxsSQIV35sMF5ThtI--foidNjhhd35wn6-uH9l_NPzcXnj6vzs4vGtJJXobWtG4SzzLp1LwaqBbP1tA6MJJS1ljPat4a2tNV8banR0DEi-8EZ1hHKT9DbJe8uxe8z5KImnw2Mow4Q56xYzyTrOiF4RV__hV7GOYX6uwM1DFL2or2nNnoE5YOLJWlzSKrOZB1QbfRtrtN_UHVZmHztBjhf4w8Eb_4QbEGPZZvjOBdfW_cQZAtoUsw5gVO75Ced9ooSdTCKWoyiqlHUrVHUTRW9uittXk9gf0t-OaMCfAFyfQp1QPe1_yftTyNKyRo</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2829977864</pqid></control><display><type>article</type><title>Impact of non-adherence to endocrine therapy on recurrence risk in older women with stage I breast cancer after breast-conserving surgery</title><source>SpringerLink Journals - AutoHoldings</source><creator>Rodin, Danielle ; Sutradhar, Rinku ; Jerzak, Katarzyna J. ; Hahn, Ezra ; Nguyen, Lena ; Castelo, Matthew ; Fatiregun, Omolara ; Fong, Cindy ; Mata, Danilo Giffoni M. M. ; Trebinjac, Sabina ; Paszat, Lawrence ; Rakovitch, Eileen</creator><creatorcontrib>Rodin, Danielle ; Sutradhar, Rinku ; Jerzak, Katarzyna J. ; Hahn, Ezra ; Nguyen, Lena ; Castelo, Matthew ; Fatiregun, Omolara ; Fong, Cindy ; Mata, Danilo Giffoni M. M. ; Trebinjac, Sabina ; Paszat, Lawrence ; Rakovitch, Eileen</creatorcontrib><description>Purpose
We examined the impact of non-adherence to adjuvant endocrine therapy (ET) on the risk and site of recurrence among older women with early stage, hormone receptor positive (HR+) breast cancer (EBC).
Methods
A population-based cohort of women age ≥ 65 years with T1N0 HR + EBC who were diagnosed between 2010 and 2016 and treated with breast-conserving surgery (BCS) + ET was identified. Treatment and outcomes were ascertained through linkage with administrative databases. ET non-adherence was examined as a time-dependent covariate in multivariable cause-specific Cox regression models to evaluate its effect on the risks of ipsilateral local recurrence (LR), contralateral breast cancer, and distant metastases.
Results
The population cohort includes 2637 women; 73% (
N
= 1934) received radiation (RT) + ET and 27% (
N
= 703) received ET alone. At a median follow-up of 8.14 years, the first event was LR in 3.6% of women treated with ET alone and 1.4% for those treated with RT + ET (
p
< 0.001); the risk of distant metastases was < 1% in both groups. The proportion of time adherent to ET was 69.0% among those treated with RT + ET and 62.8% for those treated with ET alone. On multivariable analysis, increasing proportion of time non-adherent to ET was associated with increased risk of LR ((HR = 1.52 per 20% increase in time; 95%CI 1.25, 1.85;
p
< 0.001), contralateral BC (HR = 1.55; 95%CI 1.30, 1.84;
p
< 0.001), and distant metastases (HR = 1.44; 95%CI 1.08, 1.94;
p
= 0.01) but absolute risks were low.
Conclusion
Non-adherence to adjuvant ET was associated with an increased risk of recurrence, but absolute recurrence rates were low.</description><identifier>ISSN: 0167-6806</identifier><identifier>EISSN: 1573-7217</identifier><identifier>DOI: 10.1007/s10549-023-06989-x</identifier><identifier>PMID: 37326765</identifier><language>eng</language><publisher>New York: Springer US</publisher><subject>Breast cancer ; Breast surgery ; Cancer research ; Cancer therapies ; Endocrine therapy ; Epidemiology ; Football (College) ; Lumpectomy ; Medicine ; Medicine & Public Health ; Metastases ; Metastasis ; Middle aged women ; Oncology ; Patient compliance ; Regression analysis ; Surgery</subject><ispartof>Breast cancer research and treatment, 2023-08, Vol.201 (1), p.77-87</ispartof><rights>The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2023. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.</rights><rights>2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.</rights><rights>COPYRIGHT 2023 Springer</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c473t-cdd4f96fd2dfb8691a62d869dfec70124d32184c1414a3bd1cae520789fc25013</citedby><cites>FETCH-LOGICAL-c473t-cdd4f96fd2dfb8691a62d869dfec70124d32184c1414a3bd1cae520789fc25013</cites><orcidid>0000-0001-9647-2851</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s10549-023-06989-x$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s10549-023-06989-x$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,27923,27924,41487,42556,51318</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/37326765$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Rodin, Danielle</creatorcontrib><creatorcontrib>Sutradhar, Rinku</creatorcontrib><creatorcontrib>Jerzak, Katarzyna J.</creatorcontrib><creatorcontrib>Hahn, Ezra</creatorcontrib><creatorcontrib>Nguyen, Lena</creatorcontrib><creatorcontrib>Castelo, Matthew</creatorcontrib><creatorcontrib>Fatiregun, Omolara</creatorcontrib><creatorcontrib>Fong, Cindy</creatorcontrib><creatorcontrib>Mata, Danilo Giffoni M. M.</creatorcontrib><creatorcontrib>Trebinjac, Sabina</creatorcontrib><creatorcontrib>Paszat, Lawrence</creatorcontrib><creatorcontrib>Rakovitch, Eileen</creatorcontrib><title>Impact of non-adherence to endocrine therapy on recurrence risk in older women with stage I breast cancer after breast-conserving surgery</title><title>Breast cancer research and treatment</title><addtitle>Breast Cancer Res Treat</addtitle><addtitle>Breast Cancer Res Treat</addtitle><description>Purpose
We examined the impact of non-adherence to adjuvant endocrine therapy (ET) on the risk and site of recurrence among older women with early stage, hormone receptor positive (HR+) breast cancer (EBC).
Methods
A population-based cohort of women age ≥ 65 years with T1N0 HR + EBC who were diagnosed between 2010 and 2016 and treated with breast-conserving surgery (BCS) + ET was identified. Treatment and outcomes were ascertained through linkage with administrative databases. ET non-adherence was examined as a time-dependent covariate in multivariable cause-specific Cox regression models to evaluate its effect on the risks of ipsilateral local recurrence (LR), contralateral breast cancer, and distant metastases.
Results
The population cohort includes 2637 women; 73% (
N
= 1934) received radiation (RT) + ET and 27% (
N
= 703) received ET alone. At a median follow-up of 8.14 years, the first event was LR in 3.6% of women treated with ET alone and 1.4% for those treated with RT + ET (
p
< 0.001); the risk of distant metastases was < 1% in both groups. The proportion of time adherent to ET was 69.0% among those treated with RT + ET and 62.8% for those treated with ET alone. On multivariable analysis, increasing proportion of time non-adherent to ET was associated with increased risk of LR ((HR = 1.52 per 20% increase in time; 95%CI 1.25, 1.85;
p
< 0.001), contralateral BC (HR = 1.55; 95%CI 1.30, 1.84;
p
< 0.001), and distant metastases (HR = 1.44; 95%CI 1.08, 1.94;
p
= 0.01) but absolute risks were low.
Conclusion
Non-adherence to adjuvant ET was associated with an increased risk of recurrence, but absolute recurrence rates were low.</description><subject>Breast cancer</subject><subject>Breast surgery</subject><subject>Cancer research</subject><subject>Cancer therapies</subject><subject>Endocrine therapy</subject><subject>Epidemiology</subject><subject>Football (College)</subject><subject>Lumpectomy</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Metastases</subject><subject>Metastasis</subject><subject>Middle aged women</subject><subject>Oncology</subject><subject>Patient compliance</subject><subject>Regression analysis</subject><subject>Surgery</subject><issn>0167-6806</issn><issn>1573-7217</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>8G5</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNp9kl1vFCEUhonR2Fr9A14YEhPjzVQ-ZmDmsmn82KSJN3pNWDjsUmdgBabt_gT_tWynWmuMIYFweN4TzjkvQi8pOaWEyHeZkq4dGsJ4Q8TQD83NI3RMO8kbyah8jI4JFbIRPRFH6FnOl4SQQZLhKTrikjMhRXeMfqymnTYFR4dDDI22W0gQDOASMQQbTfKhXmpU7_Y4BpzAzGlBks_fsA84jhYSvo4TBHztyxbnojeAV3idQOeCja50wtqVui-xxsSQIV35sMF5ThtI--foidNjhhd35wn6-uH9l_NPzcXnj6vzs4vGtJJXobWtG4SzzLp1LwaqBbP1tA6MJJS1ljPat4a2tNV8banR0DEi-8EZ1hHKT9DbJe8uxe8z5KImnw2Mow4Q56xYzyTrOiF4RV__hV7GOYX6uwM1DFL2or2nNnoE5YOLJWlzSKrOZB1QbfRtrtN_UHVZmHztBjhf4w8Eb_4QbEGPZZvjOBdfW_cQZAtoUsw5gVO75Ced9ooSdTCKWoyiqlHUrVHUTRW9uittXk9gf0t-OaMCfAFyfQp1QPe1_yftTyNKyRo</recordid><startdate>20230801</startdate><enddate>20230801</enddate><creator>Rodin, Danielle</creator><creator>Sutradhar, Rinku</creator><creator>Jerzak, Katarzyna J.</creator><creator>Hahn, Ezra</creator><creator>Nguyen, Lena</creator><creator>Castelo, Matthew</creator><creator>Fatiregun, Omolara</creator><creator>Fong, Cindy</creator><creator>Mata, Danilo Giffoni M. M.</creator><creator>Trebinjac, Sabina</creator><creator>Paszat, Lawrence</creator><creator>Rakovitch, Eileen</creator><general>Springer US</general><general>Springer</general><general>Springer Nature B.V</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7TO</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>H94</scope><scope>K9-</scope><scope>K9.</scope><scope>M0R</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>MBDVC</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>Q9U</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-9647-2851</orcidid></search><sort><creationdate>20230801</creationdate><title>Impact of non-adherence to endocrine therapy on recurrence risk in older women with stage I breast cancer after breast-conserving surgery</title><author>Rodin, Danielle ; Sutradhar, Rinku ; Jerzak, Katarzyna J. ; Hahn, Ezra ; Nguyen, Lena ; Castelo, Matthew ; Fatiregun, Omolara ; Fong, Cindy ; Mata, Danilo Giffoni M. M. ; Trebinjac, Sabina ; Paszat, Lawrence ; Rakovitch, Eileen</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c473t-cdd4f96fd2dfb8691a62d869dfec70124d32184c1414a3bd1cae520789fc25013</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Breast cancer</topic><topic>Breast surgery</topic><topic>Cancer research</topic><topic>Cancer therapies</topic><topic>Endocrine therapy</topic><topic>Epidemiology</topic><topic>Football (College)</topic><topic>Lumpectomy</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Metastases</topic><topic>Metastasis</topic><topic>Middle aged women</topic><topic>Oncology</topic><topic>Patient compliance</topic><topic>Regression analysis</topic><topic>Surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Rodin, Danielle</creatorcontrib><creatorcontrib>Sutradhar, Rinku</creatorcontrib><creatorcontrib>Jerzak, Katarzyna J.</creatorcontrib><creatorcontrib>Hahn, Ezra</creatorcontrib><creatorcontrib>Nguyen, Lena</creatorcontrib><creatorcontrib>Castelo, Matthew</creatorcontrib><creatorcontrib>Fatiregun, Omolara</creatorcontrib><creatorcontrib>Fong, Cindy</creatorcontrib><creatorcontrib>Mata, Danilo Giffoni M. M.</creatorcontrib><creatorcontrib>Trebinjac, Sabina</creatorcontrib><creatorcontrib>Paszat, Lawrence</creatorcontrib><creatorcontrib>Rakovitch, Eileen</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Oncogenes and Growth Factors Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Public Health Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>Consumer Health Database (Alumni Edition)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Consumer Health Database</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Research Library</collection><collection>Research Library (Corporate)</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>Breast cancer research and treatment</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Rodin, Danielle</au><au>Sutradhar, Rinku</au><au>Jerzak, Katarzyna J.</au><au>Hahn, Ezra</au><au>Nguyen, Lena</au><au>Castelo, Matthew</au><au>Fatiregun, Omolara</au><au>Fong, Cindy</au><au>Mata, Danilo Giffoni M. M.</au><au>Trebinjac, Sabina</au><au>Paszat, Lawrence</au><au>Rakovitch, Eileen</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Impact of non-adherence to endocrine therapy on recurrence risk in older women with stage I breast cancer after breast-conserving surgery</atitle><jtitle>Breast cancer research and treatment</jtitle><stitle>Breast Cancer Res Treat</stitle><addtitle>Breast Cancer Res Treat</addtitle><date>2023-08-01</date><risdate>2023</risdate><volume>201</volume><issue>1</issue><spage>77</spage><epage>87</epage><pages>77-87</pages><issn>0167-6806</issn><eissn>1573-7217</eissn><abstract>Purpose
We examined the impact of non-adherence to adjuvant endocrine therapy (ET) on the risk and site of recurrence among older women with early stage, hormone receptor positive (HR+) breast cancer (EBC).
Methods
A population-based cohort of women age ≥ 65 years with T1N0 HR + EBC who were diagnosed between 2010 and 2016 and treated with breast-conserving surgery (BCS) + ET was identified. Treatment and outcomes were ascertained through linkage with administrative databases. ET non-adherence was examined as a time-dependent covariate in multivariable cause-specific Cox regression models to evaluate its effect on the risks of ipsilateral local recurrence (LR), contralateral breast cancer, and distant metastases.
Results
The population cohort includes 2637 women; 73% (
N
= 1934) received radiation (RT) + ET and 27% (
N
= 703) received ET alone. At a median follow-up of 8.14 years, the first event was LR in 3.6% of women treated with ET alone and 1.4% for those treated with RT + ET (
p
< 0.001); the risk of distant metastases was < 1% in both groups. The proportion of time adherent to ET was 69.0% among those treated with RT + ET and 62.8% for those treated with ET alone. On multivariable analysis, increasing proportion of time non-adherent to ET was associated with increased risk of LR ((HR = 1.52 per 20% increase in time; 95%CI 1.25, 1.85;
p
< 0.001), contralateral BC (HR = 1.55; 95%CI 1.30, 1.84;
p
< 0.001), and distant metastases (HR = 1.44; 95%CI 1.08, 1.94;
p
= 0.01) but absolute risks were low.
Conclusion
Non-adherence to adjuvant ET was associated with an increased risk of recurrence, but absolute recurrence rates were low.</abstract><cop>New York</cop><pub>Springer US</pub><pmid>37326765</pmid><doi>10.1007/s10549-023-06989-x</doi><tpages>11</tpages><orcidid>https://orcid.org/0000-0001-9647-2851</orcidid></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0167-6806 |
| ispartof | Breast cancer research and treatment, 2023-08, Vol.201 (1), p.77-87 |
| issn | 0167-6806 1573-7217 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_2827255663 |
| source | SpringerLink Journals - AutoHoldings |
| subjects | Breast cancer Breast surgery Cancer research Cancer therapies Endocrine therapy Epidemiology Football (College) Lumpectomy Medicine Medicine & Public Health Metastases Metastasis Middle aged women Oncology Patient compliance Regression analysis Surgery |
| title | Impact of non-adherence to endocrine therapy on recurrence risk in older women with stage I breast cancer after breast-conserving surgery |
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