title: Socioeconomic factors associated with adjuvant hormone therapy use in older breast cancer survivors.
abstract: BACKGROUND
  The authors sought to identify socioeconomic (SES) factors associated with adjuvant hormone therapy (HT) use among a contemporary population of older breast cancer survivors.
  
  
  METHODS
  Telephone surveys were conducted among women (ages 65-89 years) residing in 4 states (California, Florida, Illinois, and New York) who underwent initial breast cancer surgery in 2003. Demographic, SES, and treatment information was collected.
  
  
  RESULTS
  Of 2191 women, 67% received adjuvant HT with either tamoxifen or an aromatase inhibitor (AI); 71% of those women were on an AI. When adjusting for multiple demographic and SES factors, predictors of HT use were better education (high school degree or higher), better informational/emotional support, and younger age (ages 65-79 years). Race/ethnicity, income, and insurance coverage for medication costs were not associated with receiving HT. For those on HT, when adjusting for all other factors, women were more likely to receive an AI if they had insurance coverage for some or all medication costs, if they were wealthier, if they had better informational/emotional support, and if they were younger (ages 65-69 years).
  
  
  CONCLUSIONS
  The majority of older women in this population-based cohort received adjuvant HT, and the adoption of AIs was early. The results indicted that providers should be aware that a woman's education level and support system influence her decision to take HT. Given the high cost of AIs, their benefits in postmenopausal women with hormone receptor-positive breast cancer, and the current finding that women with no insurance coverage for medication costs were significantly less likely to receive an AI, we recommend that policymakers address this issue.
authors.affiliation: Division of Surgical Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin 53226, USA. tyen@mcw.edu
authors.forename: Tina W F
authors.initials: TW
authors.lastname: Yen
authors.forename: Linda K
authors.initials: LK
authors.lastname: Czypinski
authors.forename: Rodney A
authors.initials: RA
authors.lastname: Sparapani
authors.forename: Changbin
authors.initials: C
authors.lastname: Guo
authors.forename: Purushottam W
authors.initials: PW
authors.lastname: Laud
authors.forename: Liliana E
authors.initials: LE
authors.lastname: Pezzin
authors.forename: Ann B
authors.initials: AB
authors.lastname: Nattinger
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D047072:Aromatase Inhibitors / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000188:drug therapy*; D017024:Chemotherapy, Adjuvant; D004522:Educational Status; D005260:Female; D006801:Humans; D012944:Social Support; D012959:Socioeconomic Factors; D017741:Survivors; D013629:Tamoxifen / Q000627:therapeutic use*
chemical_list: D047072:Aromatase Inhibitors; D013629:Tamoxifen
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