Familial adversity: association with discontinuation of adjuvant hormone therapy and breast cancer prognosis

Erwei Zeng; Wei He; Arvid Sjölander; Jenny Bergqvist; Fang Fang; Kamila Czene

doi:10.1093/jnci/djae061

Familial adversity: association with discontinuation of adjuvant hormone therapy and breast cancer prognosis

J Natl Cancer Inst. 2024 Mar 12:djae061. doi: 10.1093/jnci/djae061. Online ahead of print.

Authors

Erwei Zeng¹, Wei He^{1

2

3}, Arvid Sjölander¹, Jenny Bergqvist¹, Fang Fang⁴, Kamila Czene¹

Affiliations

¹ Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
² Chronic Disease Research Institute, the Children's Hospital, and National Clinical Research Center for Child Health, School of Public Health, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.
³ Department of Nutrition and Food Hygiene, School of Public Health, Zhejiang University, Hangzhou, Zhejiang, China.
⁴ Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.

PMID: 38471102
DOI: 10.1093/jnci/djae061

Abstract

Background: Many studies have examined patient-related factors affecting adjuvant hormone therapy adherence in breast cancer patients. Our study aimed to examine associations of family-related factors with adjuvant hormone therapy discontinuation and breast cancer-specific mortality.

Methods: By cross-linking seven Swedish health registers, we performed a cohort study including all breast cancer patients who initiated adjuvant hormone therapy during 2006-2019 in Sweden (N = 10,701). A group-based multi-trajectory model was used to identify familial adversity groups based on three dimensions: material deprivation, negative family dynamics, and loss or threat of loss. Cox proportional hazard models were used to investigate associations of familial adversity with hormone therapy discontinuation and breast cancer-specific mortality.

Results: We identified five distinctive familial adversity groups among the cohort participants. Compared to women with low familial adversity, higher risks to discontinue adjuvant hormone therapy were observed among women with material deprivation (hazard ratio (HR), 1.31; 95% CI, 1.20-1.43), negative family dynamics (HR, 1.16; 95% CI, 1.06-1.28), loss or threat to loss (HR, 1.15; 95% CI, 1.00-1.32), or high familial adversity (HR, 1.53; 95% CI, 1.40-1.68). Furthermore, women with material deprivation (HR, 1.37; 95% CI, 1.05-1.79), negative family dynamics (HR, 1.41; 95% CI, 1.01-1.97), or high adversity (HR, 1.67; 95% CI, 1.26-2.23) were at higher risks of dying from breast cancer.

Conclusion: Familial adversity is associated with a higher risk of adjuvant hormone therapy discontinuation and breast cancer-specific mortality. Family-related factors identified in our study may help identify high-risk patients for interventions to prevent treatment discontinuation and subsequently improve breast cancer outcomes.