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  • One significant problem associated with chronic conditions i

    2019-05-31

    One significant problem associated with chronic conditions is the lack of treatment persistence and compliance. It has been demonstrated that around 50% of patients suffering from such conditions discontinue their therapy early [10]. In the case of BC, older women are known to be at a higher risk of treatment discontinuation than younger women [11]. This has also been demonstrated in several studies concerning the adjuvant treatment of women with BC. Consequently, lower persistence in older women with BC and bone metastases treated with BIS would lead to a reduced clinical benefit. Recently, Hadji and colleagues demonstrated that persistence with intravenous and oral BIS is unexpectedly low and ought to be increased [12]. The aim of our study was to compare persistence with intravenous and oral breast cancer-related BIS treatment in younger (<70) and older (≥70) women with BC treated in gynecological practices in Germany.
    Methods
    Results
    Discussion BC is a cancer that is frequently associated with metastases, particularly bone metastases. These malignant bone diseases have a negative impact on the balance between bone formation and resorption [12]. Although BIS are one component of the standard recommended treatment for women with BC and bone metastases, both their safety and their efficacy profile need to be taken into account. Thus, therapy persistence is of the utmost importance in achieving the optimal outcome as observed in RCTs. Nonetheless, treatment discontinuation rates are high, reaching 50% in patients with chronic diseases. One of the major factors impacting treatment discontinuation in women with BC is age [11,17]. On the basis of their study in 2003 including 2378 postmenopausal women with BC from New Jersey, Partridge et al. demonstrated that both patients aged <45 and >85 were at a higher risk of therapy discontinuation [18]. He and his colleagues recently corroborated these results in 3395 women with BC from Sweden, since women <40 and >65 had a higher likelihood of treatment discontinuation [19]. There are several hypotheses that may explain this tlr signaling non-linear, complex relationship between therapy persistence and age. It is known that older women are more commonly affected by BC than younger women and thus tend to adjust better to this chronic disease [20–22]. Since the prognosis for younger women with BC is worse on average than that for older women with the disease, their poor compliance and persistence is of particular concern [23]. By contrast, patients aged >80 usually suffer from multiple diseases and insufficient social/familial support, leading to a decrease in treatment compliance and persistence [18,24]. Interestingly, several studies have also demonstrated that persistence with BIS therapy increases with age [25,26]. In their 2005 study comprising 2124 postmenopausal women treated with alendronate, etidronate, or risedronate, Penning-van Beest and colleagues found that BIS persistence was higher in patients aged between 65 and 69 and between 70 and 74 than in patients aged between 55 and 59 [25]. Three years later, Gallagher et al. showed in 44,531 patients treated with oral BIS that patients aged >60 exhibit higher compliance and persistence rates than patients <60 [26]. Therefore, our findings are in line with these reports and demonstrate that age positively impacts BIS treatment persistence in women with BC and bone metastases. Our study also showed that the risk of treatment discontinuation is lower in patients treated in gynecological practices than in those receiving treatment in general practices. In this context, Haploid is worth mentioning that in Germany, gynecologists are customarily responsible for the treatment and management of women with BC. Interestingly, chemotherapy, endocrine treatment, pain medications, and the number of drugs served in preventing discontinuation. This result is not in line with those of He et al., who recently reported that the number of medications decreased persistence with endocrine treatment in BC patients [19]. Nonetheless, there are two important differences in our study. We did not analyze persistence with endocrine treatment, rather, we focused on BIS therapy and also only included women with BC and bone metastases. It is possible that the follow-up of patients with high numbers of treatments was more specific than the follow-up of patients with lower numbers of medications.