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Analysis of the influence of the doctor on the compliance of breast cancer patients

Dira Marie Schneider / Prof. Dr. re. medical habil. Karel Kostev MA / Laura Oschmann / Prof. Dr. habil. Lilia Waehlert / Stefan Groeger / Tobias Karsten

Breast cancer is the most common type of cancer in women. In Germany, approximately 71,600 women were diagnosed with breast cancer in 2008; around 17,000 died from it (1). This corresponds to approximately 30% of new cancer cases and 15% of deaths (2). In recent years there have been significant advances in the treatment of breast cancer. Today, thanks to improved surgical methods and modern medications, the majority of patients can be cured. In order to reduce the risk of recurrence, patients affected by carcinoma are usually prescribed adjuvant therapy with tamoxifen or aromatase inhibitors for a period of five years. The active ingredient tamoxifen has proven itself in adjuvant therapy after surgical tumor removal in premenopausal patients. It is considered a standard medication for antihormone therapy and reduces the number of breast cancer relapses by half (3, 4). Aromatase inhibitors are a treatment option that is mainly used in postmenopausal women. According to many studies, aromatase inhibitors are superior in use to tamoxifen (5-8).

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First publication date: 27.02.2012
Dira-Marie SchneiderDira Marie SchneiderProf. Dr. rer. med. habil. Karel Kostev MAProf. Dr. re. medical habil. Karel Kostev MALaura OschmannLaura OschmannProf. Dr. habil. Lilia WaehlertProf. Dr. habil. Lilia WaehlertStefan GrögerStefan GroegerTobias KarstenTobias Karsten

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Abstract: Analyse des Einflusses des Arztes auf die Compliance von Brustkrebs-Patientinnen

In den letzten Jahren gab es bedeutende Fortschritte in der Behandlung von Brustkrebs. Aber entscheidend für den Therapieerfolg ist die regelmäßige Einnahme des verordneten Medikamentes über einen ausreichenden Zeitraum. Bisher gibt es im deutschsprachigen Raum keine publizierten datenbankbasierten Studien, die den Einfluss des Arztes auf die Compliance seiner Patienten empirisch untersuchen. Ziel der vorliegenden Studie ist es, den Einfluss behandelnder Ärzte auf die Compliance ihrer Brustkrebspatientinnen zu untersuchen, zu quantifizieren und die Ergebnisse kritisch zu diskutieren. Patientinnen mit der gesicherten Diagnose Brustkrebs im Zeitraum 01/2004-12/2011, die mit einer Therapie (Tamoxifen bzw. Aromatasehemmer) begonnen haben, wurden in der repräsentativen IMS Disease Analyzer Datenbank selektiert und hinsichtlich ihrer Compliance ausgewertet. Praxen wurden in Bezug auf Compliance aller in diesen Praxen behandelten Patientinnen in zwei Kategorien unterteilt. Aus dem Regressionsmodel ergab sich, dass eine Brustkrebspatientin, die in einer Praxis mit tendenziell schlechter Compliance behandelt wird, ein fast 60% höheres Risiko für den Therapieabbruch aufweist, als es in einer Praxis mit guter Compliance der Fall wäre. Allein diese Aussage macht die Dringlichkeit deutlich, Ärzte zu motivieren, für die Gesundheit ihrer Patienten auf gute Compliance-Werte zu achten.

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Summary
In recent years there have been significant advances in the treatment of breast cancer. But taking the prescribed medication regularly over a sufficient period of time is crucial for the success of the therapy. To date, there are no published database-based studies in German-speaking countries that empirically examine the influence of doctors on their patients' compliance. The aim of the present study is to examine and quantify the influence of treating physicians on the compliance of their breast cancer patients and to critically discuss the results.
Patients with a confirmed diagnosis of breast cancer in the period 01/2004-12/2011 who started therapy (tamoxifen or aromatase inhibitors) were selected in the representative IMS Disease Analyzer database and evaluated for their compliance. Practices were divided into two categories in terms of compliance of all patients treated in these practices. The regression model showed that a breast cancer patient who is treated in a practice with poor compliance has an almost 60% higher risk of treatment discontinuation than would be the case in a practice with good compliance. This statement alone makes clear the urgency of motivating doctors to ensure good compliance values for the health of their patients.

The effect of the prescribing doctor on the compliance of brest cancer patients
In the last few years, there have been significant advances in the treatment of breast cancer. However, important for the success of the therapy is the regular intake of prescribed drugs over an adequate time period. Up to now, there have been no published, evidence based studies in German speaking countries which have investigated the effect of the prescribing doctor on the compliance of his patients. It is the aim of the present study to assess and quantify the prescriber effect on compliance of breast cancer patients and to discuss the results critically. Patients with an ascertained diagnosis of breast cancer in the time period 01/2004-12/2011 who started therapy in this time frame with Tamoxifen or an aromatase inhibitor were selected in the representative database IMS Disease Analyzer and investigated with respect to treatment compliance. Practices were divided into two groups depending on the compliance of their patients. The regression model showed that a patient treated in a practice with inferior compliance patients had an almost 60% higher risk of terminating treatment than would have been the case in a high compliance practice. This result alone demonstrates the importance of motivating doctors to check the compliance of their patients for the sake of the latter's health.”

keywords
Breast cancer, compliance, disease analyzer, doctor-patient relationship

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