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KMID : 1134120190220010086
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Journal of Breast Cancer
2019 Volume.22 No. 1 p.86 ~ p.95
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Prescription Refill Gap of Endocrine Treatment from Electronic Medical Records as a Prognostic Factor in Breast Cancer Patients
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Lee Yu-Ra
Park Yu-Rang
Lee Ji-Sung
Lee Sae-Byul
Chung Il-Yong
Son Byung-Ho
Ahn Sei-Hyun
Lee Jong-Won
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Abstract
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Purpose: Discontinuation of hormone therapy is known to lead to a poorer prognosis in breast cancer patients. We aimed to investigate the prescription gap as a prompt index of medication adherence by using prescription data extracted from patient electronic medical records.
Methods: A total of 5,928 patients diagnosed with invasive, non-metastatic breast cancer, who underwent surgery from January 1, 1997 to December 31, 2009, were enrolled retrospectively. The prescription data for 4.5 years of hormonal treatment and breast cancer-related events after treatment completion were analyzed. We examined the characteristics and prognoses of breast cancer in patients with and without a 4-week gap.
Results: Patients with a gap showed a significantly higher risk of breast cancer recurrence, distant metastasis, breast cancer-specific death, and overall death after adjustment (hazard ratio [HR], 1.389; 95% confidence interval [CI], 1.089?1.772; HR, 1.568; 95% CI, 1.158?2.123; HR, 2.108; 95% CI, 1.298?3.423; and HR, 2.102; 95% CI, 1.456?3.034, respectively). When patients were categorized based on gap summation, the lower third (160 days) and fourth (391 days) quartiles showed a significantly higher risk of distant metastasis (HR, 1.758; 95% CI, 1.186?2.606 and HR, 1.844; 95% CI, 1.262?2.693, respectively).
Conclusion: A gap of > 4 weeks in hormonal treatment has negative effects on breast cancer prognosis, and can hence be used as a sentinel index of higher risk due to treatment non-adherence. Further evaluation is needed to determine whether the gap can be used as a universal index for monitoring the adherence to hormonal treatment.
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KEYWORD
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Breast neoplasms, Estrogen antagonists, Medication adherence, Neoplasm metastasis
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