Adherence to adjuvant endocrine therapy in early breast cancer patients on supported self management: Real world evidence from a cancer unit at a district general hospital


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Sarah Howlett1, May Teoh1
1Royal Surrey NHS Foundation Trust

Abstract

Background

Adjuvant endocrine therapy (ET) for 5- 10 years is recommended for patients with hormone receptor positive (HR+) early breast cancer (EBC) to reduce recurrence risk and improve survival. The majority of EBC patients at Ashford and St Peter’s Hospitals (ASPH) are followed up with supported self-management (SSM). ET-related adverse effects (AE) potentially lead to non-adherence, treatment interruptions and early discontinuation. There is lack of evidence on ET adherence for patients in SSM. We conducted a retrospective review of HR+EBC patients on adjuvant ET in SSM to evaluate treatment adherence.

Method

Patients entering SSM and starting ET over a 12-month period (2017-2018) were identified from the local database. Retrospective analysis was performed using clinic letters and electronic patient records. Patients were excluded if they received ET for non-adjuvant indications. Information collected related to patients’ demographics, AEs, treatment switches or discontinuation.

Results

100/124 patients were eligible for inclusion. Median age was 64.5 years (range 40-88). First-line ET prescribed was Letrozole (68%) or Tamoxifen (32%).  50% of patients experienced documented ET-related AE.  This was more common in premenopausal patients (58% vs 48%). Common AEs were arthralgia (26%), hot flushes/night sweats (20%) and fatigue (5%). 10% required an ET switch due to AE. 4% required treatment interruptions while 6% discontinued treatment early. Of those with ET-related AE, 7/50 (14%) trialled interventions (4 acupuncture, 2 pharmacological interventions, 1 both). 23% attended additional outpatient appointments for review of ET-related AE; of these, 52% required ≥2 outpatient reviews.

Conclusion

A significant proportion of HR+ EBC patients experience ET-related AE, which can lead to treatment interruptions or discontinuation. It is possible that the numbers experiencing AE and treatment discontinuation are under-reported in patients on SSM. The use of interventions to manage ET-related AE was relatively low. The results highlight a need to improve personalised care and support for these patients to improve adherence to ET. We intend to explore the feasibility of dedicated nurse or support worker-led clinics at ASPH to address this need.

Impact statement

These findings will act as a local driver for change to provide better support for EBC patients on SSM pathways to improve adherence to adjuvant endocrine therapy.