Originally published as JCO Early Release 10.1200/JCO.2008.18.4127 on February 23 2009

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Effectiveness of a Letter Notification Program for Women With Early-Stage Breast Cancer Eligible for Extended Adjuvant Letrozole

From the Breast Cancer Medicine Service, Memorial Sloan-Kettering Cancer Center, New York, NY; Systemic Therapy Program; University of British Columbia; Breast Cancer Outcomes Unit; Radiation Therapy Program; Population and Preventive Oncology Program, British Columbia Cancer Agency, Vancouver, British Columbia; and the Systemic Therapy Program, BCCA, Kelowna, BC, Canada.

Corresponding author: Hagen Kennecke, MD, Vancouver Cancer Clinic, 600 West 10th Ave, Vancouver, British Columbia, Canada, V5Z 4E6; e-mail: hkennecke{at}bccancer.bc.ca.

Purpose After National Cancer Institute of Canada trial MA.17 demonstrated benefits with letrozole after 5 years of tamoxifen, oncologists needed to identify and offer therapy to patients in community follow-up who were eligible for extended adjuvant hormone therapy. In British Columbia (BC), letters about extended letrozole therapy were sent to eligible BC women, their primary care physicians (PCPs), and their oncologists. We evaluated the effectiveness of this communication strategy.

Patients and Methods Eight hundred eighty-five women with stage I-III breast cancer who completed 4 to 6 years of tamoxifen in 2004 with no documented recurrence were sent letters describing extended adjuvant letrozole in February 2005. Treatment uptake and characteristics for women who did or did not receive a subsequent letrozole prescription were described.

Results Among 838 eligible women, 305 (36%) received a letrozole prescription before April 2006. More women in the letrozole cohort had tumors larger than 2.0 cm (44.2% v 30.8%); node-positive disease (52.5% v 22.5%); prior radiotherapy (71.1% v 58.5%); and prior chemotherapy (51.5% v 20.8%; all P .001). Among women younger than 70 years with node-positive disease, 65% received letrozole (122 of 188). Most prescribing physicians were oncologists (57.0%) or PCPs (30.8%). A significant increase in letrozole prescriptions was observed after the letter mail-out.

Conclusion In this population-based setting, extended adjuvant letrozole was more common among younger women with higher risk disease and more prior therapy but underutilized overall. The reasons for extended therapy underutilization and the role of the letter mail-out strategy in informing breast cancer survivors of new available treatments in other health systems warrant further study.

Presented in part at the 29th Annual San Antonio Breast Cancer Symposium, December, 14-17, 2006, San Antonio, TX.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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