title: Prescription drug coverage: implications for hormonal therapy adherence in women diagnosed with breast cancer.
abstract: In spite of its demonstrated benefits, many women do not initiate hormonal therapy, and among those who do, many discontinue it prematurely. We examined whether differences in hormonal therapy adherence may be at least partially explained by the availability of prescription drug coverage. Women aged 20-79 years diagnosed with stage I-III breast cancer between June 2005 and February 2007 were enrolled in the study. Women completed a mailed survey, on average 9 months after diagnosis, and again approximately 4 years later (N = 712). Adjusted logistic regression was used to predict the likelihood of initiating hormonal therapy and hormonal therapy continuation. Women who had prescription drug coverage were more likely to initiate hormonal therapy relative to women without prescription drug coverage (OR 2.91, 95 % CI 1.24-6.84). Women with prescription drug coverage were also more likely to continue hormonal therapy (OR 2.23; 95 % CI 0.99-5.05, p = 0.0543). The lowest income women were also less likely to continue hormonal therapy relative to women with annual household income that exceeded $70,000 (OR 0.55; 95 % CI 0.29-1.04) with a borderline significance of (p = 0.08). This study demonstrates the critical role of prescription drug coverage in hormonal therapy initiation and continuation, independent of health insurance coverage. These findings add to the body of literature that addresses medication adherence. Financial factors must be considered along with behavioral factors that influence adherence, which is becoming increasingly relevant to oncology as treatments are shifted to oral medications, many of which are very expensive.
authors.affiliation: University of Colorado Comprehensive Cancer Center, Aurora, USA. cathy.bradley@ucdenver.edu.|Department of Health Systems, Management, and Policy, School of Public Health, University of Colorado, MS F-434, Bldg. 500, 6th Floor, C6004, 13001 E. 17th Pl., Aurora, CO, 80045, USA. cathy.bradley@ucdenver.edu.
authors.forename: Cathy J
authors.initials: CJ
authors.lastname: Bradley
authors.affiliation: Department of Health Behavior and Policy, School of Medicine, Virginia Commonwealth University, Richmond, VA, USA. Bassam.Dahman@vcuhealth.org.
authors.forename: Bassam
authors.initials: B
authors.lastname: Dahman
authors.affiliation: Department of Radiation Oncology, School of Medicine, University of Michigan, Ann Arbor, MI, 48109, USA. rjagsi@umich.edu.
authors.forename: Reshma
authors.initials: R
authors.lastname: Jagsi
authors.affiliation: Division of General Medicine, Department of Internal Medicine, University of Medicine, University of Michigan, Ann Arbor, MI, 48109, USA. skatz@umich.edu.
authors.forename: Steven
authors.initials: S
authors.lastname: Katz
authors.affiliation: Division of General Medicine, School of Medicine, University of Medicine, University of Michigan, Ann Arbor, MI, 48109, USA. sarahawl@med.umich.edu.
authors.forename: Sarah
authors.initials: S
authors.lastname: Hawley
mesh_terms: D000368:Aged; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D005260:Female; D006801:Humans; D019458:Insurance Coverage; D007348:Insurance, Health; D015141:Los Angeles / Q000453:epidemiology; D055118:Medication Adherence; D008824:Michigan / Q000453:epidemiology; D008875:Middle Aged; D055553:Prescription Drugs / Q000191:economics* / Q000600:supply & distribution*; D012959:Socioeconomic Factors
chemical_list: D018931:Antineoplastic Agents, Hormonal; D055553:Prescription Drugs
keywords: Health insurance; Hormonal therapy adherence; Prescription drug coverage