Improving Aromatase Inhibitor Adherence for Breast Cancer May Require Support

Among patients with hormone-sensitive breast cancer, adherence to aromatase inhibitor therapy over the recommended 5 years is suboptimal. Dawn Hershman, MD, professor of medicine and epidemiology at Columbia University Medical Center, shed some light on factors associated with aromatase inhibitor nonadherence during a session at the San Antonio Breast Cancer Symposium in San Antonio, Texas.

“Issues related to nonadherence are increasingly important,” Dr Hershman explained, “as analyses from prospective randomized trials show compliance to endocrine therapy is associated with improved disease-free survival.”

Patient characteristics linked with nonadherence include older and younger age, minority race, being single, having multiple comorbidities, and having a history of nonadherence to other medications for chronic issues. A lack of knowledge about the effectiveness of aromatase inhibitors, limited insurance, and higher out-of-pocket costs are also associated with nonadherence, according to the session.

Side effects, specifically joint pain, are a common reason behind early discontinuation. Despite a lack of data into their effectiveness for treating aromatase inhibitor-induced arthralgia and an association with potentially severe side effects, nonsteroidal anti-inflammatory drugs (NSAIDs) are often prescribed. Yet randomized placebo-controlled trials have identified benefit from other interventions: aerobic and strength-training exercise, acupuncture, omega-3 fatty acids, and duloxetine. Time, too, has been shown to ease aromatase inhibitor-induced arthralgia, Dr Hershman explained, even in patients taking placebo.

Unfortunately, a systematic review found no evidence that educational interventions significantly improved adherence to hormone therapy compared with care as usual, according to the session. In a randomized clinical trial, biweekly unidirectional text messages over 3 years also failed to improve aromatase inhibitor adherence.

“Improving long-term adherence will likely require sustained behavioral interventions and support,” Dr Hershman stated.

—Jolynn Tumolo

Reference

Hershman DL. Everything comes at a price—toxicity, cost, and adherence to endocrine therapy. December 10, 2019.