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

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Abstract

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.

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Data availability

All data generated or analyzed during this study are included in this published article.

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Acknowledgements

The project described was supported in part by the National Center for Advancing Translational Sciences, National Institutes of Health, Award Number TL1TR001062. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

Funding

Additional support was provided by the Susan G. Komen for the Cure Training Grant in Health Disparities (GTDR15333918) and the American Cancer Society (CRP-17–112-06-COUN).

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Author notes

  1. Daqin Mao and Hilal Hachem have dual first authors.

Authors and Affiliations

  1. Tufts Clinical and Translational Science Institute (CTSI), Boston, MA, 02111, USA

    Daqin Mao, Hong Chang, Karen M. Freund & Susan K. Parsons

  2. Division of Hematology/Oncology, Tufts Medical Center, Boston, MA, 02111, USA

    Hilal Hachem, John K. Erban & Susan K. Parsons

  3. The Institute for Clinical Research and Health Policy Studies (ICRHPS), Boston, MA, 02111, USA

    Hong Chang, Karen M. Freund & Susan K. Parsons

  4. Department of Medicine, Tufts Medical Center, 800 Washington St. #345, Boston, MA, 02111, USA

    Danai Dima, Joshua Dower, Michael Wismer, John K. Erban, Karen M. Freund & Susan K. Parsons

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Contributions

DM and HH participated in study design, data collection, and analysis. They also participated in the interpretation of the results and development of the manuscript. HC oversaw the analysis plan and critically reviewed the manuscript. DD, JD, and MW participated in data collection and critically reviewed the manuscript. JKE and KMF critically reviewed the manuscript. HC, JKE, and KMF were apprised from the outset on study design, patient selection, and data collection. SKP supervised all aspects of the study, including design, data collection, analysis, interpretation, and critical review of the manuscript.

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Correspondence to Susan K. Parsons.

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The research did involve human subjects, based on the study design and retrospective review of the electronic health records.

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The Tufts Medical Center Institutional Review Board granted a waiver of consent and a HIPAA waiver of research authorization for the study.

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Mao, D., Hachem, H., Chang, H. et al. Treatment interruption and discontinuation of hormonal therapy in hormone receptor-positive breast cancer patients. Breast Cancer Res Treat 184, 665–674 (2020). https://doi.org/10.1007/s10549-020-05892-z

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