Adherence to Aromatase Inhibitors Among Postmenopausal Breast Cancer Patients In Middle Euphrates Region of Iraq

Authors

  • Ahmed Mjali Department of Hematology /Oncology, Al- Hussein Medical City, Karbala, Iraq.

Keywords:

Key words: Aromatase inhibitors, Adherence, Breast cancer, Iraq.

Abstract

Background: Aromatase inhibitors (AIs) , are now widely used hormonal therapy in postmenopausal breast cancer patients with hormone receptors positive  because of their clinical effectiveness in both adjuvant and metastatic setting. Aims: To determine the adherence of patients to (AIs) therapy and factors associated with non-adherence among breast cancer patients in Middle Euphrates region of Iraq.

Methods: This study was conducted in Al-Hussein cancer center in Karbala province of Iraq, between January 2020 and December 2020. There were 101 breast cancer patients treated with (AIs), their adherence was assessed  by using the validated Morisky Medication Adherence Scale (8-MMAS).

Results: Majority of patients had a high adherence in (62.38%) while 37.62% of our patients were suboptimal adherence. Forgetfulness was the main cause of poor adherence in 71% of patients and  bone and joint pain was the most frequent side effect among our patients. There was no association between age , educational level ,  marital status ,income , parity , prior treatment and adherence  P vale <0.05 for each.

Conclusion: These data suggest that more than one third of our patients have suboptimal adherence to AIs. Factors associated with poor adherence were unintentional (forgetfulness), but also included intentional factors, such as drug inconvenience and avoidance of adverse effects. Pay attention to the factors found in this study may help to improve treatment outcomes among breast cancer patients in our country.

References

1. Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018 Nov;68(6):394-424.

2. Waks AG, Winer EP. Breast cancer treatment: a review. JAMA. 2019 Jan 22;321(3):288-300.

3. Early Breast Cancer Trialists' Collaborative Group. Tamoxifen for early breast cancer: an overview of the randomized trials. Lancet 351, 1451–1467 (1998).
4. Cuzick J, Sestak I, Baum M, Buzdar A, Howell A, Dowsett M, et al. Effect of anastrozole and tamoxifen as adjuvant treatment for early-stage breast cancer: 10-year analysis of the ATAC trial. Lancet Oncol. 2010 Dec 1;11(12):1135-41.
5. Nabholtz JM, Buzdar A, Pollak M, Harwin W, Burton G, Mangalik A, et al. Anastrozole is superior to tamoxifen as first-line therapy for advanced breast cancer in postmenopausal women: results of a North American multicenter randomized trial. J Clin Onco. 2000 Nov 15;18(22):3758-67.
6. Hershman DL, Shao T, Kushi LH, Buono D, Tsai WY, Fehrenbacher L, et al. Early discontinuation and non-adherence to adjuvant hormonal therapy are associated with increased mortality in women with breast cancer. Breast Cancer Res Treat. 2011 Apr 1;126(2):529-37.

7. Osterberg L, Blaschke T. Adherence to medication. N Engl J Med. 2005 Aug 4;353(5):487-97.

8. Verma S, Madarnas Y, Sehdev S, Martin G, Bajcar J. Patient adherence to aromatase inhibitor treatment in the adjuvant setting. Curr Oncol. 2011 May;18(Suppl 1):S3.

9. Morisky DE, Ang A, Krousel‐Wood M, Ward HJ. Predictive validity of a medication adherence measure in an outpatient setting. J Clin Hypertens. 2008 May;10(5):348-54.
10. Morisky DE, Green LW, Levine DM. Concurrent and predictive validity of a self-reported measure of medication adherence. Med Care. 1986;24:67–74.
11. Mjali A, Abbas SK. Imatinib Mesylate Adherence in Chronic Myeloid Leukemia Patients: Data from Middle Euphrates Region of Iraq. Sys Rev Pharm. 2021 Jan ; 12(1): 83-87.
12. Philipovskiy A, Campbell A, Heydarian R, Castillo B, Dwivedi AK, Mccallum R, et al. Adherence to Adjuvant Aromatase Inhibitor Therapy Among Postmenopausal Hispanic/Latino Women With Breast Cancer. Anticancer Res. 2020 Feb 1;40(2):857-64.

13. Kesmodel SB, Goloubeva OG, Rosenblatt PY, Heiss B, Bellavance EC, Chumsri S, et al. Patient-reported Adherence to Adjuvant Aromatase Inhibitor Therapy Using the Morisky Medication Adherence Scale. Am J Clin Oncol. 2018 May 1;41(5):508-12.
14. Mjali A. Clinical & Pathological Pattern of Hodgkin Lymphoma in Middle Euphrates Region of Iraq. Karbala J Med. 2021 Jan 11;13(2):2355-60.

15. Mjali A, Al Baroodi BN. Some Facts About Cancers in Karbala province of Iraq, 2012-2020. Asian Pac J Cancer Care. 2020 Jun 7;5(2):67-9.
16. Mjali A, Sheikha A, Amin HA, Al-Anssari MJ, Aljawdah ZD, Abbas SK. Association between Female Breast Cancer and Different ABO Blood Groups & Rh Factor in the Sulaymaniyah Province of Iraqi Kurdistan. Indian J Public Health Res Dev. 2019;10(6):454-9.

17. Mjali A, Hasan ZK. Incidence of Hand-Foot Syndrome in Metastatic Breast Cancer Patients Treated with Capecitabine in Middle Euphrates Region of Iraq. Sci J Med Res. 2020;4(16):138-41.
18. Mjali A, Kareem YA, Al–Shammari HH, et al. Chronic myeloid leukemia patient with isolated central nervous system blast crisis. World J Pharm Pharm Sci.2019;8(9):111-117.

19. Mjali A, Hasan DM, Al-Anssari MJ, et al. Myeloid sarcoma as the presenting symptom of chronic myeloid leukemia chronic phase: A case report. World J PharmRes.2017; 6 (13): 10-15.

20. Kimmick G, Anderson R, Camacho F, Bhosle M, Hwang W, Balkrishnan R. Adjuvant hormonal therapy use among insured, low-income women with breast cancer. J Clin Oncol. 2009 Jul 20;27(21):3445.
21. Wigertz A, Ahlgren J, Holmqvist M, Fornander T, Adolfsson J, Lindman H, et al. Adherence and discontinuation of adjuvant hormonal therapy in breast cancer patients: a population-based study. Breast Cancer Res Treat. 2012 May 1;133(1):367-73.

22. Partridge AH, La Fountain A, Mayer E, Taylor BS, Winer E, Asnis-Alibozek A. Adherence to initial adjuvant anastrozole therapy among women with early-stage breast cancer. J Clin Oncol. 2008 Feb 1;26(4):556-62.
23.Philipovskiy A, Campbell A, Heydarian R, Lin K, Nahleh ZA. Adherence to aromatase inhibitors (AIs) in Hispanic patients with early stage breast cancer. J Clin Oncol. 36, 70–70 (2018).

24.Ali EE, Cheung KL, Lee CP, Leow JL, Yap KY, Chew L. Prevalence and determinants of adherence to oral adjuvant endocrine therapy among breast cancer patients in Singapore. Asia Pac J Oncol Nurs. 2017 Oct;4(4):283.

25. Mjali A, Hasan ZK, Mohsin KK. Outcomes of Patients with Chronic Lymphocytic Leukemia Treated with Chemotherapy in Middle Euphrates Region of Iraq: Data from Developing Country. Int J Pharm Res. 2020 Oct;12(4).

26. Neugut AI, Zhong X, Wright JD, Accordino M, Yang J, Hershman DL. Nonadherence to medications for chronic conditions and nonadherence to adjuvant hormonal therapy in women with breast cancer. JAMA Oncol. 2016 Oct 1;2(10):1326-32.

27. Mjali A, Al Baroodi BN , Al–Shammari HH, et al. "Skin Reaction at Site of Intrathecal Methotrexate". World J Pharm Res.2019;8 (10):170-173.
28. Mjali A, Al-Anssari MJ, Al-Shammari HH. "Vincristine Induced Vocal Cord Paralysis in Patient with Diffuse Large B-cell Lymphoma: A Case Report". World J Pharm Res. 2017; 6(12): 11-15.
29. Shi Q, Giordano SH, Lu H, Saleeba AK, Malveaux D, Cleeland CS. Anastrozole-associated joint pain and other symptoms in patients with breast cancer. J Pain. 2013 Mar 1;14(3):290-6.
30. Mouridsen HT. Incidence and management of side effects associated with aromatase inhibitors in the adjuvant treatment of breast cancer in postmenopausal women. Curr Med Res Opin. 2006 Aug 1;22(8):1609-21.

Published

2021-06-29