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Erschienen in:
16.02.2017 | Original paper
Can demographic, clinical and treatment-related factors available at hormonal therapy initiation predict non-persistence in women with stage I–III breast cancer?
Erschienen in: Cancer Causes & Control | Ausgabe 3/2017
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Purpose
To investigate whether demographic, clinical and treatment-related risk factors known at treatment initiation can be used to reliably predict future hormonal therapy non-persistence in women with breast cancer, and to inform intervention development.
Methods
Women with stage I–III breast cancer diagnosed 2000–2012 and prescribed hormonal therapy were identified from the National Cancer Registry Ireland (NCRI) and linked to pharmacy claims data from Ireland’s Primary Care Reimbursement Services (PCRS). Non-persistence was defined as a treatment gap of ≥180 days within 5 years of initiation. Seventeen demographic, clinical and treatment-related risk factors, identified from a systematic review, were abstracted from the NCRI-PCRS dataset. Multivariate binomial models were used to estimate relative risks (RR) and risk differences (RD) for associations between risk factors and non-persistence. Calibration and discriminative performance of the models were assessed. The analysis was repeated for early non-persistence (<1 year of initiation).
Results
Within 5 years of treatment initiation 680 women (19.9%) were non-persistent. Women aged <50 years (adjusted RR 1.41, 95% CI 1.16–1.70) and those prescribed antidepressants (RR 1.22, 95% CI 1.04–1.45) had increased risk of non-persistence. Married women (RR 0.82 95% CI 0.71–0.94) and those with prior medication use (RR 0.62 95% CI 0.51–0.75) had reduced risk of non-persistence. The area under the receiver-operating characteristic (ROC) curve for non-persistence was 0.61. Findings were similar for early non-persistence.
Conclusion
The risk prediction model did not discriminate well between women at higher and lower risk of non-persistence at treatment initiation. Future studies should consider other factors, such as psychological characteristics and experience of side-effects.