A system-level approach to improve the uptake of antiestrogen preventive therapy among women with atypical hyperplasia and lobular cancer in situ

Background: The low uptake of antiestrogen preventive therapy among women at high risk of developing breast cancer remains a challenge. We implemented a performance improvement program to increase the uptake of preventive therapy among women with atypical hyperplasia (AH) and lobular cancer in situ (LCIS). Methods: A performance improvement program was implemented at the MD Anderson Cancer Center (Houston, TX), November 2015 to February 2017, for patients with a new (<6 months) or existing (6 months) diagnosis of AH/LCIS. The program consisted of an audit of eligible women who were recommended and prescribed preventive therapy and the provision of clinical performance feedback to providers. The baseline uptake of preventive therapy was estimated from patients enrolled in a high-risk breast cohort. Results: Baseline uptake of preventive therapy was 44%. The program registered 408 patients with a new (n=87) or existing diagnosis (n = 321) of AH/LCIS; mean age was 57 and71% were non-Hispanic white. Ninety-eight percent of patients received a recommendation for preventive therapy. The overall prescribing of preventive therapy to patients with a new or existing diagnosis was 82% (monthly range, 40%-100%; Ptrend = 0.76) and 48% (monthly range, 27%-57%; Ptrend < 0.01), respectively. Adherence among patients with a new or existing diagnosis was76%and48% (P < 0.01) at 6 months, respectively. Conclusion: A system-level approach improved the uptake of preventive therapy. Identifying women at the time of diagnosis of AH/LCIS and offering a strong recommendation are key components for improving acceptance and adherence with preventive therapy.