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Patient-reported Adherence to Adjuvant Aromatase Inhibitor Therapy Using the Morisky Medication Adherence Scale: An Evaluation of Predictors

Kesmodel, Susan, B., MD*; Goloubeva, Olga, G., PhD, MSc; Rosenblatt, Paula, Y., MD; Heiss, Brian, MD; Bellavance, Emily, C., MD*; Chumsri, Saranya, MD; Bao, Ting, MD; Thompson, Jennifer, PharmD§; Nightingale, Ginah, PharmD§; Tait, Nancy, S., RN§; Nichols, Elizabeth, M., MD; Feigenberg, Steve, J., MD; Tkaczuk, Katherine, H., MD

American Journal of Clinical Oncology: May 2018 - Volume 41 - Issue 5 - p 508–512
doi: 10.1097/COC.0000000000000314
Original Articles: Breast

Objectives: Endocrine therapy is part of standard adjuvant therapy for patients with hormone receptor-positive breast cancer and has been shown to improve recurrence-free and overall survival. However, adherence to endocrine therapy is suboptimal and is difficult to measure. In this study we evaluate the feasibility of using the Morisky Medication Adherence Scale (MMAS) to assess patient adherence to aromatase inhibitor (AI) therapy.

Methods: Patients with stage 1 to 3, hormone receptor-positive breast cancer receiving adjuvant AI therapy were prospectively enrolled on an Institutional Review Board approved protocol. The MMAS questionnaire was administered to each patient and adherence was measured. Information on duration of AI therapy, patient and tumor characteristics, and treatment was collected. A multivariable logit model approach was utilized to evaluate potential barriers to adherence.

Results: Between 2011 and 2014, 100 patients were enrolled. The distribution of adherence levels was 13% low, 37% medium, and 50% high. High adherence was reported more frequently in white women (58%), patients with stage 2 and 3 disease (54%), and patients who did not receive chemotherapy (62%). Multivariable analysis demonstrated that higher adherence was more likely in white women compared with African American women (estimated odds ratio=2.8).

Conclusions: Using the MMAS, only 50% of women with stage 1 to 3 breast cancer reported high adherence to AI therapy, consistent with other reports showing suboptimal adherence to adjuvant endocrine therapy. The MMAS allows for the rapid assessment of adherence to oral adjuvant endocrine therapy and is valuable in a busy clinical setting.

Departments of *Surgery, Division of General and Oncologic Surgery

Epidemiology and Public Health

Medicine, Division of Hematology and Oncology

Radiation Oncology

§Marlene and Stewart Greenebaum Cancer Center, University of Maryland, Baltimore, MD

The authors declare no conflicts of interest.

Reprints: Susan B. Kesmodel, MD, Department of Surgery, Division of General and Oncologic Surgery, University of Maryland School of Medicine, 29 S. Greene St., Rm GS609B, Baltimore, MD 21201. E-mail:

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