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Oral endocrine therapy (OET) improves survival rates and quality of life while reducing recurrence, mortality, morbidity, and medical costs. However, adherence to OET is challenging because OET is prescribed for 5\u201310\u2009years. Determinants of OET nonadherence (NA) among women aged 65 and older remain poorly characterized. Existing studies are limited, often focusing on small, single\u2010site samples and focusing on patient\u2010level rather than multi\u2010level determinants. Despite the unique needs of older women, research on OET\u2010NA remains scarce.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This study identified multi\u2010level determinants of OET\u2010NA in older women using ecological systems theory and the World Health Organization's five\u2010dimension model.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A descriptive, correlational secondary data analysis was conducted using the 2019 Surveillance\u2010Epidemiology\u2010End\u2010Results (SEER) Medicare database, which includes more than 9\u2009million cancer cases in the United States.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Result<\/jats:title>\n                    <jats:p>\n                      OET\u2010NA was significantly affected by (a) patient\u2010related factors of ethnicity (i.e., Black [AOR 1.55; 95% CI 1.34\u20131.78;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001]) and psychological issues (i.e., depression [OR 1.40; 95% CI 1.27\u20131.54;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001]), (b) socioeconomic\u2010related factors of marital status (i.e., divorced [OR 1.17; 95% CI 1.04\u20131.32;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009\u2264\u20090.01]), and lifestyle (i.e., tobacco use [OR 1.41; 95% CI 1.22\u20131.63;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001]), (c) therapy\u2010related factors of switching OET medications (OR 2.72; 95% CI 2.41\u20133.07;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), (d) condition\u2010related factors of comorbidities (i.e., obesity [OR 1.13; 95% CI 1.03\u20131.23;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.01]), and (e) characteristics of the healthcare team and health system\u2010related factors (i.e., group practice type [OR 1.26; 95% CI 1.01\u20131.56;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.05]).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>OET\u2010NA was associated with multi\u2010level determinants, including being Black, having depression, being divorced, using tobacco, switching OET medications, having obesity, and receiving care in group practices. Identifying these determinants is a critical first step toward developing and testing interventions to improve OET\u2010NA and enhance survival and quality of life.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/cam4.71925","type":"journal-article","created":{"date-parts":[[2026,5,9]],"date-time":"2026-05-09T05:06:55Z","timestamp":1778303215000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The\n                    <scp>RESILIENT<\/scp>\n                    Study: A Retrospective, Descriptive, Correlational Investigation of Correlates of Oral Endocrine Therapy Adherence in Older Women With Breast Cancer"],"prefix":"10.1002","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0291-4506","authenticated-orcid":false,"given":"Sunny Y.","family":"Ruggeri","sequence":"first","affiliation":[{"name":"Solomont School of Nursing, Zuckerberg College of Health Science University of Massachusetts Lowell  Lowell Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3563-2625","authenticated-orcid":false,"given":"Cynthia L.","family":"Russell Lippincott","sequence":"additional","affiliation":[{"name":"School of Nursing and Health Studies University of Missouri\u2010Kansas City  Kansas City Missouri USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4500-8797","authenticated-orcid":false,"given":"Gregory L.","family":"Alexander","sequence":"additional","affiliation":[{"name":"School of Nursing Columbia University  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5990-3595","authenticated-orcid":false,"given":"Rebecca J.","family":"Bartlett Ellis","sequence":"additional","affiliation":[{"name":"School of Nursing Indiana University  Indianapolis Indiana USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6164-7823","authenticated-orcid":false,"given":"Steven R.","family":"Chesnut","sequence":"additional","affiliation":[{"name":"School of Nursing and Health Studies University of Missouri\u2010Kansas City  Kansas City Missouri USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0406-6595","authenticated-orcid":false,"given":"Lori A.","family":"Erickson","sequence":"additional","affiliation":[{"name":"School of Nursing and Health Studies University of Missouri\u2010Kansas City  Kansas City Missouri USA"},{"name":"Children's Mercy Kansas City  Kansas City Missouri USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,5,8]]},"reference":[{"key":"e_1_2_14_2_1","doi-asserted-by":"publisher","DOI":"10.1080\/14737167.2019.1680289"},{"key":"e_1_2_14_3_1","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21551"},{"key":"e_1_2_14_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/s13277\u2010016\u20105168\u2010x"},{"key":"e_1_2_14_5_1","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21262"},{"key":"e_1_2_14_6_1","doi-asserted-by":"publisher","DOI":"10.1007\/s13187\u2010017\u20101180\u20100"},{"key":"e_1_2_14_7_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.39069.489757.55"},{"key":"e_1_2_14_8_1","volume-title":"StatPearls: Breast Cancer","author":"Alkabban F. 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