Medicare D Subsidies and Racial Disparities in Persistence and Adherence With Hormonal Therapy

Biggers, Alana; Shi, Yushu; Charlson, John A.; Smith, Elizabeth C.; Smallwood, Alicia; Nattinger, Ann B.; Laud, Purushottam W.; Neuner, Joan

doi:10.1200/jco.2016.67.3350

Cited by 40 publications

(34 citation statements)

References 32 publications

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“…Although information on financial status was not available, the subjects in our study were patients at restructured hospitals and were eligible for subsidized treatment. It is thus less likely that any ethnic disparity observed was due to differences in financial resources 25 . An ethnic disparity in recommended treatment uptake has also been observed by others; recommended treatment uptake is frequently lower in minority populations 26,27 .…”

Section: Discussionmentioning

confidence: 99%

Impact of deviation from guideline recommended treatment on breast cancer survival in Asia

Sim

et al. 2020

Sci Rep

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Breast cancer survival has improved with significant progress in treatment and disease management. However, compliance with treatment varies. Treatment guidelines for older patients are unclear. We aim to identify predictors of noncompliance with recommended therapy in a large breast cancer population and assess the impact of noncompliance on survival. Our study included 19,241 non-metastatic female breast cancer patients, of whom 3,158 (16%) died within 10 years post-diagnosis (median survival = 5.8 years). We studied the association between treatment noncompliance and factors with logistic regression, and the impact of treatment noncompliance on survival with a flexible parametric survival model framework. The highest proportion of noncompliance was observed for chemotherapy (18%). Predictors of noncompliance with chemotherapy, radiotherapy and endocrine therapy included age, tumor size, nodal involvement and subtype (except radiotherapy). Factors associated with not receiving surgery included age and subtype. Treatment noncompliance was associated with worse overall survival for surgery (HR: 2.26 [1.80-2.83]), chemotherapy (1.25 [1.11-1.41]), radiotherapy (2.28 [1.94-2.69]) and endocrine therapy (1.70 [1.41-2.04]). Worse survival was similarly observed in older patients for whom guidelines generally do not apply. Our results highlight the importance of following appropriate treatment as recommended by current guidelines. Older patients may benefit from similar recommendations. Breast cancer is the leading type of cancer among Asian women, with an increasing number of cases diagnosed every year 1. Between 2003 and 2008, there were more than 2 million women living with breast cancer in SouthEast Asia, where a population of over 650 million women resides 2. As breast cancer is common, the number of lives claimed by the disease is high. On average ~100,000 deaths from breast cancer were recorded every year in the same region 3. With significant progress in treatment and disease management, a growing number of women are surviving breast cancer 4. However, breast cancer survival can vary between countries. While 90% of patients in the United States live at least five years after the cancer is found 5 , the corresponding proportion is lower in SouthEast Asia. In a report by Bhoo-Pathy et al., five-year overall survival rates were estimated to range from 58.5% to 75.8% in SouthEast Asia 6. Several professional organizations and consensus groups exist to translate evidence-based medicine into recommendations for best patient care 7. Examples of providers of such clinical practice guidelines include the

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Section: Discussionmentioning

confidence: 99%

Impact of deviation from guideline recommended treatment on breast cancer survival in Asia

Sim

et al. 2020

Sci Rep

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“…If a subject had an overlapping supply of more than 1 AET medication during the 12‐month period (eg, she filled a prescription for letrozole before the date by which she should have used the entire supply of anastrozole pills dispensed), we considered the new medication to start on the day after the end date for the initial medication . Following prior literature, we considered individuals possessing enough medication for ≥80% of days to be adherent …”

Section: Methodsmentioning

confidence: 99%

“…16 Following prior literature, we considered individuals Cancer November 15, 2019 possessing enough medication for ≥80% of days to be adherent. 3,[17][18][19] Statistical Analysis…”

Section: Adherencementioning

confidence: 99%

The association of pharmacy fill synchronization with breast cancer endocrine therapy adherence

Neuner

Fergestrom

Laud

et al. 2019

Cancer

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Background One‐third to one‐half of patients prescribed adjuvant endocrine therapy are nonadherent during the recommended 5‐year endocrine therapy course. This study investigated whether poor pharmacy synchronization of medication fills (requiring refills on different days) acts as a barrier to adherence. Methods A cohort of older women with stage 0 to III endocrine receptor–positive breast cancer in 2011 was identified from the Surveillance, Epidemiology, and End Result–Medicare claims‐linked cancer registry. Women with endocrine therapy and at least 1 other medication fill were identified, and the 3‐month synchronization of their fills was calculated as 1 minus the quotient of the number of pharmacy visits and the number of filled medications. Regression models were used to examine the association between synchronization (in quartiles adjusted for the number of medications) and adherence to endocrine therapy (defined as a medication possession ratio ≥80%) over the subsequent year. Results During the 3 months after the first endocrine therapy prescription, the study cohort of 3212 women had a mean of 8.6 pharmacy visits (standard deviation, 4.7) with a mean synchronization of 0.3 (standard deviation, 0.2). Those in the third (odds ratio, 1.29; 95% confidence interval, 1.04‐1.59) and fourth (most) medication number–adjusted synchronization quartiles (odds ratio, 1.49; 95% confidence interval, 1.19‐1.86) were more likely to be adherent than those in the least. Multivariate model predictions showed that the proportion of patients who were adherent over 1 year varied from 68.9% in the least synchronized quartile to 76.6% in the most synchronized one. Conclusions Prescription refill synchronization is strongly associated with adherence to endocrine therapy. Efforts to improve adherence should address this.

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“…Further, we have prospective data from the Cancer and Leukemia Group B 49907 trial that older women tolerate standard therapy well and benefit from its receipt (48). In addition, similar to younger patients, older women with breast cancer also experience suboptimal adherence to hormonal therapy (20,(49)(50)(51), increasing their risk for poor outcomes.…”

Section: Older Patientsmentioning

confidence: 99%

Emerging Data and Current Challenges for Young, Old, Obese, or Male Patients with Breast Cancer

Freedman

Partridge

2017

Clinical Cancer Research

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There are distinct subgroups of patients who have historically been underrepresented in most prospective clinical trials in breast cancer, including the youngest and oldest patients, male patients, and those struggling with obesity. Herein, we review current and future directions in research for each of these special populations with breast cancer, highlighting significant knowledge gaps and priorities in tumor biology and heterogeneity, therapeutic decision making promotion of adherence, supportive care, and psychosocial and functional well-being. In younger women, future study should focus on the biological underpinnings of aggressive disease and optimizing adherence and treatment decision making while addressing their unique survivorship needs. The latter includes generating a scientific basis for interruption of therapy for pregnancy. Among older patients, interventions should focus on increasing clinical trial accrual, predicting and mitigating toxicity so that functional status can be optimized, tailoring needs for dose modification, and anticipating life expectancy in the context of competing causes of death. For men with breast cancer, we need worldwide collaboration to answer even basic questions on optimal treatment, supportive care, and survivorship strategies. Finally, for those struggling with obesity, we need to better understand the biological associations with cancer incidence, prognosis and outcome, and how we can best intervene to assure weight loss at the "right time." It is only through highly collaborative, far-reaching, prospective, multidisciplinary, patient-centered, and patient-engaged efforts that we can optimize the physical and psychologic outcomes for all patients with breast cancer.

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Medicare D Subsidies and Racial Disparities in Persistence and Adherence With Hormonal Therapy

Cited by 40 publications

References 32 publications

Impact of deviation from guideline recommended treatment on breast cancer survival in Asia

Impact of deviation from guideline recommended treatment on breast cancer survival in Asia

The association of pharmacy fill synchronization with breast cancer endocrine therapy adherence

Emerging Data and Current Challenges for Young, Old, Obese, or Male Patients with Breast Cancer

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