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J Breast Cancer. 2019 Mar 11;22(1):86-95. doi: 10.4048/jbc.2019.22.e14. eCollection 2019 Mar.

Prescription Refill Gap of Endocrine Treatment from Electronic Medical Records as a Prognostic Factor in Breast Cancer Patients.

Author information

1
Department of Biomedical Informatics, Asan Medical Center, Seoul, Korea.
2
Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
3
Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Korea.
4
Clinical Research Center, Asan Medical Center, Seoul, Korea.

Abstract

Purpose:

Discontinuation of hormone therapy is known to lead to a poorer prognosis in breast cancer patients. We aimed to investigate the prescription gap as a prompt index of medication adherence by using prescription data extracted from patient electronic medical records.

Methods:

A total of 5,928 patients diagnosed with invasive, non-metastatic breast cancer, who underwent surgery from January 1, 1997 to December 31, 2009, were enrolled retrospectively. The prescription data for 4.5 years of hormonal treatment and breast cancer-related events after treatment completion were analyzed. We examined the characteristics and prognoses of breast cancer in patients with and without a 4-week gap.

Results:

Patients with a gap showed a significantly higher risk of breast cancer recurrence, distant metastasis, breast cancer-specific death, and overall death after adjustment (hazard ratio [HR], 1.389; 95% confidence interval [CI], 1.089-1.772; HR, 1.568; 95% CI, 1.158-2.123; HR, 2.108; 95% CI, 1.298-3.423; and HR, 2.102; 95% CI, 1.456-3.034, respectively). When patients were categorized based on gap summation, the lower third (160 days) and fourth (391 days) quartiles showed a significantly higher risk of distant metastasis (HR, 1.758; 95% CI, 1.186-2.606 and HR, 1.844; 95% CI, 1.262-2.693, respectively).

Conclusion:

A gap of > 4 weeks in hormonal treatment has negative effects on breast cancer prognosis, and can hence be used as a sentinel index of higher risk due to treatment non-adherence. Further evaluation is needed to determine whether the gap can be used as a universal index for monitoring the adherence to hormonal treatment.

KEYWORDS:

Breast neoplasms; Estrogen antagonists; Medication adherence; Neoplasm metastasis

Conflict of interest statement

Conflict of Interest: The authors declare that they have no competing interests, and there are no financial conflicts of interest to disclose.

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