@article{9cd1058b71ce466ca5e3378ccf949873,
title = "Persistence, adherence, and toxicity with oral CMF in older women with early-stage breast cancer (Adherence companion study 60104 for CALGB 49907)",
abstract = "Background: Cyclophosphamide-methotrexate-5-fluorouracil (CMF) is often selected as adjuvant chemotherapy for older patients with early-stage breast cancer due to perceived superior tolerability. We sought to measure persistence with CMF, adherence to oral cyclophosphamide, and the association of these with toxic effects. Patients and methods: CALGB 49907 was a randomized trial comparing standard chemotherapy (CMF or AC, provider/patient choice) with capecitabine in patients aged ≥65 with stage I-IIIB breast cancer. Those randomized to standard therapy and choosing CMF were prescribed oral cyclophosphamide 100 mg/m. 2 for 14 consecutive days in six 28-day cycles. Persistence was defined as being prescribed six cycles of at least one of the three CMF drugs. Adherence was the number of cyclophosphamide doses that women reported they had taken divided by the number prescribed. Persistence and adherence were based on case report forms and medication calendars. Results: Of 317 randomized to standard chemotherapy, 133 received CMF. Median age was 73 (range 65-88). Seventy-one percent submitted at least one medication calendar; 65% persisted with CMF. Non-persistence was associated with node negativity (P = 0.019), febrile neutropenia (P = 0.002), and fatigue (P = 0.044). Average adherence was 97% during prescribed cycles. Conclusions: Self-reported adherence to cyclophosphamide was high, but persistence was lower, which may be attributable to toxic effects.",
keywords = "Antineoplastic combined chemotherapy protocols, Breast neoplasms, Geriatrics, Medication adherence, Patient compliance, Toxicity",
author = "Ruddy, {K. J.} and Pitcher, {B. N.} and Archer, {L. E.} and Cohen, {H. J.} and Winer, {E. P.} and Hudis, {C. A.} and Muss, {H. B.} and Partridge, {A. H.}",
note = "Funding Information: University of Chicago, Chicago, IL—Hedy L. Kindler, MD, supported by CA41287; Funding Information: North Central Cancer Treatment Group, Rochester, MN—Jan Buckner, MD, Chairman, supported by CA25224; National Cancer Institute of Canada, Toronto, ON—Elizabeth Eisenhauer, MD, President; supported by CA77202. Funding Information: University of Missouri/Ellis Fischel Cancer Center, Columbia, MO—Michael C. Perry, MD, supported by CA12046; Funding Information: University of Oklahoma, Oklahoma, OK—Howard Ozer, MD, supported by CA37447; Funding Information: Christiana Care Health Services, Inc., CCOP, Wilmington, DE —Stephen Grubbs, MD, supported by CA45418; Funding Information: Duke University Medical Center, Durham, NC—Jeffrey Crawford, MD, supported by CA47577; Funding Information: University of Vermont, Burlington, VT—Steven M. Grunberg, MD, supported by CA77406; Funding Information: Dartmouth Medical School – Norris Cotton Cancer Center, Lebanon, NH—Konstantin Dragnev, MD, supported by CA04326; Funding Information: This work was supported by the National Cancer Institute at the National Institutes of Health (grant numbers CA32291, CA33601, CA32102, CA77202, CA25224, CA21115, CA105409, CA77651, and CA77406; grant number CA31946 to the Cancer and Leukemia Group B and Richard L. Schilsky; and grant number CA33601 to the CALGB Statistical Center and Stephen George, PhD). The content of this manuscript is solely the responsibility of the authors and does not necessarily represent the official views of the National Cancer Institute. Funding Information: University of North Carolina at Chapel Hill, Chapel Hill, NC— Thomas C. Shea, MD, supported by CA47559; Funding Information: North Shore-Long Island Jewish Health System, New Hyde Park, NY—Daniel Budman, MD, supported by CA35279; Northern Indiana Cancer Research Consortium CCOP, South Bend, IN—Rafat Ansari, MD, supported by CA86726; Roswell Park Cancer Institute, Buffalo, NY—Ellis Levine, MD, supported by CA59518; Southeast Cancer Control Consortium, Inc., CCOP, Goldsboro, NC—James N. Atkins, MD, supported by CA45808; Funding Information: Illinois Oncology Research Association, Peoria, IL—John W. Kugler, MD, supported by CA35113; Funding Information: University of Maryland Greenebaum Cancer Center, Baltimore, MD—Martin Edelman, MD, supported by CA31983;",
year = "2012",
month = dec,
doi = "10.1093/annonc/mds133",
language = "English (US)",
volume = "23",
pages = "3075--3081",
journal = "Annals of Oncology",
issn = "0923-7534",
publisher = "Oxford University Press",
number = "12",
}