It is known that suboptimal adherence rates may affect endocrine treatments for breast cancer, but little information has been reported whether any efforts to improve treatment adherence have been successful. We designed a randomized, controlled study to investigate the effect of oral or written patient information program on adherence and persistence when receiving an aromatase inhibitor (AI).

Osteoporosis can be effectively treated with a number of medications. However, high persistence and compliance are required to assure efficacy. This study analyses persistence and compliance with a variety of medical interventions including p.o., i.v. and s.c. administrations in Germany. This retrospective cohort study used a representative longitudinal database (IMS® LRx) comprising longitudinal prescription data for Germany from almost 80% of all German prescriptions of members of the German statutory health insurance system. Persistence is defined as the proportion of patients who remained on their initially prescribed therapy at 1 year. Compliance is measured indirectly based on the medication possession ratio (MPR). A total of more than 1 million patients (1,107,482) for the period 07/2007 - 06/2009 was identified in the database who received a prescription for a bisphosphonate, strontium or PTH. Of these, 268,568 patients fulfilled further inclusion criteria and were included in the persistence and compliance analysis. At 12 months the proportion of patients that remained on treatment were 65.6% for zoledronate 5 mg; 56.6% for ibandronate i.v. 3 mg; 54.7% for PTH (teriparatide and 1-84 PTH), 51.0% for ibandronate 150 mg p.o.; 44.8% for alendronate 70 mg; 43.4% for etidronate. Other values were risedronate plus calcium 42.3%; alendronate plus vitamin D 37.8%; risedronate 35 mg 35.2%; risedronate 5 mg 30.6%; strontium ranelate 31.4% and alendronate 10 mg 17.3%. Persistence and compliance during the treatment of osteoporosis were found to be insufficient. Treatment using the intravenous route and PTH showed the highest persistence and compliance rates and daily oral bisphosphonates the lowest. More effort to improve treatment compliance and persistence is needed to assure clinical efficacy.

Objectives The use of aromatase inhibitors for the adjuvant treatment of breast cancer may affect the quality of life of patients, as well as adherence to treatment. Methods Here we report the 2-year results of the 180 patients in the COMPAS study. This is the first randomized, controlled study reporting on menopausal symptoms under endocrine treatment with aromatase inhibitors in breast cancer patients, based on the Menopause Rating Scale. We analyzed the prevalence of menopausal symptoms as well as their associations with patient adherence. Results Baseline characteristics showed no significant differences among the control and the intervention groups. The majority of women experienced the symptoms at various severities. Overall, we found an increase in the prevalence of hot flushes, sleep disorders, bladder problems, dryness of the vagina as well as of joint and muscular discomfort between the 12- and 24-month visits. In compliant patients, all symptoms except for vaginal dryness improved between the 12- and 24-month visits while, in non-compliant women, hot flushes, irritability, dryness of the vagina as well as joint and muscular discomfort deteriorated. When comparing compliant and non-compliant patients, we found a significant difference only for anxiety (p = 0.028) in the 12-month analysis, as well as a large but non-significant difference for heart discomfort (p = 0.089) in the 24-month visit. Conclusions Our results indicate that the majority of women treated with aromatase inhibitors are experiencing menopausal symptoms at various severities. We showed that the mean symptom values in compliant patients improve with longer therapy duration. Furthermore, anxiety correlates with better compliance, while heart discomfort may lead to therapy discontinuation.