Wheeler SB, et al. - Authors evaluated the racial differences in endocrine therapy (ET) behaviors in breast cancer outcome. Important racial differences in ET-adherence behaviors, perceptions of benefits/harms, and shared decision making that could be targeted with culturally tailored interventions were highlighted in the findings. Hot flashes, night sweats, breast sensitivity, joint pain, believing that if they stopped ET their recurrence risk would not change, forgetting to take ET, and cost-related barriers were most often reported in black women.

Methods

• Researchers included women aged 20–74 years with a first primary, stage I–III, hormone receptor–positive (HR+) breast cancer.
• They evaluated the nonadherence (defined as not taking ET every day or missing more than two pills in the past 14-days), discontinuation, and a composite of underuse, defined as either missing pills or discontinuing completely, at 2-years postdiagnosis.
• They assessed the relationship between race and nonadherence, discontinuation, and overall underuse in unadjusted, clinically adjusted, and socioeconomically adjusted models using logistic regression.

Results

• As per data, a total of 1,280 women were included; 43.2% self-identified as black.
• Black women vs white women more often reported nonadherence (13.7% vs 5.2%) but not discontinuation (10.0% vs 10.7%).
• Findings suggested hot flashes, night sweats, breast sensitivity, joint pain, believing that if they stopped ET their recurrence risk would not change, forgetting to take ET, and cost-related barriers were most often reported in black women.
• Multivariable analysis showed statistically significant association of black race with nonadherence after adjusting for clinical characteristics (adjusted odds ratio = 2.72, 95% confidence interval = 1.75 to 4.24) and after adding socioeconomic to clinical characteristics (adjusted odds ratio = 2.44, 95% confidence interval = 1.50 to 3.97), but it was not independently associated with discontinuation after adjustment.
• Across races, ET underuse was strongly predicted by low recurrence risk perception and lack of a shared decision making.