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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

1
Division of Research, Kaiser Permanente Northern California, 2000 Broadway, 5th floor, Oakland, CA, USA. Candyce.H.Kroenke@kp.org.
2
Columbia University Medical Center, New York, NY, USA.
3
University of California, San Francisco, CA, USA.
4
Cancer Prevention Institute of California, Fremont, CA, USA.
5
Stanford Cancer Institute, Stanford, CA, USA.
6
Division of Research, Kaiser Permanente Northern California, 2000 Broadway, 5th floor, Oakland, CA, USA.

Abstract

PURPOSE:

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.

METHODS:

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).

RESULTS:

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).

CONCLUSIONS:

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.

KEYWORDS:

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

PMID:
29671113
PMCID:
PMC6026067
[Available on 2019-08-01]
DOI:
10.1007/s10549-018-4774-2
[Indexed for MEDLINE]

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