SpringerLink
Log in

Tamoxifen adherence and its relationship to mortality in 116 men with breast cancer

  • Clinical Trial
  • Published:
Breast Cancer Research and Treatment Aims and scope Submit manuscript

Abstract

Recent studies have revealed that many, perhaps most women with hormone-responsive breast cancer have low adherence to tamoxifen adjuvant hormonal therapy. However, limited data are available on tamoxifen adherence in male breast cancer (MBC) patients. The goal of this study was to assess tamoxifen adherence and its relationship to mortality in MBC patients. A cohort of 116 men who were diagnosed with receptor-positive breast cancer between June 1987 and July 2012 was recruited for the study using the cancer prevention and treatment system database of Heilongjiang Province. From the 116 patients who received a five-year tamoxifen prescription, only 64.6 % were still taking their medication 1 year later, and this percentage decreased to 46.4 and 28.7 % after 2 and 3 years, respectively, to 25.8 % after 4 years, and to 17.7 % in the last year. After multivariate adjustment, factors that significantly decreased tamoxifen adherence were low social support [Hazard ratio (HR) = 2.45, 95 % CI 1.32–4.55], age (HR = 1.10, 95 % CI 1.01–1.21), and adverse effects (HR = 2.19, 95 % CI 1.57–3.04). The primary endpoints in the adherence or low-adherence groups from this study were overall survival (OS) and disease-free survival (DFS) of the MBC patients. The five- and ten-year OS of the patients was 97.9 and 79.6 %, respectively, in the adherence group, and 84.7 and 50.4 %, respectively, in the low-adherence group (p = 0.008). The five- and ten-year DFS of the patients was 95.4 and 72.8 %, respectively, in the adherence group, and 72.6 and 42.3 %, respectively, in the low-adherence group (p = 0.007). The consequences of low treatment adherence in men, who have a potentially long life expectancy, may be significant. In light of these findings, there is an urgent need to acknowledge and tackle the issue of tamoxifen adherence in this patient group.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price includes VAT (Germany)

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Larissa A (2012) Perspective: not just for women. Nature 485:S66. doi:10.1038/485S66a

    Article  Google Scholar 

  2. Korde JA, Zujewski LK et al (2010) Multidisciplinary meeting on male breast cancer: summary and research recommendations. J Clin Oncol 28:2114–2122. doi:10.1200/JCO.2009.25.5729

    Article  PubMed  Google Scholar 

  3. Jemal A, Tiwari RC, Murray T et al (2004) Cancer statistics. CA Cancer J Clin 54:8–29

    Article  PubMed  Google Scholar 

  4. Anderson WF, Jatoi I, Tse J, Rosenberg PS (2009) Male breast cancer: a population-based comparison with female breast cancer. J Clin Oncol 28:232–239. doi:10.1200/JCO

    Article  PubMed  Google Scholar 

  5. Anelli TF, Anelli A, Tran KN, Lebwohl DE, Borgen PI (1994) Tamoxifen administration is associated with a high rate of treatment-limiting symptoms in male breast cancer patients. Cancer 74:74–77. doi:10.1002/1097-0142

    Article  PubMed  CAS  Google Scholar 

  6. Ying MWL, Agrawal A, Cheung K-L (2005) The ‘other half’ of breast cancer: a review of male breast cancer. JMHG 2:406–413. doi:10.1016/j.jmhg.2005.10.012

    Google Scholar 

  7. The BIG 1–98 Collaborative Group (2009) Letrozole therapy alone or in sequence with tamoxifen in women with breast cancer. N Engl J Med 361:766–776

    Article  Google Scholar 

  8. Lan S, Fentiman AF, Hortobagy NG (2006) Male breast cancer. Lancet 367:595–604. doi:10.1016/S0140-6736(06)68226-3

    Article  Google Scholar 

  9. Rbeiro GG, Swindell R, Harris M (1996) A review of the management of the male breast carcinoma based on an analysis of 420 treated cases. Breast 5:141–146. doi:10.1016/S0960-9776(96)90058-2

    Article  Google Scholar 

  10. Rbeiro G, Swindell R (1992) Adjuvant tamoxifen for male breast cancer (MBC). Br J Cancer 65:252–254. doi:10.1038/bjc.1992.50

    Article  Google Scholar 

  11. Goss PE, Reid C, Pinttile M, Banerjee SS, Cramer A (1999) Male breast carcinoma: a review of 229 patients who presented to the Princess Margaret Hospital during 40 years: 1995–1996 Cancer 85:629–639

    Google Scholar 

  12. Ruddy KJ, Mayer E, Partridge AH (2009) Patient adherence and persistence with oral anticancer treatment. CA Cancer J Clin 59:56–66. doi:10.3322/caac.20004

    Article  PubMed  Google Scholar 

  13. Lash TL, Fox MP, Westrup JL, Fink AK, Silliman RA (2006) Adherence to tamoxifen over the five-year course. Breast Cancer Res Treat 99:215–220. doi:10.1007/s10549-006-9193-0

    Article  PubMed  Google Scholar 

  14. Barron TI, Connolly R, Bennett K, Feely J, Kennedy MJ (2007) Early discontinuation of tamoxifen: a lesson for oncologists. Cancer 109:829–832

    Article  Google Scholar 

  15. Owusu C, Buist DS, Field TS (2008) Predictors of tamoxifen discontinuation among older women with estrogen receptor-positive breast cancer. J Clin Oncol 26:549–555. doi:10.1200/JCO.2006.10.1022

    Article  PubMed  Google Scholar 

  16. Mc Cowan C, Shearer J, Donnan PT, Dewar JA, Crilly M, Thompson AM, Fahey TP (2008) Cohort study examining tamoxifen adherence and its relationship to mortality in women with breast cancer. Br J Cancer 99:1763–1768. doi:10.1038/sj.bjc.6604758

    Article  CAS  Google Scholar 

  17. Hershman DL, Kushi LH, Shao T, Buono D, Kershenbaum A, Tsai WY, Fehrenbacher L, Gomez SL, Miles S, Neugut AI (2010) Early discontinuation and nonadherence to adjuvant hormonal therapy in a cohort of 8,769 early-stage breast cancer patients. J Clin Oncol 28:4120–4128. doi:10.1200/JCO.2009.25.9655

    Article  PubMed  Google Scholar 

  18. Early Breast Cancer Trialists Collaborative Group (2005) Effects of chemotherapy and hormonal therapy for early breast cancer on recurrence and 15-year survival: an overview of the randomized trials. Lancet 365:1687–1717

    Article  Google Scholar 

  19. The WHOQOL Group (1998) Development of the World Health Organization WHOQOL-BREF quality of life assessment. Psychol Med 28:551–558

    Article  Google Scholar 

  20. Baumann C, Erpelding ML, Regat S, Collin JF, Briancon S (2010) The WHOQOL-BREF questionnaire: French adult population norms for the physical health, psychological health and social relationship dimensions. Rev Epidemiol Sante Publique 58:33–39

    Article  PubMed  CAS  Google Scholar 

  21. Fuhrer R, Wessely S (1995) The epidemiology of fatigue and depression: a French primary-care study. Psychol Med 25:895–905

    Article  PubMed  CAS  Google Scholar 

  22. Andrade SE, Kahler KH, Frech F, Chan KA (2006) Methods for evaluation of medication adherence and persistence using automated databases. Pharmacoepidemiol Drug Saf 15:565–574

    Article  PubMed  Google Scholar 

  23. Cramer JA, Roy A, Burrell A, Fairchild CJ, Fuldeore MJ, Ollendorf DA, Wong PK (2008) Medication compliance and persistence: terminology and definitions. Value Health 11:44–47

    Article  PubMed  Google Scholar 

  24. Fisher B, Costantino J, Redmond C et al (1989) A randomized clinical trial evaluates tamoxifen in the treatment of patients with node-negative breast cancer who have estrogen-receptor-positive tumors. N Engl J Med 320:479–484

    Article  PubMed  CAS  Google Scholar 

  25. Love RR (1990) Prospects for antiestrogen chemoprevention of breast cancer. J Natl Cancer Inst 82:18–21

    Article  PubMed  CAS  Google Scholar 

  26. Waterhouse DM, Calzone KA, Mele C, Brenner DE (1993) Adherence to oral tamoxifen: a comparison of patient self-report, pill counts, and microelectronic monitoring. J Clin Oncol 11:1189–1197

    PubMed  CAS  Google Scholar 

  27. Partridge AH, Lafountain A, Mayer E, Taylor BS, Winer E, Asnis-Alibozek A (2008) Adherence to initial adjuvant anastrozole therapy among women with early-stage breast cancer. J Clin Oncol 26:556–562. doi:10.1200/JCO.2007.11.5451

    Article  PubMed  CAS  Google Scholar 

  28. Osterberg L, Blaschke T (2005) Adherence to medication. N Engl J Med 353:487–497

    Article  PubMed  CAS  Google Scholar 

  29. Murthy V, Bharia G, Sarin R (2002) Tamoxifennon-compliance: does it matter? Lancet Oncol 3:654. doi:10.1016/S1470-2045(02)00895-1

    Article  PubMed  Google Scholar 

  30. Partridge AH, Wang PS, Winer EP, Avorn J (2003) Nonadherence to adjuvant tamoxifen therapy in women with primary breast cancer. J Clin Oncol 21:602–606. doi:10.1200/JCO.2003.07.071

    Article  PubMed  CAS  Google Scholar 

  31. Barron TI, Connolly R, Bennett K, Feely J, Kennedy MJ (2007) Early discontinuation of tamoxifen. Cancer 109:832–883. doi:10.1002/cncr.22485

    Article  PubMed  CAS  Google Scholar 

  32. Huiart L, Bouhnike A-D, Rey D, Tarpin C, Cluze C, Bendiane MK, Viens P, Giorgi R (2012) Early discontinuation of tamoxifen intake in younger women with breast cancer: is it time to rethink the way it is prescribed? Eur J Cancer 48:1939–1946. doi:10.1016/j.ejca.2012.03.004

    Article  PubMed  Google Scholar 

  33. Kirk MC, Hudis CA (2008) Insight into barriers against optimal adherence to oral hormonal therapy in women with breast cancer. Clin Breast Cancer 8:155–161

    Article  PubMed  Google Scholar 

  34. Fink AK, Gurwitz J, Rakowski W, Guadagnoli E, Silliman RA (2004) Patient beliefs and tamoxifen discontinuance in older women with estrogen receptor positive breast cancer. J Clin Oncol 22:3309–3315. doi:10.1200/JCO.2004.11.064

    Article  PubMed  Google Scholar 

  35. Owusu C, Buist DSM, Field TS, Lash TL, Thwin SS, Geiger AM, Quinn VP, Frost F, Prout M, Ulcickas Yood M, Wei F, Silliman RA (2008) Predictors of tamoxifen discontinuation among older women with estrogen receptor positive breast cancer. J Clin Oncol 26:3125–3127. doi:10.1200/JCO.2006.10.1022

    Article  PubMed  Google Scholar 

  36. Giordano SH, Buzdar AU, Hortobagyi GN (2002) Breast cancer in men. Ann Intern Med 137:678–687. doi:10.1016/j.breastdis.2011.01.003

    PubMed  Google Scholar 

  37. Anderson WW, Althuis MD, Brinton LA, Devesa S (2004) Is male breast cancer similar or different than female breast cancer? Breast Cancer Res Treat 83:77–86. doi:10.1023/B:BREA.0000010701.08825.2d

    Article  PubMed  Google Scholar 

  38. Grunfeld EA, Hunter MS, Sikka P, Mittal S, Grunfeld EA, Hunter MS, Sikka P, Mittal S (2005) Adherence beliefs among breast cancer patients taking tamoxifen. Patient Educ Couns 59:97–102. doi:10.1016/j.pec.2004.10.005

    Article  PubMed  Google Scholar 

  39. Chlebowski RT, Geller ML (2006) Adherence to endocrine therapy for breast cancer. Oncology 71:1–9

    PubMed  CAS  Google Scholar 

  40. Dezentje VO, Guchelaar HJ, Nortier JW, vandeVelde CJ, Gelderblom H (2009) Clinical implications of CYP2D6 genoty** in tamoxifen treatment for breast cancer. Clin Cancer Res 15:15–21

    Article  PubMed  CAS  Google Scholar 

  41. Goetz MP, Knox SK, Suman VJ et al (2007) The impact of cytochrome P450 2D6 metabolism in women receiving adjuvant tamoxifen. Breast Cancer Res Treat 101:113–121. doi:10.1007/s10549-006-9428-0

    Article  PubMed  CAS  Google Scholar 

  42. Brauch H, Schroth W, Eichelbaum M, Schwab M, Harbeck N (2008) Clinical relevance of CYP2D6 genetics for tamoxifen response in breast cancer. Breast Care 3:43–50. doi:10.1159/000114642

    Article  PubMed  Google Scholar 

  43. The Scottish Trial Report from the Breast Cancer Trials Committee (1987) Adjuvant tamoxifen in the management of operable breast cancer. Scottish Cancer Trials Office (MRC). Lancet 2:171–175

    Google Scholar 

  44. Fallow field L, Cella D, Cuzick J (2004) Quality of life of postmenopausal women in the arimidex, tamoxifen, alone or in combination (ATAC) adjuvant breast cancer trial. J Clin Oncol 22:4261–4271. doi:10.1200/JCO.2004.08.029

    Article  CAS  Google Scholar 

  45. van Servellen G, Lombardi E (2005) Supportive relationships and medication adherence in HIV-infected low-income Latinos. West J Nurs Res 27:1023–1039. doi:10.1177/0193945905279446

    Article  PubMed  Google Scholar 

  46. Howell A, Cuzick J, Baum M (2005) Results of the ATAC (arimidex, tamoxifen, alone or in combination) trial after completion of 5 years’ adjuvant treatment for breast cancer. Lancet 365:60–62. doi:10.1016/S0140-6736(04)17666-6

    Article  PubMed  CAS  Google Scholar 

  47. Svensson S, Kjellgren KI, Ahlner J, Säljö R (2000) Reasons for adherence with antihypertensive medication. Int J Cardiol 76:157–163. doi:10.1016/S0167-5273(00)00374-0

    Article  PubMed  CAS  Google Scholar 

  48. Carr AJ, Thompson PW, Cooper C (2006) Factors associated with adherence and persistence to bisphosphonate therapy in osteoporosis: a cross-sectional survey. Osteoporos Int 17:1638–1644. doi:10.1007/s00198-006-0166-2

    Article  PubMed  CAS  Google Scholar 

  49. Fallow field L, Cella D, on behalf of the CRC Psychosocial Oncology Group (2002) Assessing the quality of life (QOL) of postmenopausal (PM) women randomized into the ATAC (‘Arimidex’, tamoxifen, alone or in combination) adjuvant breast cancer (BC) trial. Proc Am Soc Clin Oncol 21:159

    Google Scholar 

Download references

Acknowledgments

We would like to thank both the men who agreed to participate in this study and their physicians for the time they devoted to medical data collection. We would also like to thank the physicians and technicians who contributed to patient selection and data extraction.

Conflict of interest

Authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Cancer Research Institute, Harbin Medical University, The Affiliated Tumor Hospital of Harbin Medical University, 150 Ha** Road, Harbin, 150040, China

    Da Pang

  2. Department of Breast Surgery, The Affiliated Tumor Hospital of Harbin Medical University, 150 Ha** Road, Harbin, 150040, China

    Shou** Xu, Weiyang Tao, Yanni Song, Yanbo Chen & Yanlv Ren

  3. Department of Central Operation Room, The Second Affiliated Hospital of Harbin Medical University, 246 Xuefu Road, Harbin, 150086, China

    Yumei Yang

  4. Department of Central Operation Room, The Second Affiliated Hospital of Beihua University, 32 Datong Road, Jilin, 132022, China

    Jianxin Liu

Authors
  1. Shou** Xu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yumei Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Weiyang Tao
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yanni Song
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Yanbo Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Yanlv Ren
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Jianxin Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Da Pang
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Da Pang.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Xu, S., Yang, Y., Tao, W. et al. Tamoxifen adherence and its relationship to mortality in 116 men with breast cancer. Breast Cancer Res Treat 136, 495–502 (2012). https://doi.org/10.1007/s10549-012-2286-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10549-012-2286-z

Keywords

Search

Navigation