J Breast Cancer.  2019 Mar;22(1):86-95. 10.4048/jbc.2019.22.e14.

Prescription Refill Gap of Endocrine Treatment from Electronic Medical Records as a Prognostic Factor in Breast Cancer Patients

• Lee Y
• Park YR
• Lee JS
• Lee SB
• Chung IY
• Son BH
• Ahn SH
• Lee JW

• KMID: 2441854
• DOI: http://doi.org/10.4048/jbc.2019.22.e14

Abstract

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.

Keyword

Breast Neoplasms; Estrogen Antagonists; Medication Adherence; Neoplasm Metastasis

MeSH Terms

Breast Neoplasms*
Breast*
Electronic Health Records*
Estrogen Antagonists
Humans
Medication Adherence
Neoplasm Metastasis
Prescriptions*
Prognosis
Recurrence
Retrospective Studies
Estrogen Antagonists

Figure

• 

  Figure 1 Flow diagram of patient selection; a total of 5,928 patients were enrolled in this study. AMC = Asan Medical Center.

• 

  Figure 2 Unadjusted Kaplan-Meier curves comparing patients with a gap and patients without a gap in terms of 4 possible outcomes of breast cancer: (A) Breast cancer recurrence (of any type), (B) Distant metastasis, (C) Breast cancer-specific death, and (D) Overall death.

• 

  Figure 3 RR of the gap sum for distant metastasis of breast cancer, adjusted by age at diagnosis, breast cancer stage, chemotherapy, and radiation therapy. RR = relative risk.

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