Adjuvant endocrine therapy non-initiation and non-persistence in young women with early-stage breast cancer

Shoshana M. Rosenberg, Yue Zheng, Shari Gelber, Kathryn J. Ruddy, Philip Poorvu, Tal Sella, Rulla M. Tamimi, Johanna Wassermann, Lidia Schapira, Virginia F. Borges, Steven Come, Jeffrey Peppercorn, Karen R. Sepucha, Ann H. Partridge

Research output: Contribution to journalArticlepeer-review


Purpose: Characterizing oral adjuvant endocrine therapy (ET) non-initiation and non-persistence in young women with breast cancer can inform strategies to improve overall adherence in this population. Methods: We identified 693 women with hormone receptor-positive, stage I–III breast cancer enrolled in a cohort of women diagnosed with breast cancer at age ≤ 40 years. Women were classified as non-initiators if they did not report taking ET in the 18 months after diagnosis. Women who initiated but did not report taking ET subsequently (through 5-year post-diagnosis) were categorized as non-persistent. We assessed ET decision-making and used logistic regression to identify factors associated with non-initiation/non-persistence and to evaluate the association between non-persistence and recurrence. Results: By 18 months, 9% had not initiated ET. Black women had higher odds and women with a college degree had lower odds of non-initiation. Among 607 women who initiated, 20% were non-persistent. Younger age, being married/partnered, and reporting more weight problems were associated with higher odds of non-persistence; receipt of chemotherapy and greater hot flash and vaginal symptom burden were associated with lower odds of non-persistence. Adjusting for age and clinical characteristics, non-persistence was associated with lower odds of recurrence. Women who initiated were more likely to report shared decision-making than non-initiators (57% vs. 38%, p = 0.049), while women who were non-persistent were less likely to indicate high confidence with the decision than women who were persistent (40% vs. 63%, p < 0.001). Conclusion: Interventions to improve ET decision-making may facilitate initiation and address barriers to adherence in young breast cancer survivors. Trial registration:, NCT01468246.

Original languageEnglish (US)
Pages (from-to)547-558
Number of pages12
JournalBreast Cancer Research and Treatment
Issue number3
StatePublished - Feb 2023


  • Adherence
  • Adjuvant endocrine therapy
  • Breast cancer
  • Non-initiation
  • Survivors

ASJC Scopus subject areas

  • Oncology
  • Cancer Research


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