Endocrine therapy use in the twenty-first century: usage rates and temporal trends illustrate opportunities for improvement for South Carolina Medicaid women

Bedi, Julie; Mayo, Rachel; Truong, Khoa; Chen, Liwei; Dickes, Lori; Sherrill, Windsor Westbrook; Jones, Karyn Ogata

doi:10.1007/s10549-018-4866-z

Cited by 5 publications

(14 citation statements)

References 15 publications

(18 reference statements)

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“…Most existing research has treated initiation as occurring or not within 1 year of diagnosis. 15,18 Research in other treatment populations has similarly found that delayed treatment initiation is associated with poorer adherence, possibly owing to the role of timely initiation in emphasizing the importance of treatment. 30 This possibility aligns with research that has found perceived importance of AET to be a key factor in shaping adherence and continuation.…”

Section: Discussionmentioning

confidence: 99%

“…Although prior studies examined nonadherence and discontinuation with AET for women with HR-positive breast cancer and their associations with demographic variables, 15,18,20,21 no study has examined whether initiation timing is associated with subsequent adherence to and/or continuation of AET. Therefore, we quantified timelines of AET initiation and their associations with short-term and long-term quality of AET in a population-based cohort of Medicaid-insured women with breast cancer.…”

Section: Introductionmentioning

confidence: 99%

“…15,16 Lack of initiation is even more pronounced in low-income patients; only up to 60% of Medicaid enrollees with breast cancer initiated AET within a year, and of those who initiated, only 40% were adherent during the first year of treatment, with adherence further declining over time. [17][18][19] Even fewer Medicaid-insured women continue AET for the recommended 5 years-as low as approximately 20% of patients. 18 This nonadherence may lead to unequal distribution of the prognostic benefits of AET.…”

Section: Introductionmentioning

confidence: 99%

“…[17][18][19] Even fewer Medicaid-insured women continue AET for the recommended 5 years-as low as approximately 20% of patients. 18 This nonadherence may lead to unequal distribution of the prognostic benefits of AET.…”

Section: Introductionmentioning

confidence: 99%

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Association of Endocrine Therapy Initiation Timeliness With Adherence and Continuation in Low-Income Women With Breast Cancer

et al. 2022

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IMPORTANCEThough adjuvant endocrine therapy (AET) has proven efficacy in treating hormone receptor-positive (HR-positive) breast cancer, patient adherence to AET and continuation of treatment as recommended by guidelines remain suboptimal, especially for low-income patients. OBJECTIVE To quantify timelines for initiating AET and assess their association with short-and longterm adherence and continuation of AET in low-income women with breast cancer. DESIGN, SETTING, AND PARTICIPANTS This population-based retrospective cohort study included women younger than 65 years diagnosed with first primary HR-positive breast cancer between January 1, 2007, and December 31, 2013, followed up for 5 years after the first use of AET through December 2018, and identified from the linked Missouri Cancer Registry and Medicaid claims data set. EXPOSURES Time to initiation (TTI) as days from the date of last treatment (surgery, radiotherapy, or chemotherapy) to the first date of AET prescription fill. MAIN OUTCOMES AND MEASURESThe main outcomes were adherence to AET as medication possession ratio of 80% or greater and continuation of AET as no gap in medication supply for at least 90 days. Odds ratios (ORs) of adherence and continuation over 1 to 5 years were estimated using logistic regression adjusted for demographic, clinical, and neighborhood variables. Analyses were performed between September 1, 2020, and May 31, 2022. RESULTS Among 1711 patients, median TTI was 53 (IQR, 26-117) days. A total of 1029 patients (60.1%) were aged 50 to 64 years old, 1270 (74.2%) were non-Hispanic White, and 1133 (66.2%) were unmarried. In the first year after initiation, 1317 (77.0%) were adherent and 1015 (59.3%) continued AET. Over the full 5 years, 376 (22.0%) were adherent and 409 (23.9%) continued AET.Longer TTI was significantly associated with poorer adherence at every year, with an OR of 0.97 (95% CI, 0.95-0.99) for 1-year adherence and an OR of 0.94 (95% CI, 0.90-0.97) for 5-year adherence per 1-month increase in TTI. Longer TTI was also associated with lower odds of short-term, but not longterm, continuation (OR, 0.97 [95% CI, 0.95-0.99] for 1-year continuation and 0.98 [95% CI, 0.96-0.99] for 2-year continuation). CONCLUSIONS AND RELEVANCEIn this cohort study, longer time to AET initiation was associated with lower odds of short-term and long-term adherence to AET in Medicaid-insured patients with breast cancer. Therefore, early interventions targeting treatment initiation timelines may positively impact adherence throughout the course of treatment and, therefore, outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Association of Endocrine Therapy Initiation Timeliness With Adherence and Continuation in Low-Income Women With Breast Cancer

et al. 2022

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“…Specifically, 98.6% of the sample population was white and non-Hispanic. Differences in AET adherence by race has been documented, with several reports showing black and Hispanic patients are at higher risk [70]; however, further work is needed to understand this complex issue [64][65][66][67][68][69]. Interventions to address non-adherence and non-persistence should address racial/ethnic differences and aim to eliminate outcome disparities.…”

Section: Discussionmentioning

confidence: 99%

Preventing metastatic recurrence in low-risk ER/PR + breast cancer patients—a retrospective clinical study exploring the evolving challenge of persistence with adjuvant endocrine therapy

Kuhn

Pirruccello

Boothe

et al. 2023

Breast Cancer Res Treat

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Purpose In the genomic era, more women with low-risk breast cancer will forego chemotherapy and rely on adjuvant endocrine therapy (AET) to prevent metastatic recurrence. However, some of these patients will unfortunately relapse. We sought to understand this outcome. Preliminary work suggested that early discontinuation of AET, also known as non-persistence, may play an important role. A retrospective analysis exploring factors related to our breast cancer patients’ non-persistence with AET was performed. Methods Women who underwent Oncotype-DX® testing between 2011 and 2014 with minimum 5 years follow-up were included. ‘Low risk’ was defined as Oncotype score < 26. Outcomes of recurrence and persistence were determined by chart review. Patient, tumor and treatment factors were collected, and persistent versus non-persistent groups compared using multivariable ANOVA and Fisher Chi square exact test. Results We identified six cases of distant recurrence among low-risk patients with a median follow-up of 7.7 years. Among them, five of six patients (83%) were non-persistent with AET. The non-persistence rate in our cohort regardless of recurrence was 57/228 (25%). Non-persistent patients reported more severe side effects compared with persistent patients (p = 0.002) and were more likely to be offered a switch in endocrine therapy, rather than symptom-relief (p = 0.006). In contrast, persistent patients were 10.3 times more likely to have been offered symptom-alleviating medications compared with non-persistent patients (p < 0.001). A subset analysis revealed that patients who persisted with therapy had a higher Oncotype-DX® score than patients who discontinued early (p = 0.028). Conclusion Metastatic recurrence in low-risk breast cancer patients may be primarily due to non-persistence with endocrine therapy. Further work is needed to optimize care for patients who struggle with side effects. To our knowledge, these are the first published data suggesting that Oncotype-DX® score may influence persistence with AET.

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Endocrine therapy initiation among women with stage I–III invasive, hormone receptor-positive breast cancer from 2001–2016

Bowles

Ramin

Buist

et al. 2022

Breast Cancer Res Treat

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Endocrine therapy use in the twenty-first century: usage rates and temporal trends illustrate opportunities for improvement for South Carolina Medicaid women

Cited by 5 publications

References 15 publications

Association of Endocrine Therapy Initiation Timeliness With Adherence and Continuation in Low-Income Women With Breast Cancer

Association of Endocrine Therapy Initiation Timeliness With Adherence and Continuation in Low-Income Women With Breast Cancer

Preventing metastatic recurrence in low-risk ER/PR + breast cancer patients—a retrospective clinical study exploring the evolving challenge of persistence with adjuvant endocrine therapy

Endocrine therapy initiation among women with stage I–III invasive, hormone receptor-positive breast cancer from 2001–2016

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