The economic consequences of breast cancer adjuvant hormonal treatments. J Gen Intern Med 2009 Nov;24 Suppl 2(Suppl 2):S446-50
Date
11/05/2009Pubmed ID
19838848Pubmed Central ID
PMC2763163DOI
10.1007/s11606-009-1079-5Scopus ID
2-s2.0-71949091480 (requires institutional sign-in at Scopus site) 25 CitationsAbstract
RATIONALE: Adjuvant hormone therapy (HT) based on tamoxifen (TX) or aromatase inhibitors (AIs) has become the standard of care for treating hormone receptor -positive (HR+) breast cancer (BC) over the past 20 years. Based on clinical trial results, AI use is recommended by the American Society of Clinical Oncology for treatment of postmenopausal women with HR+ breast cancer. AIs, however, are significantly more expensive than TX, raising concerns about access and use of effective treatment among women of lower socio-economic status.
OBJECTIVES: To examine the relationship between adjuvant HT modality and experience of financial hardship among a cohort of older BC survivors. Also, to examine the extent to which financial concerns affect the probability of switching between adjuvant HT modalities.
DESIGN: Population-based, prospective survey study.
PARTICIPANTS: Elderly (65+) women who had an incident BC surgery in 2003 and who reported receiving adjuvant HT during the first 12 months post-surgery.
METHODS: Multivariate regression models.
RESULTS: Use of AIs was associated with a significantly higher probability of financial hardship. Women who had taken only an AI were more likely to experience financial difficulty than women who took only TX (OR = 1.4; 95% CI: 1.1-1.7), but women who switched between TX and AI were not more likely to experience financial difficulty. Breast cancer survivors with no drug coverage (OR = 4.5; 95% CI: 3.3-5.9) or partial drug coverage (OR = 3.6; 95% CI: 2.8-4.5) were more likely to experience financial difficulty compared to those with full coverage. Lack of drug coverage was also the main factor associated with the likelihood that BC survivors did not switch adjuvant HT modalities.
CONCLUSIONS: Adjuvant HTs have important economic consequences for BC survivors. These consequences are ameliorated by full, but not partial, drug coverage.
Author List
Pezzin LE, O'Niel MB, Nattinger ABAuthors
Ann B. Nattinger MD, MPH Associate Provost, Professor in the Medicine department at Medical College of WisconsinLiliana Pezzin PhD, JD Director, Professor in the Institute for Health and Humanity department at Medical College of Wisconsin
MESH terms used to index this publication - Major topics in bold
AgedAged, 80 and over
Antineoplastic Agents, Hormonal
Aromatase Inhibitors
Breast Neoplasms
Chemotherapy, Adjuvant
Cohort Studies
Data Collection
Female
Humans
Longitudinal Studies
Prospective Studies
Tamoxifen
