Effects of Previous Medication Regimen Factors and Bipolar and Psychotic Disorders on Breast Cancer Endocrine Therapy Adherence. Clin Breast Cancer 2020 Jun;20(3):e261-e280
Date
03/07/2020Pubmed ID
32139273Pubmed Central ID
PMC7103521DOI
10.1016/j.clbc.2019.09.005Scopus ID
2-s2.0-85080951165 (requires institutional sign-in at Scopus site) 1 CitationAbstract
BACKGROUND: Endocrine therapy adherence remains a barrier to optimal estrogen receptor-positive breast cancer outcomes. We theorized that experience navigating difficult medication regimen factors, such as route of administration complexity, might improve subsequent adherence after stressful cancer diagnoses but not for patients with bipolar and psychotic disorders at risk of poor access and nonadherence.
MATERIALS AND METHODS: We included 21,894 women aged ≥ 68 years at their first surgically treated stage I-IV estrogen receptor-positive breast cancer (2007-2013) from the Surveillance, Epidemiology, and End Results-Medicare data set, of whom 5.8% had bipolar or psychotic disorders. We required continuous fee-for-service Medicare (parts A and B) data for ≥ 36 months before and 18 months after the cancer diagnosis. The medication regimen factors in the part D claims for 4 months before included the number of all medications used, pharmacy visits, and administration complexity (medication regimen complexity index subscale). Cox regression analysis was used to model the time to initiation and discontinuation, with longitudinal linear regression for adherence to endocrine therapy.
RESULTS: Women with more frequent previous medication use and pharmacy visits were more likely to initiate, 4+ medications and 2+ visits versus no medication (hazard ratio [HR], 1.47; 95% confidence interval [CI], 1.33-1.63), to adhere (6.0%; 95% CI, 4.3-7.6), and to continuously use their endocrine therapy (discontinuation HR, 0.48; 95% CI, 0.39-0.59). Medication administration complexity had modest effects. Difficult medication regimens were more common for patients with bipolar and psychotic disorders but had no statistically significant effects.
CONCLUSIONS: Experience with frequent previous medication use and pharmacy visits might increase the likelihood of endocrine therapy use for most patients but not for those with bipolar and psychotic disorders.
Author List
Haskins CB, Neuner JM, McDowell BD, Carnahan RM, Fiedorowicz JG, Wallace RB, Smith BJ, Chrischilles EAAuthor
Joan Neuner MD, MPH Professor in the Medicine department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
Administrative Claims, HealthcareAged
Aged, 80 and over
Antineoplastic Agents, Hormonal
Antineoplastic Combined Chemotherapy Protocols
Bipolar Disorder
Breast
Breast Neoplasms
Chemotherapy, Adjuvant
Comorbidity
Datasets as Topic
Drug Costs
Female
Health Expenditures
Humans
Mastectomy
Medicare Part D
Medication Adherence
Psychotic Disorders
Receptors, Estrogen
Retrospective Studies
SEER Program
United States