[Adherence to adjuvant hormonal therapy in patients with breast cancer]

Rev Med Inst Mex Seguro Soc. 2019 Dec 30;57(6):357-363.
[Article in Spanish]


Background: Adherence to hormonal therapy (HT) treatment is a complex and multifaceted issue that can determine variations in response to treatment. However, it is little known about it in routine clinical practice.

Objective: To assess adherence to HT from 1 to 5 years of 190 patients treated at the Hospital de Clínicas (in Montevideo, Uruguay), and to identify factors for the interruption of therapy.

Material and methods: 190 patients treated with HT due to S I-III breast cancer were included from 2002 to 2012. The Kaplan Meier method was used to assess the proportion of patients who discontinued HT, and the univariate analysis with log-rank test was used to identify factors leading to its interruption.

Results: Out of 190 patients enrolled in the study, 95.3, 87.9, 80.6, 76.4, and 69.5% were still complying with their HT by the first, second, third, fourth and fifth year, respectively. Therapy continuity was greater in patients who received HT combined with tamoxifen and aromatase inhibitors vs. those who received a single drug (p = 0.017).

Conclusion: This real-life evaluation showed that HT adherence was reduced by 30.5% at 5 years, despite that there is a well-known benefit of this treatment on overall survival (OS), that it is well-tolerated, and provided for free. In view of the significant impact that HT interruption may have on OS, further investigation is required to determine what cause patients to discontinue their HT, in order to guide our efforts and enable us to increase and optimize adherence.

Introducción: la adhesión al tratamiento con hormonoterapia (HT) es un tema complejo y polifacético que puede determinar variantes en la respuesta al tratamiento. Sin embargo, se sabe poco acerca de la misma en la práctica clínica habitual.

Objetivo: evaluar la adherencia a HT de uno a cinco años de 190 pacientes tratadas en el Hospital de Clínicas (de Montevideo, Uruguay) e identificar factores de interrupción de la terapia.

Material y métodos: se incluyeron, de 2002 a 2012, 190 pacientes tratadas con HT por cáncer de mama E I-III. Se utilizó el método de Kaplan Meier para valorar la proporción de pacientes que abandonó la HT y el análisis univariado con prueba de log-rank para identificar los factores que podrían influir en su interrupción.

Resultados: de las 190 pacientes incluidas, las proporciones de quienes mantuvieron adhesión a la HT, desde el primero hasta el quinto año, fueron sucesivamente de 95.3, 87.9, 80.6, 76.4 y 69.5%. Las pacientes que recibieron HT combinada con tamoxifeno e inhibidores de la aromatasa tuvieron mayor continuidad en el tratamiento respecto de aquellas que recibieron una única droga (p = 0.017).

Conclusión: evaluamos la adhesión a la HT en la vida real y se redujo un 30.5% en cinco años, a pesar de su conocido beneficio en sobrevida global (SVG), de ser un tratamiento bien tolerado y brindado en forma gratuita. Se deben investigar los motivos de su interrupción, a fin de optimizar su adhesión y ahondar en los esfuerzos para aumentar su cumplimiento, dado el impacto que puede tener en la SVG.

Keywords: Aromatase Inhibitors; Breast Neoplasms; Tamoxifen; Treatment Adherence and Compliance.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Antineoplastic Agents, Hormonal / therapeutic use*
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use*
  • Aromatase Inhibitors / therapeutic use
  • Breast Carcinoma In Situ / drug therapy*
  • Breast Carcinoma In Situ / pathology
  • Breast Carcinoma In Situ / surgery
  • Breast Neoplasms / drug therapy*
  • Breast Neoplasms / pathology
  • Breast Neoplasms / surgery
  • Carcinoma, Ductal, Breast / drug therapy*
  • Carcinoma, Ductal, Breast / pathology
  • Carcinoma, Ductal, Breast / surgery
  • Female
  • Humans
  • Kaplan-Meier Estimate
  • Medication Adherence / statistics & numerical data*
  • Middle Aged
  • Patient Dropouts
  • Retrospective Studies
  • Tamoxifen / therapeutic use
  • Time Factors
  • Uruguay


  • Antineoplastic Agents, Hormonal
  • Aromatase Inhibitors
  • Tamoxifen