Ethnic differences in initiation and timing of adjuvant endocrine therapy among older women with hormone receptor-positive breast cancer enrolled in Medicare Part D

Farias, Albert J.; Du, Xianglin L.

doi:10.1007/s12032-016-0732-1

Cited by 20 publications

(11 citation statements)

References 35 publications

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“…Our study is consistent with previous findings showing that younger women were more likely to discontinue endocrine therapy than older women [18]. Numerous studies have identified variation in receipt of endocrine therapy by race and ethnicity [18, 37–39]. …”

Section: Discussionsupporting

confidence: 93%

Endocrine therapy initiation, discontinuation and adherence and breast imaging among 21-gene recurrence score assay-eligible women under age 65

O’Neill¹,

Isaacs²,

Lynce³

et al. 2017

Breast Cancer Res

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BackgroundAside from chemotherapy utilization, limited data are available on the relationship between gene expression profiling (GEP) testing and breast cancer care. We assessed the relationship between GEP testing and additional variables and the outcomes of endocrine therapy initiation, discontinuation and adherence, and breast imaging exams in women under age 65 years.MethodsData from five state cancer registries were linked with claims data and GEP results. We assessed variables associated with survivorship care outcomes in an incident cohort of 5014 commercially insured women under age 65 years, newly diagnosed with stage I or II hormone-receptor-positive, human epidermal growth factor receptor 2 (HER2) non-positive breast cancer from 2006 to 2010.ResultsAmong tested women, those with high Oncotype DX® Breast Recurrence Score® (RS) were significantly less likely to initiate endocrine therapy than women with low RS tumors (OR 0.40 (95% CI 0.20 to 0.81); P = 0.01). Among all test-eligible women, receipt of Oncotype DX testing was associated with a greater likelihood of endocrine therapy initiation (OR 2.48 (95% CI 2.03 to 3.04); P <0.0001). The odds of initiation were also significantly higher for tested vs. untested women among women who did not initiate chemotherapy within six months of diagnosis (OR 3.25 (95% CI 2.53 to 4.16)), with no effect in women who received chemotherapy. Discontinuation and adherence and breast imaging exams were unrelated to tested status or RS.ConclusionsLower endocrine therapy initiation rates among women with high RS tumors and among untested women not receiving chemotherapy are concerning, given its established efficacy. Additional research is needed to suggest mechanisms to close this gap.

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Section: Discussionsupporting

confidence: 93%

Endocrine therapy initiation, discontinuation and adherence and breast imaging among 21-gene recurrence score assay-eligible women under age 65

O’Neill¹,

Isaacs²,

Lynce³

et al. 2017

Breast Cancer Res

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“…Use of adjuvant endocrine therapy was appropriately dictated by ER status. The rate of adjuvant endocrine therapy initiation in patients with ER‐positive tumors was 82%, comparable to the rates reported in U.S. cohorts [44–46]. Adjuvant endocrine therapy is a vital component in the care of these patients, and, as expected, therapy initiation was associated with longer EFS.…”

Section: Discussionsupporting

confidence: 69%

Patient Characteristics and Outcomes of Nonmetastatic Breast Cancer in Haiti: Results from a Retrospective Cohort

Fadelu

Damuse²,

Lormil³

et al. 2020

The Oncologist

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Background There are few studies on breast cancer outcomes in the Caribbean region. This study identified a retrospective cohort of female patients with nonmetastatic breast cancer in Haiti and conducted survival analyses to identify prognostic factors that may affect patient outcomes. Methods The cohort included 341 patients presenting between June 2012 and December 2016. The primary endpoint was event‐free survival (EFS), defined as time to disease progression, recurrence, or death. Descriptive summaries of patient characteristics and treatments were reported. Survival curves were plotted using Kaplan‐Meier estimation. Multivariate survival analyses were performed using Cox proportional hazards regression. Results Median age at diagnosis was 49 years, with 64.2% being premenopausal. Most patients (55.1%) were staged as locally advanced. One hundred and sixty patients received neoadjuvant therapy: 33.3% of patients with early stage disease and 61.2% of those with locally advanced stage disease. Curative‐intent surgery was performed in 278 (81.5%) patients, and 225 patients received adjuvant therapy. Adjuvant endocrine therapy was used in 82.0% of patients with estrogen receptor–positive disease. During the follow‐up period, 28 patients died, 77 had disease recurrence, and 10 had progressive disease. EFS rates at 2 years and 3 years were 80.9% and 63.4%, respectively. After controlling for multiple confounders, the locally advanced stage group had a statistically significant adjusted hazard ratio for EFS of 3.27 compared with early stage. Conclusion Patients with nonmetastatic breast cancer in Haiti have more advanced disease, poorer prognostic factors, and worse outcomes compared with patients in high‐income countries. Despite several limitations, curative treatment is possible in Haiti. Implications for Practice Patients with breast cancer in Haiti have poor outcomes. Prior studies show that most Haitian patients are diagnosed at later stages. However, there are no rigorous studies describing how late‐stage diagnosis and other prognostic factors affect outcomes in this population. This study presents a detailed analysis of survival outcomes and assessment of prognostic factors in patients with nonmetastatic breast cancer treated in Haiti. In addition to late‐stage diagnosis, other unfavorable prognostic factors identified were young age and estrogen receptor‐negative disease. The study also highlights that the availability of basic breast cancer treatment in Haiti can lead to promising early patient outcomes.

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“…(40) Other studies have found initiation between 68–70%, but those women were younger and commercially insured (41, 42) and may have better initiation rates than our study population. We also found that Blacks, compared with non-Hispanic whites, had lower odds of initiating AET, but after stratifying by hormone receptor status there was no association.…”

Section: Discussionmentioning

confidence: 57%

“…(40) AIs were defined as anastrozole, exemestane, or letrozole. We created a binary variable (yes or no) for initiation if a women filled a prescription for any AET medication and an indicator for the type of AET (AI or Tamoxifen) at initiation.…”

Section: Methodsmentioning

confidence: 99%

Racial Differences in Adjuvant Endocrine Therapy Use and Discontinuation in Association with Mortality among Medicare Breast Cancer Patients by Receptor Status

Farias

2017

Cancer Epidemiology, Biomarkers &Amp; Prevention

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Background There are racial disparities in breast cancer mortality. Our purpose was to determine whether racial/ethnic differences in use and discontinuation of AET differed by hormone receptor status and whether discontinuation was associated with mortality. Methods We conducted a retrospective cohort study with SEER/Medicare dataset of women age ≥65 years diagnosed with stage I-III breast cancer in Medicare Part-D from 2007-2009, stratified by hormone receptor status. We performed multivariable logistic regressions to assess racial differences for the odds of AET initiation and Cox proportional hazard models to determine the risk of discontinuation and mortality. Results Of 14,902 women, 64.5% initiated AET <12 months of diagnosis. Among those with hormone receptor–positive cancer, 74.8% initiated AET compared with 5.6% of women with negative and 54.0% with unknown-receptor status. Blacks were less likely to initiate (OR: 0.76, 95% CI: 0.66–0.88) compared to whites. However, those with hormone-receptor positive disease were less likely to discontinue (HR: 0.89, 95% CI: 0.80–0.98). Women who initiated with aromatase inhibitors had increased risk of discontinuation compared with women who initiated tamoxifen (1.12, 1.05–1.20). Discontinuation within 12 months was associated with higher risk of all-cause (1.75, 1.74–2.00) and cancer-specific mortality (2.76, 1.74–4.38) after controlling for race/ethnicity. Conclusions There are racial/ethnic differences in AET use and discontinuation. Discontinuing treatment was associated with higher risk of all-cause and cancer-specific mortality regardless of hormone receptor status. Impact This study underscores the need to study factors that influence discontinuation and the survival benefits of receiving AET for hormone receptor–negative breast cancer.

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Ethnic differences in initiation and timing of adjuvant endocrine therapy among older women with hormone receptor-positive breast cancer enrolled in Medicare Part D

Cited by 20 publications

References 35 publications

Endocrine therapy initiation, discontinuation and adherence and breast imaging among 21-gene recurrence score assay-eligible women under age 65

Endocrine therapy initiation, discontinuation and adherence and breast imaging among 21-gene recurrence score assay-eligible women under age 65

Patient Characteristics and Outcomes of Nonmetastatic Breast Cancer in Haiti: Results from a Retrospective Cohort

Racial Differences in Adjuvant Endocrine Therapy Use and Discontinuation in Association with Mortality among Medicare Breast Cancer Patients by Receptor Status

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