Endocrine Therapy Nonadherence and Discontinuation in Black and White Women

CPCRN principal investigator Stephanie Wheeler of the University of North Carolina was lead author on a new publication in the Journal of the National Cancer Institute, “Endocrine Therapy Nonadherence and Discontinuation in Black and White Women.”


Background: Differential use of endocrine therapy (ET) by race may contribute to breast cancer outcome disparities, but racial differences in ET behaviors are poorly understood.
Methods: Women aged 20–74 years with a first primary, stage I–III, hormone receptor–positive (HRþ) breast cancer were in- cluded. At 2 years postdiagnosis, we assessed nonadherence, defined as not taking ET every day or missing more than two pills in the past 14 days, discontinuation, and a composite measure of underuse, defined as either missing pills or discontinu- ing completely. Using logistic regression, we evaluated the relationship between race and nonadherence, discontinuation, and overall underuse in unadjusted, clinically adjusted, and socioeconomically adjusted models.
Results: A total of 1280 women were included; 43.2% self-identified as black. Compared to white women, black women more often reported nonadherence (13.7% vs 5.2%) but not discontinuation (10.0% vs 10.7%). Black women also more often reported the following: hot flashes, night sweats, breast sensitivity, and joint pain; believing that their recurrence risk would not change if they stopped ET; forgetting to take ET; and cost-related barriers. In multivariable analysis, black race remained sta- tistically significantly associated with nonadherence after adjusting for clinical characteristics (adjusted odds ratio 1⁄4 2.72, 95% confidence interval 1⁄4 1.75 to 4.24) and after adding socioeconomic to clinical characteristics (adjusted odds ratio 1⁄4 2.44, 95% confidence interval 1⁄4 1.50 to 3.97) but was not independently associated with discontinuation after adjustment. Low re- currence risk perception and lack of a shared decision making were strongly predictive of ET underuse across races.Conclusions: Our results highlight important racial differences in ET-adherence behaviors, perceptions of benefits/harms, and shared decision making that may be targeted with culturally tailored interventions.


Link to Full Publication

Citation: Wheeler, S. B., Spencer, J., Pinheiro, L. C., Murphy, C. C., Earp, J. A., Cary, L., … & Reeder-Hayes, K. E. (2018). Endocrine therapy nonadherence and discontinuation in black and white women. Journal of the National Cancer Institute, 111(5), 1-11. doi: 10.1093/jnci/djy136