Treatment interruption and discontinuation of hormonal therapy in hormone receptor-positive breast cancer patients

• Published in: Breast cancer research and treatment 2020-12, Vol.184 (3), p.665-674
• Main Authors: Mao, Daqin, Hachem, Hilal, Chang, Hong, Dima, Danai, Dower, Joshua, Wismer, Michael, Erban, John K., Freund, Karen M., Parsons, Susan K.
• Format: Article
• Language: English
• Subjects: Adjuvant treatment; Affective disorders; Analysis; Antineoplastic Agents, Hormonal - adverse effects; Breast cancer; Breast Neoplasms - drug therapy; Breast Neoplasms - epidemiology; Cancer; Cancer patients; Cancer therapies; Care and treatment; Chemotherapy, Adjuvant; Chronic pain; Comorbidity; Data collection; Female; Hormones - therapeutic use; Hot flash; Humans; Medical research; Medication Adherence; Medicine; Medicine & Public Health; Oncology; Pain; Patient compliance; Patients; Regression analysis; Retrospective Studies; Review; Symptom management; Womens health
• ISSN: 0167-6806; 1573-7217; 1573-7217
• DOI: 10.1007/s10549-020-05892-z

Purpose To investigate predictors of treatment interruption and early discontinuation of adjuvant hormonal therapy (HT) in a retrospective cohort of women with newly diagnosed hormone receptor-positive (HR +) breast cancer. Methods Eligible cases were identified from a single institutional tumor registry from 2009 to 2015. Patients were followed from initiation of adjuvant HT for a minimum of one year through December 1, 2016. Predictors of treatment interruption or early discontinuation were analyzed with Cox proportional hazards regression models. Results With a median follow-up time of 3.0 years (IQR 1.5–4.5), 22 women (10.9%) discontinued HT early and 47 (23.4%) had at least one treatment interruption of > 14 days. Adjusted Cox proportional hazards regression models showed that women with pre-existing affective disorders were more likely to discontinue therapy early (HR 3.15; 95% CI 1.35–7.37), while those with pre-existing chronic pain disorders were at increased risk for treatment interruption (HR 2.24; 95% CI 1.20–4.19). HT-related symptoms were the most commonly reported reason for HT interruption or discontinuation. Women who experienced severe treatment-related symptoms were at increased risk for both HT interruption (HR 2.64; 95% CI 1.07–6.50) and HT discontinuation (HR 3.48; 95% CI 1.20–10.1). Conclusions This study showed that HT interruptions and discontinuation were common, often associated with HT-related symptoms. Clinicians caring for breast cancer patients on HT should monitor closely for treatment-emergent symptoms, especially women with pre-existing disorders, and support them to continue therapy through aggressive symptom management and other patient-centered approaches.