Adherence to Newly Implemented Tamoxifen Therapy for Breast Cancer Patients in Rural Western Ethiopia

C.F. Reibold, W. Tariku, P. Eber-Schulz, S. Getachew, A. Addisie, S. Unverzagt, A. Wienke, S. Hauptmann, C. Wickenhauser, M. Vetter, A. Jemal, C. Thomssen, E.J. Kantelhardt*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Introduction: Endocrine therapy for breast cancer (BC) patients is highly underutilized in rural Ethiopia and other African countries. Objective: This study aims to assess the feasibility of and adherence to tamoxifen therapy in rural Ethiopia. Methods: We ascertained the hormone receptor (HR) status in 101 women diagnosed with BC from January 2010 to December 2015 and who had surgery in Aira Hospital, in rural Ethiopia. From 2013, tamoxifen was offered to patients with HR-positive (HR+) tumors. Prescription refill records and a structured questionnaire were used to assess receipt of and adherence to tamoxifen. Results: Of the 101 BC patients tested for HR status during the study period, 66 (65%) patients were HR+ and were eligible for tamoxifen treatment. However, 15 of the HR+ patients died before tamoxifen became available in 2013. Of the remaining 51 HR+ patients, 26 (51%) initiated tamoxifen but only 9 of them (35%) adhered to therapy (medication possession rate >= 80%, median observation 16.2 months). After 1 year, 52% of the patients were still adherent, and 9 patients had discontinued therapy. The reasons for non-initiation of tamoxifen included patient factors (n = 5), including financial hardship or lack of transportation, and health care provider factors (n = 12). Conclusions: Endocrine therapy for BC patients seems feasible in rural Western Ethiopia, although non-adherence due to financial hardship and a less developed health care infrastructure remains a major challenge. We postulate that the implementation of breast nurses could reduce patient and health system barriers and improve initiation of and adherence to endocrine treatment. (C) 2021 The Author(s) Published by S. Karger AG, Basel
Original languageEnglish
Pages (from-to)484-490
Number of pages7
JournalBreast Care
Issue number5
Early online date15 Jan 2021
Publication statusPublished - Oct 2021


  • adjuvant endocrine therapy
  • africa
  • breast neoplasms
  • clinical-practice
  • cohort
  • developing-countries
  • discontinuation
  • endocrine therapy
  • ethiopia
  • guidelines
  • hormonal-therapy
  • survival
  • tamoxifen
  • Breast neoplasms
  • Africa
  • Endocrine therapy
  • Tamoxifen
  • Ethiopia


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