HR+, HER2- Early Breast Cancer
Medication Adherence and Patient Support
Standard of care: oral endocrine therapy
For patients with hormone receptor–positive (HR+) early breast cancer (EBC), oral endocrine therapies (ET) such as tamoxifen and aromatase inhibitors (AIs) are effective treatment options and the current standards of care for adjuvant therapy.1-4 Despite the clinical benefits of adjuvant therapy, only around half of patients with EBC are fully adherent to their oral adjuvant treatment within 5 years.5,6
The graph tracks overall adherence, by percentage, over 4 years since tamoxifen initiation. Half of patients with EBC are fully adherent to their oral adjuvant treatment within 5 years.
Medication adherence and persistence
Supporting patient adherence and persistence to their adjuvant therapy is important for the management of these patients.7,8 For patients with EBC, increases in adherence and persistence to adjuvant therapy were associated with a decrease in all-cause mortality.9
Medication adherence is “the extent to which a patient acts in accordance with the prescribed interval and dose of a dosing regimen”
Start medication or observation
Adherence: Percentage of doses taken as prescribed
Stop medication or end observation
Medication adherence is “the duration of time from initiation to discontinuation of therapy”
Start medication or observation
Persistence: Days taking medication (without exceeding permissible gap)
Stop medication or end observation
Factors that influence medication adherence are multidimensional7,10
Understanding these factors can help facilitate the development of effective adherence interventions with the goal of improving patient outcomes.7
Social and economic factors
- Age
- Financial status
- Personal or clinical support
Condition-related factors
- Comorbidity burden
- Disease stage
Therapy-related factors
- Tamoxifen use
- Experience with adverse events and/or chemotherapy.
Healthcare team and system-related factors
- Out-of-pocket costs
- Hospitalizations
- Personalized care plan
Patient-related factors
- Pre-existing depression
- Belief in drug efficacy
- Value in doctor’s opinion
Strategies to promote therapy adherence in patients with HR+ EBC
SIMPLE strategy
The SIMPLE strategy is a summary of methodologically proven, adherence-enhancing strategies that can be applied to patient care. Below are some examples of adherence-enhancing strategies12:
- S – Simplifying regimen characteristics (adjusting the dose schedule)
- I – Imparting knowledge (sharing written information or pamphlets)
- M – Modifying patient beliefs (assessing benefits and barriers)
- P – Patient and family communication (active listening and including patients in the decision-making process)
- L – Leaving the bias (adapting education for a patient-centric audience)
- E – Evaluating adherence (utilizing self-reports or pill counting)
The first treatment cycle
The first treatment cycle is a vital stage of the treatment journey, during which HCPs establish patient-provider trust and effective communication.
- During the first treatment cycle, it is essential to see your patients frequently and help manage adverse events and dose adjustments as needed.
- The initial treatment cycle helps establish trust for the subsequent cycles and for the rest of their treatment journey.15
Related Resources
Downloadable PDFs
INFOGRAPHIC: Survivorship Care for Patients with High-Risk EBC (PDF)
INFOGRAPHIC: High-Risk, HR+/HER2- EBC: Treatment Adherence (PDF)
INFOGRAPHIC: High-Risk EBC: Supporting Patients Throughout Their Treatment Journey (PDF)
INFOGRAPHIC: Practical Management of Patients with High-Risk HR+,HER2- EBC (PDF)
The Challenge of Adherence & Persistence
Dr. Dawood highlights the challenges of patient adherence and provides insights on how she works with patients to identify and overcome any barriers.
Individualizing Therapy: Setting the Patient Up For Success
Dr. Dawood shares how she identifies, manages, and motivates patients who are at higher risk of poor adherence and persistence.
The Importance of Getting the First Cycle Right
Dr. Dawood discusses how getting the first treatment cycle right establishes trust with the patient through the rest of their treatment journey.
Managing Adherence & Persistence in Clinic
Dr. Dawood summarizes her top advice for managing adherence and persistence throughout the treatment cycle with patients in the clinic, including reiterating the benefits of treatment and coordination with the multidisciplinary care team.
Managing Fatigue to Maintain Quality of Life
Fatigue is a very important side effect of cancer therapy. Dr. Dawood shares how she counsels patients to manage fatigue, how to assess fatigue and modify treatment as needed.
References
- Early Breast Cancer Trialists’ Collaborative Group (EBCTCG). Lancet. 2005;365(9472):1687-1717.
- Early Breast Cancer Trialists’ Collaborative Group (EBCTCG). Lancet. 2015;386(10001):1341-1352.
- Burstein HJ, et al. J Clin Oncol. 2019;37(5):423-438.
- Burstein HJ, et al. Ann Oncol. 2021;32(10):1216-1235.
- Partridge AH, et al. J Clin Oncol. 2003;21(4):602-606.
- Hershman DL, et al. J Clin Oncol. 2010;28(27):4120-4128.
- Paranjpe R, et al. Breast Cancer Res Treat. 2019;174(2):297-305.
- Cramer JA, et al. Value Health. 2008;11(1):44-47.
- Hershman DL, et al. Breast Cancer Res Treat. 2011;126(2):529-537.
- Yussof I, et al. Breast. 2022;62:22-35.
- Elwyn G, et al. J Gen Intern Med. 2012;27(10):1361-1367.
- Atreja A, et al. MedGenMed. 2005;7(1):4.
- Salvo MC and Cannon-Breland ML. J Am Pharm Assoc (2003). 2015;55(4):e354-e363.
- Franzoi MA, et al. Lancet Oncol. 2021;22(7):e303-e313.
- Dawood S. The importance of getting the first cycle right. Lilly Medical Education website. Published February 14, 2023. Accessed May 25, 2023. https://education.lillymedical.com/en-us/disease-education-resources/oncology/breast-cancer/education-resources/adherence-and-persistence-for-patients
VV-MED-154879