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

• Published in: Journal of breast cancer Vol. 22; no. 1; pp. 86 - 95
• Main Authors: Lee, Yura, Park, Yu Rang, Lee, Ji Sung, Lee, Sae Byul, Chung, Il Yong, Son, Byung Ho, Ahn, Sei Hyun, Lee, Jong Won
• Format: Journal Article
• Language: English
• Published: Korea (South) Korean Breast Cancer Society 01.03.2019; 한국유방암학회
• Subjects: Original; 일반외과학; Medication adherence; Breast neoplasms; Estrogen antagonists; Neoplasm metastasis
• ISSN: 1738-6756; 2092-9900
• DOI: 10.4048/jbc.2019.22.e14

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. 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. 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). 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.