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Anti-androgen prescribing patterns, patient treatment adherence and influencing factors; results from the nationwide PCBaSe Sweden

  • Pharmacoepidemiology and Prescription
  • Published:
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Abstract

Purpose

Adherence has not been studied in male oncology populations. The aim of this study on both the prescriber and user perspectives in prostate cancer treatment was to analyse real-life prescribing patterns of anti-androgens (AA), primarily bicalutamide, and factors influencing the patients’ adherence to treatment.

Methods

A nationwide clinical cohort of incident prostate cancer, PCBaSe, was linked to the Swedish Prescribed Drug Register. Men with a planned first line monotherapy AA treatment were identified; dosages and extent of off-label treatment were investigated. Cumulative incidence proportions for reasons for drug discontinuation were calculated. Factors potentially influencing adherence were explored using the medical possession ratio based on the individual prescribed daily dose.

Results

First line monotherapy AA was planned in 4.4 % of all incident cases and in 2.1 % of low risk disease cases. Among 1,406 men prescribed bicalutamide, 1,109 (79 %) received the approved daily dose of 150 mg. Discontinuation reasons differed with disease severity. Off-label, low-dose prescription associated with age above 75 years and disease categorised as low risk was noted in 297 men (21 %). Sixty percent of the men adhered well, i.e. to ≥80 %. Age above 75 years and less severe disease were both negatively associated with adherence.

Conclusions

Patient age and tumour risk group influenced the prescriber’s choice of dose, pointing to important issues for critical reflection. Possible over-treatment was noted in low risk disease. Interventions to increase adherence in older men and in men with less severe disease are worth considering after critically reviewing the appropriateness of the treatment indication, especially in the latter case.

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Acknowledgements

This work was supported by the Swedish Research Council, grant number 825 2010-5950 and by the Swedish Cancer Society, Grant 2009/941. B.G. and L.H. were supported by the Swedish Cancer Society and L.H. also by Cancer Research UK.

Results and opinions in the presented study represent the authors and not necessarily any official views of the Swedish Medical Products Agency, where two of the authors are employed (B.G., B.Z.). This article was made possible by the continuous work of the National Prostate Cancer Register of Sweden Steering Group: Chair Pär Stattin, Anders Widmark, Stefan Carlsson, Magnus Törnblom, Jan Adolfsson, Anna Bill-Axelson, Ove Andrén, David Robinson, Bill Pettersson, Jonas Hugosson, Jan-Erik Damber, Ola Bratt, Göran Ahlgren, Lars Egevad, and Mats Lambe.

Conflict of interest statement

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Surgical Sciences, Uppsala University, Uppsala, Sweden

    B. Grundmark, H. Garmo & L. Holmberg

  2. Regional Cancer Centre of the Uppsala-Orebro Region, Uppsala University Hospital, 75185, Uppsala, Sweden

    B. Grundmark, H. Garmo, M. Lambe & L. Holmberg

  3. Medical Products Agency, Uppsala, Sweden

    B. Grundmark & B. Zethelius

  4. Division of Cancer Studies, King’s College London, Medical School, London, UK

    H. Garmo & L. Holmberg

  5. Department of Public Health and Caring Sciences/Geriatrics, Uppsala University, Uppsala, Sweden

    B. Zethelius

  6. Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University Hospital, Umeå, Sweden

    P. Stattin

  7. Department of Surgery, Urology Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA

    P. Stattin

  8. Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden

    M. Lambe

Authors
  1. B. Grundmark
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  2. H. Garmo
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  4. P. Stattin
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  5. M. Lambe
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  6. L. Holmberg
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Corresponding author

Correspondence to B. Grundmark.

Additional information

B. Grundmark and H. Garmo contributed equally to the article

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Grundmark, B., Garmo, H., Zethelius, B. et al. Anti-androgen prescribing patterns, patient treatment adherence and influencing factors; results from the nationwide PCBaSe Sweden. Eur J Clin Pharmacol 68, 1619–1630 (2012). https://doi.org/10.1007/s00228-012-1290-x

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  • DOI: https://doi.org/10.1007/s00228-012-1290-x

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