title: Initiation of adjuvant hormone therapy by Medicaid insured women with nonmetastatic breast cancer.
abstract: Hormone therapy is the mainstay of adjuvant treatment for hormone receptor positive (HR-positive) nonmetastatic breast cancer. We evaluated adjuvant hormone therapy (AHT) initiation among Medicaid-insured women aged 21-64 years with stage I-III HR-positive breast cancer. We used multivariable logistic regression to identify independent predictors of AHT initiation. Within 1 year of diagnosis, 68% (1049/1538) initiated AHT; by 18 months, 80% (1168/1461) initiated AHT. In multivariable analysis, women less likely to initiate AHT had more comorbidity (≥ 2 vs none: adjusted odds ratio (AOR) = 0.55; 95% CI = 0.32 to 0.97), more advanced disease (stage III vs I: AOR = 0.27; 95% CI = 0.18 to 0.39), and no radiation after breast conserving surgery (AOR = 0.15; 95% CI = 0.10 to 0.22). Race, age, and history of mental health disorders were not independently associated with initiation of AHT. Among initiators of AHT, 58% (604/1049) were adherent to treatment for the year after initiation. Despite comprehensive prescription coverage, only 39% (604/1538) received optimal AHT including prompt initiation and adherence for the year after treatment. Partnerships between Medicaid programs and cancer registries may help identify at-risk women and facilitate the implementation of quality improvement strategies.
authors: Department of Medical Oncology, Center for Outcomes and Policy Research, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02215, USA. ryung1@partners.org.
authors: Rachel L
authors: RL
authors: Yung
authors: Michael J
authors: MJ
authors: Hassett
authors: Kun
authors: K
authors: Chen
authors: Foster C
authors: FC
authors: Gesten
authors: Patrick J
authors: PJ
authors: Roohan
authors: Francis P
authors: FP
authors: Boscoe
authors: Amber H
authors: AH
authors: Sinclair
authors: Maria J
authors: MJ
authors: Schymura
authors: Deborah
authors: D
authors: Schrag
mesh_terms: D000328:Adult; D018931:Antineoplastic Agents, Hormonal / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use*; D019985:Benchmarking; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000191:economics* / Q000473:pathology; D017024:Chemotherapy, Adjuvant; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D016015:Logistic Models; D008484:Medicaid; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D016017:Odds Ratio; D014481:United States
chemical_list: D018931:Antineoplastic Agents, Hormonal