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A prospective cohort study of early discontinuation of adjuvant chemotherapy in women with breast cancer: the breast cancer quality of care study (BQUAL)

  • Epidemiology
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Abstract

For many women with non-metastatic breast cancer, adjuvant chemotherapy prevents recurrence and extends survival. Women who discontinue chemotherapy early may reduce those benefits, but little is known about what predicts early discontinuation. We sought to determine prospectively the rate and reasons for early discontinuation of adjuvant chemotherapy in women with breast cancer. We conducted a prospective cohort study among three U.S. health care organizations. Of 1158 women with newly diagnosed non-metastatic breast cancer, 2006–2010, we analyzed 445 (38.4 %) patients who initiated standard adjuvant chemotherapy as defined by accepted guidelines. We interviewed patients at baseline and twice during treatment regarding sociodemographic/psychosocial factors and treatment decision-making and collected clinical data. They were categorized according to the number of cycles required by the chemotherapy regimen they had initiated. The outcome was early discontinuation (<80 % of planned cycles). Of patients analyzed, 392 (88.1 %) completed the prescribed therapy. The strongest predictor was receipt of a regimen entailing >4 cycles of therapy (18.1 % for longer regimens, 7.4 % for 4 cycles) (odds ratio [OR] 2.59, 95 % CI 1.32–5.08), controlling for race, age, stage, hormone receptor status, social support, optimism, spirituality, stress, and physical symptoms. Higher levels of psychological symptoms on the Memorial symptom assessment scale also increased the odds of early discontinuation (OR 1.92, 95 % CI 0.998–3.68). The large majority of patients who initiated adjuvant chemotherapy for breast cancer completed their prescribed regimens, but early discontinuation was associated with lengthier regimens and, with borderline statistical significance, for those with psychological side effects.

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Acknowledgments

This study was supported by the Department of Defense Breast Cancer Center of Excellence Award (BC043120) to Dr. Neugut, NCI R01 (CA105274), Department of Defense Center for Biobehavioral Breast Cancer Research to Dr. Kushi, and Department of Defense (DAMD-17-01-1-0334) to Dr. Bovbjerg, and K05 (CA96940) to Dr. Mandelblatt. Dr. Hershman is a recipient of funding from the Breast Cancer Research Foundation.

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Authors and Affiliations

  1. Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY, USA

    Alfred I. Neugut & Dawn L. Hershman

  2. Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons, Columbia University, New York, NY, USA

    Alfred I. Neugut, Grace Clarke Hillyer, Wei-Yann Tsai, Judith S. Jacobson & Dawn L. Hershman

  3. Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA

    Alfred I. Neugut, Grace Clarke Hillyer, Donna L. Buono, Judith S. Jacobson & Dawn L. Hershman

  4. Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA

    Wei-Yann Tsai

  5. Division of Research, Kaiser Permanente of Northern California, Oakland, CA, USA

    Lawrence H. Kushi

  6. Department of Public Health Sciences, Henry Ford Health System, Detroit, MI, USA

    Lois Lamerato

  7. Department of Surgery, Henry Ford Health System, Detroit, MI, USA

    S. David Nathanson

  8. Departments of Psychiatry, Psychology and Behavioral & Community Health Sciences, University of Pittsburgh, University of Pittsburgh Cancer Institute, Pittsburgh, PA, USA

    Dana H. Bovbjerg

  9. Department of Oncology and Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA

    Jeanne S. Mandelblatt

  10. Columbia University Medical Center, 722 W 168th Street, Room 725, New York, NY, 10032, USA

    Alfred I. Neugut

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  1. Alfred I. Neugut
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  2. Grace Clarke Hillyer
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  3. Lawrence H. Kushi
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  7. Dana H. Bovbjerg
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  8. Jeanne S. Mandelblatt
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Correspondence to Alfred I. Neugut.

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Conflict of interest

Dr. Neugut has served as a consultant to Pfizer, Teva, Otsuka, and United Biosource Corporation. He is on the medical advisory board of EHE, Intl. No other authors report any potential conflicts of interest. All of the authors are responsible for the data analysis and interpretation.

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Neugut, A.I., Hillyer, G.C., Kushi, L.H. et al. A prospective cohort study of early discontinuation of adjuvant chemotherapy in women with breast cancer: the breast cancer quality of care study (BQUAL). Breast Cancer Res Treat 158, 127–138 (2016). https://doi.org/10.1007/s10549-016-3855-3

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