264842 Preliminary medication adherence data over one year in a longitudinal cohort of post-menopausal women with early-stage breast cancer initiating aromatase inhibitors

Wednesday, October 31, 2012

Jessica Islam, BA , Women's Health Research, Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN
Angel Sherrill, MPH , Women's Health Research, Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN
Liana Castel, PhD, MSPH , Women's Health Research, General Internal Medicine and Public Health / Epidemiology, Vanderbilt Ingram Cancer Center, and Vanderbilt University Medical Center, Nashville, TN
BACKGROUND: In 2005, aromatase inhibitors (AIs) became standard care for postmenopausal early-stage breast cancer patients to prevent recurrence. AIs are taken orally daily for 3-5 years. There is concern about nonadherence to AIs in clinical populations. Our objectives are to measure AI adherence prospectively and better understand AI adherence predictors. METHODS: To date we collected data from 72 postmenopausal female oncology outpatients within 10 days of AI initiation, via self-report by paper surveys, completed every 2 weeks for 12 weeks, and at 52 weeks. We assess also clinical and sociodemographic characteristics, side effects, physical function, depression, and menopausal symptoms. Adherence is assessed via the Morisky Medication Adherence-Hormonal scale with scores ranging from 0-8. Scores <6 denote low adherence and =8 denote high adherence. We conducted univariate analyses and multivariable logistic regression modeling with robust standard errors. RESULTS: Seven women (10%) were classified as having low adherence, 17(24%) medium adherence, and 48(67%) high adherence over the 52-week period. In univariate analyses, we observed no association between adherence and any other factor measured. In the multivariable analysis, baseline income (p<0.01), physical function (p=0.04), and depression (p=0.04), and longitudinal out-of-pocket costs (p<.01) and menopausal symptoms (p=0.04) were associated with low adherence. DISCUSSION: If only two thirds of women taking AIs are adherent, reduced clinical effectiveness of AIs could lead to recurrence and mortality in cancer populations. In this cohort, we plan in future analyses to further investigate factors associated with adherence and to compare self-reported adherence with electronic monitoring and pill count data.

Learning Areas:
Chronic disease management and prevention
Public health or related research
Social and behavioral sciences

Learning Objectives:
Understand aromatase inhibitor adherence over the first year of adjuvant therapy in postmenopausal women with early stage breast cancer Assess the impact of baseline and time-varying factors on aromatase inhibitor therapy adherence over time Compare self-reported adherence rates to electronically monitored adherence rates and pill counts in this population Demonstrate validity in this population of the Morisky Medication Adherence-Hormonal Therapy scale adaptation (MMAS-8-Hormonal)

Keywords: Cancer, Adherence

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: As a Research Analyst on the Breast Cancer Adjuvant Therapy Cohort study team, I facilitate recruitment and collaborate with oncologists and community leaders in order to enroll participants into the study. I prepare and submit Institutional Review Board and protocol materials for this study, and help design medication adherence data collection. I also help conduct quantitative data analysis in the area of adherence for this study.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.