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Master Thesis

Impact de l'adhérence et de la persistance aux hormonothérapies orales sur la mortalité des patientes traitées pour un cancer du sein

Abstract : Background: Non-persistence and non-adherence to oral hormonal anticancer drugs (tamoxifen or aromatase inhibitors) have been reported in women treated for hormone receptor-positive breast cancer (BC) but little is known about their impact on mortality. Objective: To evaluate the association of non-adherence and non-persistence of hormonal therapy in BC on mortality Method: A retrospective cohort of women initiating an hormonal therapy between 2006 and 2008, surviving after the first year of treatment, and followed 5 years after initiation or until death was set up using reimbursement data of the French national healthcare insurance database (Echantillon Généraliste de Bénéficiaires, EGB). Within this cohort, a nested case-control has been conducted to evaluate the impact on mortality of i) hormonal therapy non-persistence (treatment discontinuation > 90 days) and ii) hormonal therapy non-adherence (Medication Possession Ratio, MPR, <80%). Cases were defined as women who died from any causes during the study period. Controls (1:3) were selected among those still alive at the date of cases death (index date) and matched on the onset date of treatment. Associations were assessed globally, for the 1rst year of treatment and the year preceding the index date. Conditional logistic regression was used for analysis. Results: A total of 125 cases and 374 controls were identified for the study. Globally, non-adherent (ORadj=5.3, 95%CI [3.0; 9.6]) and non-persistent women (ORadj=2.5, 95%CI [1.3; 4.9]) were more likely to die. This association was not found for the 1rst year after treatment onset (non-adherence:1.8, 95%CI [1.0; 3.4]); non-persistence: 0.7, 95%CI [0.2; 2.7]). Considering the year prior the index date, non-adherent women had a significant higher risk of death (ORadj=4.1, 95%CI [1.3; 13.3]). No significant association was found for non-persistence (ORadj=0.3, 95%CI [0.1; 3.2]). Conclusion: This study showed that non-adherence and non-persistence to hormonal therapy may have an impact of mortality risk. However, the risk varies according the time-window considered to measure adherence and non-persistence.
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Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-01216648
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Submitted on : Friday, October 16, 2015 - 3:41:49 PM
Last modification on : Wednesday, August 23, 2017 - 4:33:32 PM
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Pauline Bosco-Lévy. Impact de l'adhérence et de la persistance aux hormonothérapies orales sur la mortalité des patientes traitées pour un cancer du sein. Médecine humaine et pathologie. 2015. ⟨dumas-01216648⟩

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