Abstract A136: Racial disparities in delayed initiation of adjuvant endocrine therapy among patients with breast cancer

2020 ◽  
Author(s):  
Kimberley T Lee ◽  
Vered Stearns ◽  
Lisa K Jacobs
Keyword(s):  
Breast Cancer ◽  
Racial Disparities ◽  
Endocrine Therapy ◽  
Adjuvant Endocrine Therapy ◽  
Delayed Initiation

Impact of delays in initiation of adjuvant endocrine therapy and survival among patients with breast cancer.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 537-537
Author(s):  
Kimberley Lee ◽  
Lisa K. Jacobs ◽  
Jodi Segal
Keyword(s):  
Breast Cancer ◽  
Overall Survival ◽  
Endocrine Therapy ◽  
Invasive Breast Cancer ◽  
Population Level ◽  
Initial Diagnosis ◽  
Adjuvant Endocrine Therapy ◽  
Delayed Surgery ◽  
Delayed Initiation

537 Background: Time to adjuvant endocrine therapy concerns patients and clinicians, but its impact on overall survival is not clear. There are no population level studies that address this question. Our primary objective is to describe the relationship between time from diagnosis of breast cancer to start of adjuvant endocrine therapy and overall survival. Methods: This is a population-based cohort study using prospectively collected population level data from the National Cancer Database (NCDB). The NCDB prospectively collects data on incident cancer cases from over 1500 Commission on Cancer-accredited facilities nationally. NCDB captures approximately 70% of incident cases of cancer in the United States. The participants are women with Stage II and III estrogen or progesterone receptor positive, human epidermal receptor 2 negative, invasive breast cancer who underwent definitive surgical treatment. Results: Of the 391,594 women in this study, 12,162 (3.1%) began treatment with adjuvant endocrine therapy more than 12 months after initial diagnosis of hormone receptor positive, invasive breast cancer. Mean age at diagnosis was 59.7 years (SD 13.4). Predictors of delayed initiation of adjuvant endocrine therapy include Black race or Hispanic ethnicity (adjusted odds ratio [aOR] of Black vs White, 1.57; 95% CI, 1.48-1.66; P < .001, Hispanic vs White, aOR 1.22, 95% CI 1.13-1.32; P < .001), Insurance other than private insurance (Medicare vs Private, aOR 1.09, 95% CI 1.01-1.17; P = .007, Medicaid vs Private, aOR 1.36, 95% CI 1.28-1.45; P < .001), higher stage of disease at diagnosis (Stage III vs II, aOR 1.24, 95% CI 1.19-1.30; P < .001), and delayed surgery or chemotherapy (Delayed surgery vs On-time lumpectomy, aOR 2.76, 95% CI 2.60-2.93; P < .001 and Delayed chemotherapy vs no chemotherapy, aOR 11.5, 95%CI 10.6-12.5). With median follow-up of 63.2 months, 67,335 (17.2%) patients died by the end of follow-up. Delayed initiation of AET resulted in no change in the hazard of death (HR, 1.00; 95% CI, 0.95-1.05; P = .97) compared to initiation within 12 months of diagnosis after adjusting for age, race and ethnicity, insurance type, urban vs rural residence, neighborhood income and education, comorbidity, cancer grade, stage, and receipt of timely or delayed surgery, chemotherapy, and/or radiation therapy. Conclusions: These results suggest that there may be no detriment to survival if initiation of adjuvant endocrine therapy occurs 12 to 24 months after initial diagnosis compared to within 12 months of diagnosis, as currently recommended.

scholarly journals Racial disparities in initiation of adjuvant endocrine therapy of early breast cancer

2014 ◽  
Vol 145 (3) ◽  
pp. 743-751 ◽  
Author(s):  
Katherine E. Reeder-Hayes ◽  
Anne Marie Meyer ◽  
Stacie B. Dusetzina ◽  
Huan Liu ◽  
Stephanie B. Wheeler
Keyword(s):  
Breast Cancer ◽  
Racial Disparities ◽  
Endocrine Therapy ◽  
Early Breast Cancer ◽  
Adjuvant Endocrine Therapy

scholarly journals Association Between Out-Of-Pocket Costs, Race/Ethnicity, and Adjuvant Endocrine Therapy Adherence Among Medicare Patients With Breast Cancer

2017 ◽  
Vol 35 (1) ◽  
pp. 86-95 ◽  
Author(s):  
Albert J. Farias ◽  
Xianglin L. Du
Keyword(s):  
Breast Cancer ◽  
Endocrine Therapy ◽  
Ethnic Disparities ◽  
Medication Possession Ratio ◽  
Adjuvant Endocrine Therapy ◽  
Hormone Receptor Positive ◽  
Medication Costs ◽  
Poverty Status ◽  
Racial Ethnic ◽  
Out Of Pocket Costs

Purpose Previous studies suggest that adherence to adjuvant endocrine therapy (AET) for patients with breast cancer is suboptimal, especially among minorities, and is associated with out-of-pocket medication costs. This study aimed to determine whether there are racial/ethnic differences in 1-year adherence to AET and whether out-of-pocket costs explain the racial/ethnic disparities in adherence. Methods This retrospective cohort study used the SEER-Medicare linked database to identify patients ≥ 65 years of age with hormone receptor–positive breast cancer who were enrolled in Medicare Part D from 2007 to 2009. The cohort included non-Hispanic whites, blacks, Hispanics, and Asians. Out-of-pocket costs for AET medications were standardized for a 30-day supply. Adherence to tamoxifen, aromatase inhibitors (AIs), and overall AET (tamoxifen or AIs) was assessed using the medication possession ratio (≥ 80%) during the 12-month period. Results Of 8,688 patients, 3,197 (36.8%) were nonadherent to AET. Out-of-pocket costs for AET medication were associated with lower adjusted odds of adherence for all four cost categories compared with the lowest category of ≤ $2.65 ( P < .01). In the univariable analysis, Hispanics had higher odds of adherence to any AET at initiation (OR, 1.30; 95% CI, 1.07 to 1.57), and blacks had higher odds of adherence to AIs at initiation (OR, 1.27; 95% CI, 1.04 to 1.54) compared with non-Hispanic whites. After adjusting for copayments, poverty status, and comorbidities, the association was no longer significant for Hispanics (OR, 0.95; 95% CI, 0.78 to 1.17) or blacks (OR, 0.96; 95% CI, 0.77 to 1.19). Blacks had significantly lower adjusted odds of adherence than non-Hispanic whites when they initiated AET therapy with tamoxifen (OR, 0.54; 95% CI, 0.31 to 0.93) after adjusting for socioeconomic, clinic, and prognostic factors. Conclusion Racial/ethnic disparities in AET adherence were largely explained by women's differences in socioeconomic status and out-of-pocket medication costs.

scholarly journals Beliefs about medicines and adherence in women with breast cancer on adjuvant endocrine therapy

2021 ◽  
pp. 135910532199077
Author(s):  
Eng Hooi Tan ◽  
Andrea Li Ann Wong ◽  
Chuan Chien Tan ◽  
Patrick Wong ◽  
Sing Huang Tan ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Factor Analysis ◽  
Medication Adherence ◽  
Endocrine Therapy ◽  
Internal Consistency ◽  
Early Stage ◽  
Adjuvant Endocrine Therapy ◽  
Beliefs About Medicines ◽  
Good Internal Consistency ◽  
English Speaking

The Beliefs about Medicines Questionnaire (BMQ) and Adherence Starts with Knowledge (ASK-12) questionnaire were originally developed and validated in Western populations to assess beliefs and barriers to medication adherence. The study aim is to validate the BMQ and ASK-12 questionnaire for use in a Singapore population with early stage breast cancer. English-speaking women on adjuvant endocrine therapy ( n = 157) were recruited. The BMQ-Specific showed good internal consistency with structural validity. The internal consistency of BMQ-General and ASK-12 Behaviour scale improved with the new factor structure obtained from exploratory factor analysis. Further studies are needed to confirm these factor structures.

Extended adjuvant endocrine therapy in early breast cancer: a meta-analysis of published randomized trials

2017 ◽  
Vol 34 (7) ◽  
Author(s):  
Ezzeldin M. Ibrahim ◽  
Marwan R. Al-Hajeili ◽  
Ali M. Bayer ◽  
Omalkhair A. Abulkhair ◽  
Ahmed A. Refae
Keyword(s):  
Breast Cancer ◽  
Endocrine Therapy ◽  
Early Breast Cancer ◽  
Randomized Trials ◽  
Meta Analysis ◽  
Adjuvant Endocrine Therapy

scholarly journals Study protocol for a randomised controlled feasibility trial of a virtual intervention (STRIDE) for symptom management, distress and adherence to adjuvant endocrine therapy after breast cancer

BMJ Open ◽  
2021 ◽  
Vol 11 (1) ◽  
pp. e041626
Author(s):  
Jamie M Jacobs ◽  
Chelsea S Rapoport ◽  
Arielle Horenstein ◽  
Madison Clay ◽  
Emily A Walsh ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Endocrine Therapy ◽  
Symptom Management ◽  
Adjuvant Endocrine Therapy ◽  
Feasibility Trial ◽  
Cancer Center ◽  
Control Group ◽  
Evidence Based ◽  
Pill Bottle ◽  
Randomised Controlled

IntroductionPatient adherence to adjuvant endocrine therapy (AET) after a diagnosis of hormone-sensitive breast cancer is poor. Previous interventions have failed to produce changes in adherence, address patient preferences or include theoretically informed and evidence-based components. Therefore, we iteratively developed a patient-centred, evidence-based, small-group, videoconference intervention to improve adherence and symptom management as well as reduce distress for patients taking AET after breast cancer (Symptom-Targeted Randomised Intervention for Distress and Adherence to Adjuvant Endocrine Therapy, STRIDE).Methods and analysisThe current study is a non-blinded, randomised, controlled, feasibility trial of STRIDE compared with a medication monitoring control group. The primary objective is to examine the feasibility and acceptability of STRIDE, while secondary objectives are to assess changes in objective and subjective adherence, symptom distress and satisfaction with AET. Patients will be recruited from the Massachusetts General Hospital Cancer Center in Boston, Massachusetts. The total number of patients accrued will be 75, with ≥60 patients completing the study. All patients will store their AET in an electronic pill bottle for objective adherence monitoring. Patients randomly assigned to the STRIDE intervention will receive 6 weekly 1-hour sessions, in small groups of two, delivered via videoconferencing by a trained mental health professional. Patients assigned to the control group will store their medication in the electronic pill bottle and receive follow-up oncology care as usual. All participants will complete self-report psychosocial measures at baseline, 12 weeks and 24 weeks postbaseline.Ethics and disseminationThe study is funded by the National Cancer Institute of the National Institutes of Health and is approved by the Dana-Farber/Harvard Cancer Center Institutional Review Board (Protocol #18–603, V.1.2, first approval date 1 February 2019). The study will be reported in accordance with the Consolidated Standards of Reporting Trials statement for non-pharmacological trials. Results will be published in peer-reviewed academic journals, presented at scientific meetings and disseminated to patient organisations and media outlets.Trial registration numberNCT03837496; Pre-results.

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