title: Adjuvant hormonal therapy use among insured, low-income women with breast cancer.
abstract: PURPOSE Use of adjuvant hormonal therapy, which significantly decreases breast cancer mortality, has not been well described among poor women, who are at higher risk of cancer-related death. Here we explore use of adjuvant hormonal therapy in an insured, low-income population. METHODS A North Carolina Cancer Registry-Medicaid linked data set was used. Women with hormone receptor-positive or unknown, nonmetastatic breast cancer, diagnosed between 1998 and 2002, were included. Main outcomes were (1) prescription fill within 1 year of diagnosis, (2) adherence (medication possession ratio), and (3) persistence (absence of a 90-day gap in prescription fills over 12 months). Results The population consisted of 1,491 women (mean age, 67 years). Sixty-four percent filled prescriptions. Predictors of prescription fill included the following: older age (odds ratio [OR], 1.01; P = .017), greater number of prescription medications (OR, 1.06; P < .001), nonmarried status (OR, 1.82; P = .001), higher stage (OR, 1.83; P < .001), positive hormone receptor status (positive v unknown, OR, 1.98; P < .001), not receiving adjuvant chemotherapy (OR, 1.74; P = .001), receipt of adjuvant radiation (OR, 1.55; P = .004), and treatment in a small hospital (OR, 1.49; P = .024). Adherence and persistence rates were 60% and 80%, respectively. Nonmarried status predicted greater adherence (OR, 1.90; P = .006) and persistence (OR, 1.75; P = .031). CONCLUSION Prescription fill, adherence, and persistence to adjuvant hormonal therapy among socioeconomically disadvantaged women are low. Improving use of adjuvant hormonal therapy may lead to lower breast cancer-specific mortality in this population.
authors.affiliation: Associate Professor of Medicine, Duke University Medical Center, Box 3204, Suite 3800 Duke South, Durham, NC 27710, USA. gretchen.kimmick@duke.edu
authors.forename: Gretchen
authors.initials: G
authors.lastname: Kimmick
authors.forename: Roger
authors.initials: R
authors.lastname: Anderson
authors.forename: Fabian
authors.initials: F
authors.lastname: Camacho
authors.forename: Monali
authors.initials: M
authors.lastname: Bhosle
authors.forename: Wenke
authors.initials: W
authors.lastname: Hwang
authors.forename: Rajesh
authors.initials: R
authors.lastname: Balkrishnan
mesh_terms: D000277:Adjuvants, Pharmaceutic / Q000627:therapeutic use; D000368:Aged; D000369:Aged, 80 and over; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000175:diagnosis / Q000188:drug therapy*; D017024:Chemotherapy, Adjuvant; D005260:Female; D006801:Humans; D008875:Middle Aged; D010349:Patient Compliance; D011203:Poverty; D055656:Prescriptions / Q000592:standards; D012923:Social Class; D016896:Treatment Outcome
chemical_list: D000277:Adjuvants, Pharmaceutic; D018931:Antineoplastic Agents, Hormonal