1. A System-Level Approach to Improve the Uptake of Antiestrogen Preventive Therapy among Women with Atypical Hyperplasia and Lobular Cancer In Situ
- Author
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Cristina M. Checka, Lavinia P. Middleton, Therese B. Bevers, Abenaa M. Brewster, Priya Thomas, Powel H. Brown, Robin Coyne, Yuanquing Yan, and Kim Anh Do
- Subjects
Adult ,Selective Estrogen Receptor Modulators ,Cancer Research ,medicine.medical_specialty ,Breast Neoplasms ,Atypical hyperplasia ,03 medical and health sciences ,0302 clinical medicine ,Breast cancer ,Internal medicine ,medicine ,System level ,Humans ,Breast ,030212 general & internal medicine ,Hyperplasia ,Aromatase Inhibitors ,business.industry ,Health Plan Implementation ,Cancer ,Mean age ,Middle Aged ,Antiestrogen ,medicine.disease ,Preventive therapy ,Treatment Outcome ,Oncology ,030220 oncology & carcinogenesis ,Practice Guidelines as Topic ,Patient Compliance ,Female ,Breast Carcinoma In Situ ,business ,Precancerous Conditions ,Follow-Up Studies ,Program Evaluation - Abstract
Background: The low uptake of antiestrogen preventive therapy among women at high risk of developing breast cancer remains a challenge. We implemented a performance improvement program to increase the uptake of preventive therapy among women with atypical hyperplasia (AH) and lobular cancer in situ (LCIS). Methods: A performance improvement program was implemented at the MD Anderson Cancer Center (Houston, TX), November 2015 to February 2017, for patients with a new ( Results: Baseline uptake of preventive therapy was 44%. The program registered 408 patients with a new (n = 87) or existing diagnosis (n = 321) of AH/LCIS; mean age was 57 and 71% were non-Hispanic white. Ninety-eight percent of patients received a recommendation for preventive therapy. The overall prescribing of preventive therapy to patients with a new or existing diagnosis was 82% (monthly range, 40%–100%; Ptrend = 0.76) and 48% (monthly range, 27%–57%; Ptrend < 0.01), respectively. Adherence among patients with a new or existing diagnosis was 76% and 48% (P < 0.01) at 6 months, respectively. Conclusion: A system-level approach improved the uptake of preventive therapy. Identifying women at the time of diagnosis of AH/LCIS and offering a strong recommendation are key components for improving acceptance and adherence with preventive therapy. Cancer Prev Res; 11(5); 295–302. ©2018 AACR.
- Published
- 2018