scholarly journals Household Net Worth, Racial Disparities, and Hormonal Therapy Adherence Among Women With Early-Stage Breast Cancer

2015 ◽  
Vol 33 (9) ◽  
pp. 1053-1059 ◽  
Author(s):  
Dawn L. Hershman ◽  
Jennifer Tsui ◽  
Jason D. Wright ◽  
Ellie J. Coromilas ◽  
Wei Yann Tsai ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Racial Disparities ◽  
Hormonal Therapy ◽  
Early Stage ◽  
Medication Possession Ratio ◽  
Household Wealth ◽  
Therapy Adherence ◽  
Net Worth ◽  
Black Race ◽  
The Impact

Purpose Nonadherence to adjuvant hormonal therapy is common and is associated with increased prescription copayment amount and black race. Studies suggest that household wealth may partly explain racial disparities. We investigated the impact of net worth on disparities in adherence and discontinuation. Patients and Methods We used the OptumInsight insurance claims database to identify women older than age 50 years diagnosed with early breast cancer, from January 1, 2007, to December 31, 2011, who were using hormonal therapy. Nonadherence was defined as a medication possession ratio of ≤ 80% of eligible days over a 2-year period. We evaluated the association of demographic and clinical characteristics, annual household income, household net worth (< $250,000, $250,000 to $750,000, or > $750,000), insurance type, and copayments (< $10, $10 to $20, or > $20) with adherence to hormonal therapy. Logistic regression analyses were conducted by sequentially adding sociodemographic and financial variables to race. Results We identified 10,302 patients; 2,473 (24%) were nonadherent. In the unadjusted analyses, adherence was negatively associated with black race (odds ratio [OR], 0.76; P < .001), advanced age, comorbidity, and Medicare insurance. Adherence was positively associated with medium (OR, 1.33; P < .001) and high (OR, 1.66; P < .001) compared with low net worth. The negative association of black race with adherence (OR, 0.76) was reduced by adding net worth to the model (OR, 0.84; P < .05). Correcting for other variables had a minimal impact on the association between race and adherence (OR, 0.87; P = .08). The interaction between net worth and race was significant (P < .01). Conclusion We found that net worth partially explains racial disparities in hormonal therapy adherence. These results suggest that economic factors may contribute to disparities in the quality of care.

scholarly journals Association Between Prescription Co-Payment Amount and Compliance With Adjuvant Hormonal Therapy in Women With Early-Stage Breast Cancer

2011 ◽  
Vol 29 (18) ◽  
pp. 2534-2542 ◽  
Author(s):  
Alfred I. Neugut ◽  
Milayna Subar ◽  
Elizabeth Ty Wilde ◽  
Scott Stratton ◽  
Corey H. Brouse ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Hormonal Therapy ◽  
Early Stage ◽  
Age Groups ◽  
Medication Possession Ratio ◽  
Adjuvant Hormonal Therapy ◽  
Financial Difficulties ◽  
Life Saving ◽  
Future Policy ◽  
The Impact

Purpose Noncompliance with adjuvant hormonal therapy among women with breast cancer is common. Little is known about the impact of financial factors, such as co-payments, on noncompliance. Patients and Methods We conducted a retrospective cohort study by using the pharmacy and medical claims database at Medco Health Solutions. Women older than age 50 years who were taking aromatase inhibitors (AIs) for resected breast cancer with two or more mail-order prescriptions, from January 1, 2007, to December 31, 2008, were identified. Patients who were eligible for Medicare were analyzed separately. Nonpersistence was defined as a prescription supply gap of more than 45 days without subsequent refill. Nonadherence was defined as a medication possession ratio less than 80% of eligible days. Results Of 8,110 women younger than age 65 years, 1,721 (21.1%) were nonpersistent and 863 (10.6%) were nonadherent. Among 14,050 women age 65 years or older, 3,476 (24.7%) were nonpersistent and 1,248 (8.9%) were nonadherent. In a multivariate analysis, nonpersistence (ever/never) in both age groups was associated with older age, having a non-oncologist write the prescription, and having a higher number of other prescriptions. Compared with a co-payment of less than $30, a co-payment of $30 to $89.99 for a 90-day prescription was associated with less persistence in women age 65 years or older (odds ratio [OR], 0.69; 95% CI, 0.62 to 0.75) but not among women younger than age 65, although a co-payment of more than $90 was associated with less persistence both in women younger than age 65 (OR, 0.82; 95% CI, 0.72 to 0.94) and those age 65 years or older (OR, 0.72; 95% CI, 0.65 to 0.80). Similar results were seen with nonadherence. Conclusion We found that higher prescription co-payments were associated with both nonpersistence and nonadherence to AIs. This relationship was stronger in older women. Because noncompliance is associated with worse outcomes, future policy efforts should be directed toward interventions that would help patients with financial difficulties obtain life-saving medications.

scholarly journals Early Discontinuation and Nonadherence to Adjuvant Hormonal Therapy in a Cohort of 8,769 Early-Stage Breast Cancer Patients

2010 ◽  
Vol 28 (27) ◽  
pp. 4120-4128 ◽  
Author(s):  
Dawn L. Hershman ◽  
Lawrence H. Kushi ◽  
Theresa Shao ◽  
Donna Buono ◽  
Aaron Kershenbaum ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Hormonal Therapy ◽  
Early Stage ◽  
Optimal Schedule ◽  
Medication Possession Ratio ◽  
Adjuvant Hormonal Therapy ◽  
Breast Cancer Patients ◽  
Early Discontinuation ◽  
Younger Women ◽  
Hormone Sensitive

Purpose While studies have found that adjuvant hormonal therapy for hormone-sensitive breast cancer (BC) dramatically reduces recurrence and mortality, adherence to medications is suboptimal. We investigated the rates and predictors of early discontinuation and nonadherence to hormonal therapy in patients enrolled in Kaiser Permanente of Northern California health system. Patients and Methods We identified women diagnosed with hormone-sensitive stage I-III BC from 1996 to 2007 and used automated pharmacy records to identify hormonal therapy prescriptions and dates of refill. We used Cox proportional hazards regression models to analyze factors associated with early discontinuation and nonadherence (medication possession ratio < 80%) of hormonal therapy. Results We identified 8,769 patients with BC who met our eligibility criteria and who filled at least one prescription for tamoxifen (43%), aromatase inhibitors (26%), or both (30%) within 1 year of diagnosis. Younger or older age, lumpectomy (v mastectomy), and comorbidities were associated with earlier discontinuation, while Asian race, being married, earlier year at diagnosis, receipt of chemotherapy or radiotherapy, and longer prescription refill interval were associated with completion of 4.5 years of therapy. Of those who continued therapy, similar factors were associated with full adherence. Women age younger than 40 years had the highest risk of discontinuation (hazard ratio, 1.51; 95% CI, 1.23 to 1.85). By 4.5 years, 32% discontinued therapy, and of those who continued, 72% were fully adherent. Conclusion Only 49% of patients with BC took adjuvant hormonal therapy for the full duration at the optimal schedule. Younger women are at high risk of nonadherence. Interventions to improve adherence and continuation of hormonal therapy are needed, especially for younger women.

Automated telephone reminders: Potential to improve adherence to adjuvant hormonal therapy among patients with breast cancer.

2012 ◽  
Vol 30 (34_suppl) ◽  
pp. 297-297 ◽  
Author(s):  
Virginia P. Quinn ◽  
Joanne E. Schottinger ◽  
Kelley R. Green ◽  
Craig T. Cheetham
Keyword(s):  
Breast Cancer ◽  
Hormonal Therapy ◽  
Health Care Organization ◽  
Medication Possession Ratio ◽  
Care Organization ◽  
Adjuvant Hormonal Therapy ◽  
Kaiser Permanente ◽  
Telephone Reminder ◽  
The Impact ◽  
Recommended Therapy

297 Background: As the U.S. population ages and life expectancy lengthens, the number of new estrogen receptor positive (ER+) breast cancer (bca) cases is expected to grow substantially from the current 150,000/year. Numerous studies show that adjuvant hormonal therapy (AHT) dramatically reduces bca recurrence (by 50%) and mortality (by 30%) among ER+ women. Daily treatment for 5 years is the recommended therapy. Yet, reports of under-utilization are alarming, ranging from 30% to more than 50%. Methods: We examined utilization of AHT among members of Kaiser Permanente Southern California, a nonprofit prepaid health care organization serving 3.6 million socio-economically diverse members. We identified 10,827 women diagnosed with bca between 2000 and 2007 from the plan’s SEER-affiliated cancer registry who were eligible for AHT. We used automated pharmacy records to assess uptake and utilization of AHT (primarily tamoxifen (TAM) and aromatase inhibitors (AIs)). Results: In this insured population, we found 14% of eligible bca survivors did not begin AHT. Among women who started AHT, over 30% had sub-optimal adherence defined as a medication possession ratio <80%. Discontinuation of AHT, defined as >90 days without medication, began in year 1 (7%) and reached 25% by year 5. To address this threat to quality bca care, the health plan recently initiated an innovative automated telephone reminder (ATR) system among women who filled at least 1 prescription for TAM. Each month, ATR calls are made to about 125 women >18 years, who are overdue between 2 and 6 weeks for a refill, and who have not developed intolerance to TAM or switched to an AI. To date, ATR calls have generated no or few complaints. Next steps include evaluation of the impact of the system on adherence to TAM and, subsequently, AIs, and incorporation of electronic prompts to clinical staff for follow-up with non-responders. Conclusions: Monitoring and intervention for improving adherence to AHT needs to begin at initiation and continue across the 5 years of recommended therapy. AVR can reach large numbers of bca survivors and may have the potential to ensure they receive optimal benefit from these life-saving treatments.

Impact of African ancestry on the relationship between BMI and survival in early stage breast cancer: Retrospective analysis from E5103.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 1010-1010
Author(s):  
Tarah Jean Ballinger ◽  
Guanglong Jiang ◽  
Fei Shen ◽  
Kathy Miller ◽  
Bryan P. Schneider
Keyword(s):  
Breast Cancer ◽  
Racial Disparities ◽  
Early Stage ◽  
African Ancestry ◽  
Genetic Ancestry ◽  
Early Stage Breast Cancer ◽  
European Ancestry ◽  
A Genome ◽  
The Impact ◽  
The Relationship

1010 Background: Both Black race and obesity are associated with worse survival in early stage breast cancer. Obesity disproportionately affects Black women; however, the degree this contributes to racial disparities in breast cancer remains unclear. Prior work evaluated heterogeneous populations or used self- reported race, rather than genetic ancestry. African ancestry is associated with higher BMI and worse survival in breast cancer; however, the intersection between genetic ancestry and obesity on survival outcomes remains unknown. Methods: We analyzed data from the adjuvant trial E5103. Patients with high risk, HER2 negative breast cancer received doxorubicin/cyclophosphamide x 4, followed by weekly paclitaxel x 12, with or without bevacizumab. Genetic ancestry was determined on the 2,854 patients with available germline DNA, BMI, and outcome data using principal components from a genome-wide array. The primary objective assessed impact of BMI on DFS and OS by ancestry. Multivariate Cox proportional hazard models evaluated correlation between continuous or binary BMI and survival in African (AA) and European (EA) Americans. Results: 13.4% of patients were genetically classified as AA and 86.6% as EA. Higher continuous BMI was significantly associated with worse DFS and OS only in AAs (DFS: HR = 1.25 95% CI 1.07-1.46, p = 0.004; OS: HR = 1.38 95% CI 1.10-1.73, p = 0.005); not in EAs (DFS HR = 0.97 95% CI 0.90-1.05, p = 0.50; OS HR = 1.03 95% CI 0.93-1.14, p = 0.52). By disease subtype, BMI was associated with worse outcomes only in AAs with ER+, and not TNBC. By categorical BMI, WHO class III obesity (³ 40) significantly associated with worse DFS and OS only in AAs (DFS HR = 1.98, p = 0.010; OS HR = 2.07, p = 0.064), not in EAs (DFS HR = 0.97, p = 0.86; OS HR = 1.28, p = 0.30). Proportion of African ancestry (proAA) was associated with higher BMI and worse outcomes in the total population; however, within AAs there was no significant interaction between proAA and BMI on DFS (HR = 0.36, p = 0.06) or OS (HR = 0.38, p = 0.24). In AAs, BMI remained associated with DFS (HR = 2.78, p = 0.019), suggesting higher BMI is associated with worse DFS regardless of proAA. Coefficients for the interaction term indicate that as proAA increases the impact of BMI on outcome is lessened. Conclusions: Higher BMI is significantly associated with worse breast cancer outcomes in women of African ancestry in E5103, but not in those of European ancestry. Categorically, this association was significant only for severe obesity, indicating the relationship may depend on the degree of obesity. As proAA increased in AAs, the impact of BMI on outcome was lessened, suggesting other host factors may contribute more to obesity’s influence on outcome than genetics. Determination of the optimal populations for weight loss interventions will advance precision medicine efforts to impact racial disparities and outcomes in early stage breast cancer.

Racial Disparities in Treatment and Survival Among Women With Early-Stage Breast Cancer

2005 ◽  
Vol 23 (27) ◽  
pp. 6639-6646 ◽  
Author(s):  
Dawn Hershman ◽  
Russell McBride ◽  
Judith S. Jacobson ◽  
Lois Lamerato ◽  
Kevin Roberts ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Adjuvant Chemotherapy ◽  
Racial Disparities ◽  
Treatment Duration ◽  
Early Stage ◽  
Early Stage Breast Cancer ◽  
Expected Number ◽  
Comorbidity Score ◽  
Black Race ◽  
Number Of Cycles

Purpose Black women with breast cancer are known to have poorer survival than white women. Suboptimal treatment may compromise the survival benefits of adjuvant chemotherapy. We analyzed the association of race and survival with duration of treatment and number of treatment cycles among women receiving chemotherapy for early-stage breast cancer. Patients and Methods Patients were women in the Henry Ford Health System tumor registry who were diagnosed with stage I/II breast cancer between January 1, 1996, and December 31, 2001, who received adjuvant chemotherapy. We calculated an observed/expected ratio of treatment duration and of completed chemotherapy cycles for each patient. Using Cox proportional hazards models, we analyzed the association of early treatment termination and treatment duration with all-cause mortality, controlling for age, race, stage, hormone receptor status, grade, comorbidity score, and doxorubicin use. Results Of 472 eligible patients, 28% (31% black, 23% white; P = .03) received fewer cycles of treatment than expected. Black race, receipt of ≤ 75% of the expected number of cycles, increasing age, hormone receptor negativity, and a comorbidity score of more than 1 were associated with poorer survival. Among the 344 patients receiving the expected number of cycles, 60% experienced delays. These delays did not reduce survival. Conclusion This study is the first to find that a substantial fraction of women with early-stage breast cancer terminated their chemotherapy prematurely and that early termination was associated with both black race and poorer survival. A better understanding of the determinants of suboptimal treatment may lead to interventions that can reduce racial disparities and improve breast cancer outcomes for all women.

scholarly journals Adherence and persistence to adjuvant hormonal therapy in early stage breast cancer patients: A population-based retrospective cohort study in Israel.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e12051-e12051
Author(s):  
Tal Sella ◽  
Gabriel Chodick
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Hormonal Therapy ◽  
Breast Cancer Survivors ◽  
Early Stage ◽  
Population Based ◽  
Early Stage Breast Cancer ◽  
Adjuvant Hormonal Therapy ◽  
Breast Cancer Patients ◽  
Suboptimal Adherence

e12051 Background: Adjuvant hormonal therapy has been consistently proven to improve multiple outcomes in early breast cancer. Nonetheless, data on rates of adherence and persistence with therapy outside West Europe and North America are scarce. We assessed the adherence and persistence with adjuvant hormonal in a retrospective population based cohort of breast cancer survivors in Maccabi Health Services (MHS), Israel. Methods: We identified women who were diagnosed with breast cancer and initiated adjuvant hormonal therapy between January 2000 and November 2008. Subjects were followed retrospectively from first dispensed tamoxifen or aromatase inhibitor (AI) and up to the earliest of the following events: disease recurrence (indicated by surgery, radiotherapy, chemotherapy or other related therapies), leaving MHS, death, or completion of 5 years of treatment. Discontinuation of therapy was defined as a 180-day or longer treatment gap. Adherence with therapy was assessed using proportion of days covered (PDC) during follow-up period. Survival analysis was used to determine the effect of adherence on all-cause mortality. Results: A total of 4178 women with breast cancer were followed for a median 7.8 years. Over 90% of patients received tamoxifen as the initial hormonal agent. Mean PDC was 84% with lower rates associated with younger age, smoking status, comorbidities and year of diagnosis. Residential area did not affect adherence. Differences were not found. Discontinuation of therapy occurred in 23% of study patients. Among persistent patients, 70% were optimally adherent with therapy (PDC>=80%). Association between adherence with therapy and survival is investigated. Conclusions: Adherence to adjuvant hormonal therapy among Israeli breast cancer patients with national health insurance is high in comparison to international reports. Nevertheless, suboptimal adherence was identified among younger (<45y) patients. Because of the efficacy of hormonal therapy in preventing recurrence and death in women with early-stage breast cancer, interventions are necessary to identify and prevent suboptimal adherence among high risk subgroups.

The impact of loco-regional recurrences on metastatic progression in early-stage breast cancer: a multistate model

2009 ◽  
Vol 117 (2) ◽  
pp. 401-408 ◽  
Author(s):  
G. H. de Bock ◽  
H. Putter ◽  
J. Bonnema ◽  
J. A. van der Hage ◽  
H. Bartelink ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Early Stage ◽  
Early Stage Breast Cancer ◽  
Metastatic Progression ◽  
Multistate Model ◽  
The Impact
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