Breast Cancer Coverage from Every Angle

Racial Differences in Adherence to Endocrine Therapy for Breast Cancer

By: Lauren Harrison, MS
Posted: Monday, December 10, 2018

Based on the findings of a large prospective cohort of women with hormone receptor–positive breast cancer, black women appeared to be more likely to be nonadherent to endocrine therapy but not more likely to discontinue therapy. Racial differences were identified in adherence behaviors to endocrine therapy, perceptions of the benefits/harms of therapy, and shared decision-making. Stephanie B. Wheeler, PhD, MPH, of the University of North Carolina, Chapel Hill, and colleagues published these findings in the Journal of the National Cancer Institute.

“It’s not women’s fault that they’re having a hard time with therapy,” said Dr. Wheeler, referencing the side effects of therapy in an interview with NPR. “It’s a hard medication to take. I think we can do a better job supporting women.”

The study included 1,280 women with primary stage I to III hormone receptor–positive breast cancer; 43.2% of these women self-identified as black. The women were assessed 2 years after diagnosis.

Nonadherence, or not taking endocrine therapy every day or missing more than 2 pills in 14 days, was observed in 13.7% of the black women compared with 5.2% of the white women. Black women also reported forgetting to take endocrine therapy more often and more side effects associated with the therapy, such as hot flashes, night sweats, breast sensitivity, and joint pain.

It is important to note that black women cited cost-related barriers to taking medication more often than white women. When the investigators controlled for socioeconomic status, black women were still less likely to consistently take their medication due to a low recurrence risk perception and a lack of shared-decision making with their physicians. The investigators concluded that “culturally tailored interventions” may assist women to improve both continuation and adherence to endocrine therapy for breast cancer.

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