medwireNews: Patients with breast cancer may be at increased risk for early discontinuation of adjuvant endocrine therapy (ET) if they have depression, or poor physical or social wellbeing before treatment initiation, suggests a post-hoc analysis of the TAILORx trial.
“These results support systematic screening for patient-reported outcomes [PROs] and depressive symptoms to identify women at risk for discontinuation of ET,” say the researchers in JAMA Oncology.
And they suggest “that oncology clinicians should consider referral for psychosocial care or physical rehabilitation for patients at risk for early discontinuation of ET.”
Recognizing that up to 50% of women do not adhere to the full 5 years of endocrine therapy, Betina Yanez (Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA) and colleagues identified predictors of nonadherence.
They used data from 954 participants of the TAILORx trial that previously demonstrated the noninferiority of ET alone to chemoendocrine therapy in patients with hormone receptor-positive, HER2-negative, axillary node-negative breast cancer and an intermediate 21-gene recurrence score.
Overall, 106 patients discontinued ET early, defined as discontinuation within 4 years of treatment initiation for reasons other than death or recurrence, giving a 4-year nonadherence rate of 11.4%.
An initial joint prediction model identified receipt of chemoendocrine therapy and age above 40 years as significant predictors of early treatment discontinuation, and Yanez et al therefore adjusted for these variables to investigate the influence of PROs on early discontinuation rates.
Worse physical wellbeing scores on the Functional Assessment of Cancer Therapy (FACT) scale before treatment initiation were significantly associated with an elevated risk for early ET discontinuation, with hazard ratios (HRs) of 2.12 and 1.67 for scores of 27–28 and 24–26 points, respectively, versus below 24 points.
Similarly, patients with FACT scores indicating worse social wellbeing at baseline were at a significantly increased risk for early ET discontinuation, at HRs of 1.94 and 1.79 for patients scoring 27–28 or 23–26 points, respectively, relative to those scoring below 23 points.
Patients who had a history of depression at treatment initiation were also significantly more likely to discontinue ET early than those who did not (HR=1.82), as were those who were versus were not taking antidepressants (HR=1.87), “which affirms our findings pertaining to baseline depression and early discontinuation,” say Yanez and team.
They add: “Although a history of an anxiety diagnosis was not assessed in the TAILORx trial, additional research can further elucidate how comorbid anxiety and depression differentially predict early discontinuation of ET.”
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