Initiation of Adjuvant Hormone Therapy by Medicaid Insured Women With Nonmetastatic Breast Cancer

Abstract

Hormone therapy is the mainstay of adjuvant treatment for hormone receptor positive (HR-positive) nonmetastatic breast cancer. We evaluated adjuvant hormone therapy (AHT) initiation among Medicaid-insured women aged 21-64 years with stage I-III HR-positive breast cancer. We used multivariable logistic regression to identify independent predictors of AHT initiation. Within 1 year of diagnosis, 68% (1049/1538) initiated AHT; by 18 months, 80% (1168/1461) initiated AHT. In multivariable analysis, women less likely to initiate AHT had more comorbidity (≥ 2 vs none: adjusted odds ratio (AOR) = 0.55; 95% CI = 0.32 to 0.97), more advanced disease (stage III vs I: AOR = 0.27; 95% CI = 0.18 to 0.39), and no radiation after breast conserving surgery (AOR = 0.15; 95% CI = 0.10 to 0.22). Race, age, and history of mental health disorders were not independently associated with initiation of AHT. Among initiators of AHT, 58% (604/1049) were adherent to treatment for the year after initiation. Despite comprehensive prescription coverage, only 39% (604/1538) received optimal AHT including prompt initiation and adherence for the year after treatment. Partnerships between Medicaid programs and cancer registries may help identify at-risk women and facilitate the implementation of quality improvement strategies.

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

“…We were not able to stratify Asian race/ethnicity into smaller subgroups due to limitations in sample size. Our finding regarding no association between other race/ethnicities and initiation of AET is consistent with previous studies [14, 15]. However, contradictory to these findings, studies showed that the use of AET is independently associated with lower proportion of initiation among Hispanic [16, 18] and black patients [17, 18] compared to white women.…”

“…The percentage of women who initiated AET within 12 months was slightly higher than that of previous studies which found between 68 and 71 % of women initiated AET [15–17]. However, those studies included younger commercially insured women [15, 16], or included women with stage 0 breast cancer [17], which may have explained some of the observed differences in proportion of women that initiated AET.…”

“…However, those studies included younger commercially insured women [15, 16], or included women with stage 0 breast cancer [17], which may have explained some of the observed differences in proportion of women that initiated AET.…”

“…However, a number of studies found that a substantial proportion of women with breast cancer indicated for treatment did not take AET altogether [14] or did not initiate the treatment in a timely manner [15–17], especially among ethnic minorities [16–18]. One study found that in a cohort of women enrolled in a large HMO health plan, Hispanic women were less likely to initiate AET compared to non-Hispanic white women [16], but the use of AET was not significantly associated with race/ethnicity in another study of an ethnically diverse national cohort of women [14].…”

Racial and geographic disparities in adherence and discontinuation to adjuvant endocrine therapy in Texas Medicaid-insured patients with breast cancer

“…However, unlike our study, they did not include a large proportion of low-income minority women which are factors that are associated with lower likelihood of adherence [11, 16, 17]. Studies using state cancer registry and Medicaid-linked data in North Carolina [17] and New York [42] corroborate our adherence rates and find that adherence ranges from 59 to 60% within the first year of initiation. In the New Jersey Medicaid population, patients who were less indigent than our study found that adherence was slightly higher (70%) [12].…”