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

Farias, Albert J.; Du, Xianglin L.

doi:10.1158/1055-9965.epi-17-0280

Cited by 27 publications

(34 citation statements)

References 53 publications

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“…In this study, we found that black patients were not statistically more likely to die compared to non-Hispanic white patients after controlling for long-term adherence to AET and age. This is similar to our other finding using the SEER-Medicare dataset among an older publicly insured population [ 13 ]. In this study, we found that discontinuing AET treatment was associated with a higher all-cause and cancer-specific mortality (HR: 1.75, 95% CI: 1.54-2.00) [ 13 ].…”

Section: Discussionsupporting

confidence: 91%

“…These racial/ethnic mortality disparities have been attributed to differences in factors such as tumor characteristics [ 2 , 3 , 5 , 6 ], socioeconomic factors [ 4 ], and the initiation and timing of initial and adjuvant cancer treatment [ 2 , 4 ]. Adherence to recommended treatment, such as adjuvant endocrine therapy (AET), is one way to significantly reduce breast cancer mortality [ 7 ] since adherence to AET is associated with improved disease-free survival for women with early-stage breast cancer [ 8 – 12 ].Thus, racial/ethnic differences in adherence to AET may be a determinant that contributes to disparities in breast cancer outcomes [ 13 ].…”

Section: Introductionmentioning

confidence: 99%

“…The National Comprehensive Cancer Network (NCCN) recommends women with hormone receptor-positive breast cancer receive five-years of treatment with either tamoxifen if women are premenopausal or an aromatase inhibitor (exemestane, anastrozole, and letrozole) or tamoxifen if they are postmenopausal [ 14 , 15 ]. While the benefits of AET are evident, the one-year adherence to recommended treatment (55-75%) is suboptimal [ 13 , 16 , 17 ] and adherence is even lower for racial/ethnic minorities compared white women [ 18 , 19 ].…”

Section: Introductionmentioning

confidence: 99%

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Racial differences in long-term adjuvant endocrine therapy adherence and mortality among Medicaid-insured breast cancer patients in Texas: Findings from TCR-Medicaid linked data

Farias

2018

BMC Cancer

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BackgroundThere are racial/ethnic disparities in breast cancer mortality may be attributed to differences in receipt of adjuvant cancer treatment. Our purpose was to determine whether the mortality disparities could be explained by racial/ethnic differences in long-term adherence to adjuvant endocrine therapy (AET).MethodsWe conducted a retrospective cohort study with the Texas Cancer Registry and Medicaid claims-linked dataset of women (20-64 years) diagnosed with local and regional breast cancer who filled a prescription for AET from 2000-2008. Adherence to AET was measured at three time points (1-, 3-, and 5-year adherence) using a value for the percentage of medication filled for each period divided by the total number of possible prescriptions prescribed (Medication Possession Ratio, MPR). We created a binary variable of adherence (MPR≥80%). We performed multivariable logistic regressions to assess racial differences for the odds of AET adherence and Cox proportional hazard models to determine the risk of mortality adjusting for potential confounding variables of SES, comorbidities, tumor prognostic factors, and other cancer treatment.ResultsOf the 1,497 women with breast cancer who initiated AET, 56.9%, 42.3%, and 33.3% were adherent for 1, 3, and 5-years, respectively. Hispanics compared to non-Hispanic whites did differ in the proportion that were adherent to 5-years of AET. In the adjusted analysis for long-term adherence to AET, Hispanics did not have a significantly increased risk of death compared to non-Hispanic white patients (HR: 1.13, 95% CI: 0.58-2.21). However, black compared to non-Hispanic white patients had significantly lower odds of three-year adherence (OR: 0.45, 95% CI: 0.28-0.73). After controlling for 5-year adherence to AET, the risk of death for black compared to non-Hispanic white patients was 12% lower (HR: 1.90; 95% CI: 1.03-3.51) and in the fully adjusted model, the disparity was reduced and no longer significant (OR: 1.86, 95% CI: 0.94-3.66).ConclusionsLong-term adherence in the Medicaid population is suboptimal and racial/ethnic differences in AET adherence may partially explain disparities in mortality. This study underscores the critical need to ensure long-term adherence to AET for all racial/ethnic groups to decrease disparities in mortality.

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Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Racial differences in long-term adjuvant endocrine therapy adherence and mortality among Medicaid-insured breast cancer patients in Texas: Findings from TCR-Medicaid linked data

Farias

2018

BMC Cancer

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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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“…Patients were treated with RT according to individual center policies. For patients continuously enrolled in Part D, hormonal blockade use after diagnosis was identified with prescription drug names . Current Procedural Terminology / Healthcare Common Procedure Coding System codes were additionally used to increase the capture of appropriate events.…”

Section: Methodsmentioning

confidence: 99%

Radiation therapy utilization in Medicare beneficiaries with early‐stage breast cancer

Wallace

Keene

Williams

et al. 2017

Cancer

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

Cited by 27 publications

References 53 publications

Racial differences in long-term adjuvant endocrine therapy adherence and mortality among Medicaid-insured breast cancer patients in Texas: Findings from TCR-Medicaid linked data

Racial differences in long-term adjuvant endocrine therapy adherence and mortality among Medicaid-insured breast cancer patients in Texas: Findings from TCR-Medicaid linked data

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

Radiation therapy utilization in Medicare beneficiaries with early‐stage breast cancer

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