July 12, 2023
Journal of the National Cancer Institute

Adjuvant endocrine therapy uptake, toxicity, quality of life, and prediction of early discontinuation


Many patients receiving adjuvant endocrine therapy (ET) for breast cancer experience side effects and reduced quality of life (QoL) and discontinue ET. We sought to describe these issues and develop a prediction model of early discontinuation of ET.


Among patients with hormone receptor–positive and HER2-negative stage I-III breast cancer of the Cancer Toxicities cohort (NCT01993498) who were prescribed adjuvant ET between 2012 and 2017, upon stratification by menopausal status, we evaluated adjuvant ET patterns including treatment change and patient-reported discontinuation and ET-associated toxicities and impact on QoL. Independent variables included clinical and demographic features, toxicities, and patient-reported outcomes. A machine-learning model to predict time to early discontinuation was trained and evaluated on a held-out validation set.


Patient-reported discontinuation rate of the first prescribed ET at 4 years was 30% and 35% in 4122 postmenopausal and 2087 premenopausal patients, respectively. Switching to a new ET was associated with higher symptom burden, poorer QoL, and higher discontinuation rate. Early discontinuation rate of adjuvant ET before treatment completion was 13% in postmenopausal and 15% in premenopausal patients. The early discontinuation model obtained a C index of 0.62 in the held-out validation set. Many aspects of QoL, most importantly fatigue and insomnia (European Organization for Research and Treatment of Cancer QoL questionnaire 30), were associated with early discontinuation.


Tolerability and adherence to ET remains a challenge for patients who switch to a second ET. An early discontinuation model using patient-reported outcomes identifies patients likely to discontinue their adjuvant ET. Improved management of toxicities and novel more tolerable adjuvant ETs are needed for maintaining patients on treatment.

Felix Balazard
Aurélie Bertaut
Élise Bordet
Stéphane Mulard
Julie Blanc
Nathalie Briot
Gautier Paux
Asma Dhaini Merimeche
Olivier Rigal
Charles Coutant
Marion Fournier
Christelle Jouannaud
Patrick Soulie
Florence Lerebours
Paul-Henri Cottu
Olivier Tredan
Laurence Vanlemmens
Christelle Levy
Marie-Ange Mouret-Reynier
Mario Campone
Keri J S Brady
Medha Sasane
Megan Rice
Catherine Coulouvrat
Anne-Laure Martin
Alexandra Jacquet
Ines Vaz-Luis
Christina Herold
Barbara Pistilli