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dc.contributor.authorMeggetto, Oliviaen
dc.date2015-08-27 19:48:03.611
dc.date.accessioned2015-09-10T18:52:23Z
dc.date.issued2015-09-10
dc.identifier.urihttp://hdl.handle.net/1974/13585
dc.descriptionThesis (Master, Community Health & Epidemiology) -- Queen's University, 2015-08-27 19:48:03.611en
dc.description.abstractBackground: The Mammary Prevention.3 (MAP.3) randomized placebo-controlled trial evaluating exemestane for breast cancer prevention demonstrated a 65% relative reduction in invasive breast cancer incidence. Up to 50% of participants in both trial arms reported a clinically meaningful worsening in their menopause-specific health-related quality of life (HRQL). The incidence of both worsening HRQL and treatment discontinuation was highest within the first year post-randomization. Objectives: The objectives of the two manuscripts comprising this thesis were to 1) identify factors associated with worsening menopause-specific HRQL, and, 2) evaluate the association between clinically meaningful worsening in menopause-specific HRQL and early discontinuation of study treatment. Methods: The study sample was derived from the MAP.3 chemoprevention trial conducted by the NCIC Clinical Trials Group and consisted of 4,560 postmenopausal women at elevated risk for breast cancer. Menopause-specific HRQL was assessed prior to randomization, 6 months and annually thereafter using the Menopause-Specific Quality of Life Questionnaire (MENQOL). In Manuscript 1, Cox proportional hazards analysis was used to identify factors associated with a clinically meaningful worsening in domain-specific and overall menopause-specific HRQL. In Manuscript 2, multivariable log-binomial regression was used to assess the associations between a clinically meaningful worsening in menopause- specific HRQL, baseline participant characteristics and early treatment discontinuation. Results: Manuscript 1: Risk factors of worsening in overall menopause-specific HRQL included younger age, diagnoses of depression or anxiety, increasing medication burden and assignment to exemestane. Manuscript 2: The risk of early discontinuation was 77% higher among those experiencing a worsening in their overall menopause-specific HRQL (RR=1.77 95% CI: 1.51-2.08). Those who were current or past smokers, employed at baseline and were assigned to exemestane were also at increased risk for treatment discontinuation. Conclusions: Both treatment assignment and individual characteristics contributed to the worsening HRQL experiences observed in MAP.3, which may help inform the dialogue between clinicians and patients considering chemoprevention. A negative change in menopause-specific HRQL is an important risk factor of discontinuing chemoprevention therapy. The identification of individual-level factors associated with aromatase inhibitor discontinuation may assist physicians in appropriately monitoring and counseling their patients.en
dc.language.isoengen
dc.relation.ispartofseriesCanadian thesesen
dc.rightsQueen's University's Thesis/Dissertation Non-Exclusive License for Deposit to QSpace and Library and Archives Canadaen
dc.rightsProQuest PhD and Master's Theses International Dissemination Agreementen
dc.rightsIntellectual Property Guidelines at Queen's Universityen
dc.rightsCopying and Preserving Your Thesisen
dc.rightsThis publication is made available by the authority of the copyright owner solely for the purpose of private study and research and may not be copied or reproduced except as permitted by the copyright laws without written authority from the copyright owner.en
dc.subjectEpidemiologyen
dc.subjectChemopreventionen
dc.subjectHealth-Related Quality of Lifeen
dc.subjectBreast Canceren
dc.titleFactors Associated With Worsening Menopause-Specific Health-Related Quality of Life and Treatment Discontinuation in a Breast Cancer Chemoprevention Trialen
dc.typethesisen
dc.description.restricted-thesisI am in the process of submitting this work to a journal for publication and the journal will not accept work that has been previously published or is available elsewhere.en
dc.description.degreeM.Sc.en
dc.contributor.supervisorRichardson, Harrieten
dc.contributor.departmentCommunity Health and Epidemiologyen
dc.embargo.terms1825en
dc.embargo.liftdate2020-09-08
dc.degree.grantorQueen's University at Kingstonen


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