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Breast Cancer Res Treat. 2018 Aug;170(3):623-631. doi: 10.1007/s10549-018-4774-2. Epub 2018 Apr 18.

Personal and clinical social support and adherence to adjuvant endocrine therapy among hormone receptor-positive breast cancer patients in an integrated health care system.

Author information

Division of Research, Kaiser Permanente Northern California, 2000 Broadway, 5th floor, Oakland, CA, USA.
Columbia University Medical Center, New York, NY, USA.
University of California, San Francisco, CA, USA.
Cancer Prevention Institute of California, Fremont, CA, USA.
Stanford Cancer Institute, Stanford, CA, USA.
Division of Research, Kaiser Permanente Northern California, 2000 Broadway, 5th floor, Oakland, CA, USA.



We evaluated associations between personal and clinical social support and non-adherence to adjuvant endocrine therapy (AET) in a large, Northern California breast cancer (BC) cohort from an integrated healthcare network.


This study included 3382 women from the Pathways Study diagnosed from 2005 to 2013 with stages I-III hormone receptor-positive BC and who responded to the Medical Outcomes Study Social Support and Interpersonal Processes of Care surveys, approximately 2 months post-diagnosis. We used logistic regression to evaluate associations between tertiles of social support and non-initiation (< 2 consecutive prescription fills within a year after diagnosis). Among those who initiated treatment, we used proportional hazards regression to evaluate associations with discontinuation (≥ 90 day gap) and non-adherence (< 80% medical possession ratio).


Of those who initiated AET (79%), approximately one-fourth either discontinued AET or were non-adherent. AET non-initiation was more likely in women with moderate (adjusted OR 1.18, 95% CI 0.96-1.46) or low (OR 1.30, 95% CI 1.05-1.62) versus high personal social support (P trend = 0.02). Women with moderate (HR 1.20, 95% CI 0.99-1.45) or low (HR 1.32, 95% CI 1.09-1.60) personal social support were also more likely to discontinue treatment (P trend = 0.01). Furthermore, women with moderate (HR 1.25, 95% CI 1.02-1.53) or low (HR 1.38, 95% CI 1.12-1.70) personal social support had higher non-adherence (P trend = 0.007). Associations with clinical social support and outcomes were similar. Notably, high clinical social support mitigated the risk of discontinuation when patients' personal support was moderate or low (P value = 0.04).


Women with low personal or clinical social support had higher AET non-adherence. Clinician teams may need to fill support gaps that compromise treatment adherence.


Adjuvant endocrine therapy; Breast cancer; Non-adherence; Social support; Women

[Available on 2019-08-01]
[Indexed for MEDLINE]

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