Medication delivery factors and adjuvant endocrine therapy adherence in breast cancer. Breast Cancer Res Treat 2023 Jan;197(1):223-233
Date
11/11/2022Pubmed ID
36357711DOI
10.1007/s10549-022-06704-2Scopus ID
2-s2.0-85141681578 (requires institutional sign-in at Scopus site) 3 CitationsAbstract
PURPOSE: Over 50% of breast cancer patients prescribed a 5-year course of daily oral adjuvant endocrine therapy (ET) are nonadherent. We investigated the role of costs and cancer medication delivery mode and other medication delivery factors on adherence.
METHODS: We conducted a retrospective cohort study of commercially insured and Medicare advantage patients with newly diagnosed breast cancer in 2007-2015 who initiated ET. We examined the association between 12-month ET adherence (proportion of days covered by fills ≥ 0.80) and ET copayments, 90-day prescription refill use, mail order pharmacy use, number of pharmacies, and synchronization of medications. We used regression models to estimate nonadherence risk ratios adjusted for demographics (age, income, race, urbanicity), comorbidities, total medications, primary cancer treatments, and generic AI availability. Sensitivity analyses were conducted using alternative specifications for independent variables.
RESULTS: Mail order users had higher adherence in both commercial and Medicare-insured cohorts. Commercially insured patients who used mail order were more likely to be adherent if they had low copayments (< $5) and 90-day prescription refills. For commercially insured patients who used local pharmacies, use of one pharmacy and better synchronized refills were also associated with adherence. Among Medicare patients who used mail order pharmacies, only low copayments were associated with adherence, while among Medicare patients using local pharmacies both low copayments and 90-day prescriptions were associated with ET adherence.
CONCLUSION: Out-of-pocket costs, medication delivery mode, and other pharmacy-related medication delivery factors are associated with adherence to breast cancer ET. Future work should investigate whether interventions aimed at streamlining medication delivery could improve adherence for breast cancer patients.
Author List
Neuner JM, Fergestrom N, Pezzin LE, Laud PW, Ruddy KJ, Winn ANAuthors
Purushottam W. Laud PhD Professor in the Institute for Health and Equity department at Medical College of WisconsinJoan Neuner MD, MPH Professor in the Medicine department at Medical College of Wisconsin
Liliana Pezzin PhD, JD Professor in the Institute for Health and Equity department at Medical College of Wisconsin
MESH terms used to index this publication - Major topics in bold
Adjuvants, ImmunologicAged
Breast Neoplasms
Female
Humans
Medicare
Medication Adherence
Pharmaceutical Services
Retrospective Studies
United States
