Investigators will employ the Adherence Model of Behavior to identify clinical, psychosocial, and healthcare delivery predictors of longitudinal hormonal therapy adherence in women with (hormone receptor) HR positive breast cancer. This study is significant because: (1) most breast cancers in Blacks and Whites are HR positive (\~75%)1,27; (2) hormonal therapy is recommend for all women with HR positive cancer since it reduces recurrence and mortality; (3) women who adhere to hormonal therapy have lower mortality than those who do not28; (4) adherence to hormonal therapy is suboptimal, even in HMO settings; (5) current guidelines recommend at least 5 years of hormonal therapy6; (6) along with Whites, investigators will examine adherence behaviors in Blacks, a group reported to have poorer outcomes than Whites, even among HR positive cases of similar stage;) past studies have documented poor adherence but few have systematically examined reasons for non-adherence. Overall, our results will be clinically useful and will inform interventions and pharmacogenetics research. For instance, if investigators find that communication strongly influences adherence, investigators can develop and implement patient self-efficacy or physician reminder-based interventions to enhance communication about adherence between patients and clinicians in HMOs. If investigators find that different factors predict adherence in Blacks versus Whites, investigators can develop tailored interventions. The PI has extensive experience developing tailored interventions to improve communication and uptake of chemotherapy in Blacks and Latinas.The next sections highlight the background that supports the significance of our research.
