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Use of tamoxifen and aromatase inhibitors in a large population-based cohort of women with breast cancer.

Huiart L, Dell'Aniello S, Suissa S - Br. J. Cancer (2011)

Bottom Line: Overall, 18.9% (95% CI: 15.1-23.0) of women on AIs as compared with 31.0% (95% CI: 29.6-32.2) of women on tamoxifen had discontinued their treatments within the first 5 years (P<0.001).Among older women, treatment discontinuation was less frequent for AIs as compared with tamoxifen (P<0.001).In younger women, tamoxifen is prematurely discontinued for half of patients.

View Article: PubMed Central - PubMed

Affiliation: Department of Cancer Genetics, Prevention and Screening, Institut Paoli-Calmettes, 232 Bd Saint-Marguerite, Marseille, France. huiartl@marseille.fnclcc.fr

ABSTRACT

Background: Non-compliance with oral treatment in oncology is an emerging health issue. For breast cancer (BC) patients, few data are available on compliance and persistence to tamoxifen in younger women and to aromatase inhibitors (AIs) as compared with tamoxifen in older women.

Methods: We constituted a cohort of 13,479 women with BC who received at least one prescription of tamoxifen or AI between 1998 and 2008, in the United Kingdom General Practice Research Database. Days covered by medication and treatment discontinuation were studied. Time to treatment discontinuation was calculated using Kaplan-Meier estimates.

Results: Overall, 18.9% (95% CI: 15.1-23.0) of women on AIs as compared with 31.0% (95% CI: 29.6-32.2) of women on tamoxifen had discontinued their treatments within the first 5 years (P<0.001). This rate raised to 50.7% (95% CI: 43.0-57.9) among the 416 women under 40 years receiving tamoxifen as initial hormonal therapy. Among older women, treatment discontinuation was less frequent for AIs as compared with tamoxifen (P<0.001). Among women on AI therapy, 14% of them (n=374) had switched treatments.

Conclusion: Among older women, the real-life patterns of use of AI show high rates of compliance. In younger women, tamoxifen is prematurely discontinued for half of patients.

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Related in: MedlinePlus

Study flow chart.
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fig1: Study flow chart.

Mentions: In the GPRD, we identified 24 489 women who received a first prescription of tamoxifen, anastrozole, letrozole or exemestane after 1 January 1998, who also had at least 1 year of data before this prescription in the database. We excluded 4218 women owing to the absence of a BC diagnostic code in their records, 5517 women because BC was diagnosed before the study period, 397 women because of metastases before or within the first 6 months after diagnosis and 17 had no date of diagnosis. We further excluded 516 women who received their first prescription more than 3 months before BC diagnosis, 328 who received their treatment more than a year after diagnosis and 17 women who were prescribed two drugs concomitantly (Figure 1). We therefore constituted a cohort of 13 479 women who received tamoxifen (n=10 806) or one of the AIs (n=2673) following the diagnosis of BC. Mean age at cohort entry was 62 years (s.d.=14.0) in the tamoxifen group and 70.8 (s.d.=12.4) in the AI group (Table 1).


Use of tamoxifen and aromatase inhibitors in a large population-based cohort of women with breast cancer.

Huiart L, Dell'Aniello S, Suissa S - Br. J. Cancer (2011)

Study flow chart.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3101914&req=5

fig1: Study flow chart.
Mentions: In the GPRD, we identified 24 489 women who received a first prescription of tamoxifen, anastrozole, letrozole or exemestane after 1 January 1998, who also had at least 1 year of data before this prescription in the database. We excluded 4218 women owing to the absence of a BC diagnostic code in their records, 5517 women because BC was diagnosed before the study period, 397 women because of metastases before or within the first 6 months after diagnosis and 17 had no date of diagnosis. We further excluded 516 women who received their first prescription more than 3 months before BC diagnosis, 328 who received their treatment more than a year after diagnosis and 17 women who were prescribed two drugs concomitantly (Figure 1). We therefore constituted a cohort of 13 479 women who received tamoxifen (n=10 806) or one of the AIs (n=2673) following the diagnosis of BC. Mean age at cohort entry was 62 years (s.d.=14.0) in the tamoxifen group and 70.8 (s.d.=12.4) in the AI group (Table 1).

Bottom Line: Overall, 18.9% (95% CI: 15.1-23.0) of women on AIs as compared with 31.0% (95% CI: 29.6-32.2) of women on tamoxifen had discontinued their treatments within the first 5 years (P<0.001).Among older women, treatment discontinuation was less frequent for AIs as compared with tamoxifen (P<0.001).In younger women, tamoxifen is prematurely discontinued for half of patients.

View Article: PubMed Central - PubMed

Affiliation: Department of Cancer Genetics, Prevention and Screening, Institut Paoli-Calmettes, 232 Bd Saint-Marguerite, Marseille, France. huiartl@marseille.fnclcc.fr

ABSTRACT

Background: Non-compliance with oral treatment in oncology is an emerging health issue. For breast cancer (BC) patients, few data are available on compliance and persistence to tamoxifen in younger women and to aromatase inhibitors (AIs) as compared with tamoxifen in older women.

Methods: We constituted a cohort of 13,479 women with BC who received at least one prescription of tamoxifen or AI between 1998 and 2008, in the United Kingdom General Practice Research Database. Days covered by medication and treatment discontinuation were studied. Time to treatment discontinuation was calculated using Kaplan-Meier estimates.

Results: Overall, 18.9% (95% CI: 15.1-23.0) of women on AIs as compared with 31.0% (95% CI: 29.6-32.2) of women on tamoxifen had discontinued their treatments within the first 5 years (P<0.001). This rate raised to 50.7% (95% CI: 43.0-57.9) among the 416 women under 40 years receiving tamoxifen as initial hormonal therapy. Among older women, treatment discontinuation was less frequent for AIs as compared with tamoxifen (P<0.001). Among women on AI therapy, 14% of them (n=374) had switched treatments.

Conclusion: Among older women, the real-life patterns of use of AI show high rates of compliance. In younger women, tamoxifen is prematurely discontinued for half of patients.

Show MeSH
Related in: MedlinePlus