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Can demographic, clinical and treatment-related factors available at hormonal therapy initiation predict non-persistence in women with stage I–III breast cancer?

Lookup NU author(s): Professor Linda Sharp



This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC 4.0).


© 2017, Springer International Publishing Switzerland.Purpose: To investigate whether demographic, clinical and treatment-related risk factors known at treatment initiation can be used to reliably predict future hormonal therapy non-persistence in women with breast cancer, and to inform intervention development. Methods: Women with stage I–III breast cancer diagnosed 2000–2012 and prescribed hormonal therapy were identified from the National Cancer Registry Ireland (NCRI) and linked to pharmacy claims data from Ireland’s Primary Care Reimbursement Services (PCRS). Non-persistence was defined as a treatment gap of ≥180 days within 5 years of initiation. Seventeen demographic, clinical and treatment-related risk factors, identified from a systematic review, were abstracted from the NCRI-PCRS dataset. Multivariate binomial models were used to estimate relative risks (RR) and risk differences (RD) for associations between risk factors and non-persistence. Calibration and discriminative performance of the models were assessed. The analysis was repeated for early non-persistence (<1 year of initiation). Results: Within 5 years of treatment initiation 680 women (19.9%) were non-persistent. Women aged <50 years (adjusted RR 1.41, 95% CI 1.16–1.70) and those prescribed antidepressants (RR 1.22, 95% CI 1.04–1.45) had increased risk of non-persistence. Married women (RR 0.82 95% CI 0.71–0.94) and those with prior medication use (RR 0.62 95% CI 0.51–0.75) had reduced risk of non-persistence. The area under the receiver-operating characteristic (ROC) curve for non-persistence was 0.61. Findings were similar for early non-persistence. Conclusion: The risk prediction model did not discriminate well between women at higher and lower risk of non-persistence at treatment initiation. Future studies should consider other factors, such as psychological characteristics and experience of side-effects.

Publication metadata

Author(s): Cahir C, Barron TI, Sharp L, Bennett K

Publication type: Article

Publication status: Published

Journal: Cancer Causes and Control

Year: 2017

Volume: 28

Issue: 3

Pages: 215-225

Print publication date: 01/03/2017

Online publication date: 16/02/2017

Acceptance date: 15/01/2017

Date deposited: 11/07/2017

ISSN (print): 0957-5243

ISSN (electronic): 1573-7225

Publisher: Springer International Publishing


DOI: 10.1007/s10552-017-0851-9


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