| This dissertation is comprised of three studies: Study 1—use of tamoxifen and adherence to therapy, Study 2—correspondence of clinical practice guidelines to use of tamoxifen in community practice, and Study 3—correlates and predictors of disease adjustment and well-being (quality of life). The studies were collectively designed to address the following research questions: (1) What factors differentiate tamoxifen users from non-users? (2) For those women who take tamoxifen at all, what factors are associated with adherence to prescribed therapy? (3) To what extent are older women who meet clinical practice guidelines for tamoxifen using the adjuvant therapy? (4) What factors are associated with disease adjustment and quality of life in older breast cancer patients?; The rate of tamoxifen use in these women was 60%, with younger age (60–74 years), race (non-Hispanic white versus Black), and positive estrogen receptor status being correlates. The rate of adherence to therapy was 65%; with being married and having a female surgeon predictive of adherence. A 69% correspondence rate was found between clinical practice guidelines and use of tamoxifen in community practice.; Adjustment to breast cancer was the same or better than expected for the majority of women, with stage of disease, tamoxifen use, satisfaction with medical care, nurse case manager intervention, and cognitive status being significant correlates. Ability to drive or access public transportation, general physical and emotional adjustment, spiritual coping and positive affect were positively and significantly predictive of life satisfaction, and difficulty of emotional and physical adjustment and frequency of spiritual activity were significantly and negatively associated with life satisfaction.; There are race and age disparities in the use of tamoxifen, however once taking tamoxifen, surgeon characteristics and social support factors are more salient to adherence. Based on clinical practice guidelines, not all of the women who may benefit from use of tamoxifen are using the adjuvant therapy. Optimal outcomes may be compromised in these older breast cancer patients. Predictors of disease adjustment include a myriad of psychosocial and clinical factors that warrant further attention in the overall quality of care for older women with breast cancer. |
