Prescription Patterns, Initiation, and 5-Year Adherence to Adjuvant Hormonal Therapy Among Commercially Insured Patients With Breast Cancer

2021 ◽  
pp. OP.20.00248
Author(s):  
Hui Zhao ◽  
Xiudong Lei ◽  
Jiangong Niu ◽  
Ning Zhang ◽  
Zhigang Duan ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Health Insurance ◽  
Hormonal Therapy ◽  
Private Health Insurance ◽  
Breast Cancer Incidence ◽  
Medication Possession Ratio ◽  
Adherence Rate ◽  
Research Database ◽  
Adjuvant Hormonal Therapy ◽  
Female Patients

BACKGROUND: Tamoxifen and aromatase inhibitors (AIs) are used as adjuvant hormonal therapy (AHT) for early-stage hormone receptor–positive (HR+) breast cancer. Treatment for 5 years reduces cancer mortality by 30%. Despite this benefit, adherence to AHT has been suboptimal. Here, we evaluated AHT initiation and patient adherence in women with private health insurance. MATERIALS AND METHODS: Female patients with breast cancer ≥ 18 years of age who underwent mastectomy or lumpectomy between 1999 and 2015 were identified in the IBM MarketScan Research Database. AHT initiation and adherence rates were estimated for all AHT users regardless of HR+ status. Initiation rates were standardized using HR+ breast cancer incidence rates in the Surveillance, Epidemiology, and End Results (SEER) program. Adherence was defined as medication possession ratio ≥ 80%. Risk ratios, odds ratios, and their 95% CIs were calculated for factors associated with patients' initiation and adherence. RESULTS: Among 80,224 patients, the raw initiation rate was 71.8% and the standardized rate was 87.5%. We found 61.2% patients initiated treatment with AIs and 38.8% with tamoxifen. Patients' 1-year adherence rate was 84.4% and the 5-year rate was 65.2%. Prescription by mail-in order, using a single AHT regimen, 50 to 69 years of age, monthly out-of-pocket drug payment ≤ $11, in US dollars, no depression, no comorbidity, living in the Northeast, treatment in recent years, and receipt of a combination of chemotherapy, radiation, and surgery were associated with better adherence. CONCLUSION: Five-year AHT adherence rates are low among female patients with breast cancer with private health insurance. Effective approaches to improve AHT adherence are needed.

scholarly journals Early Discontinuation and Nonadherence to Adjuvant Hormonal Therapy in a Cohort of 8,769 Early-Stage Breast Cancer Patients

2010 ◽  
Vol 28 (27) ◽  
pp. 4120-4128 ◽  
Author(s):  
Dawn L. Hershman ◽  
Lawrence H. Kushi ◽  
Theresa Shao ◽  
Donna Buono ◽  
Aaron Kershenbaum ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Hormonal Therapy ◽  
Early Stage ◽  
Optimal Schedule ◽  
Medication Possession Ratio ◽  
Adjuvant Hormonal Therapy ◽  
Breast Cancer Patients ◽  
Early Discontinuation ◽  
Younger Women ◽  
Hormone Sensitive

Purpose While studies have found that adjuvant hormonal therapy for hormone-sensitive breast cancer (BC) dramatically reduces recurrence and mortality, adherence to medications is suboptimal. We investigated the rates and predictors of early discontinuation and nonadherence to hormonal therapy in patients enrolled in Kaiser Permanente of Northern California health system. Patients and Methods We identified women diagnosed with hormone-sensitive stage I-III BC from 1996 to 2007 and used automated pharmacy records to identify hormonal therapy prescriptions and dates of refill. We used Cox proportional hazards regression models to analyze factors associated with early discontinuation and nonadherence (medication possession ratio < 80%) of hormonal therapy. Results We identified 8,769 patients with BC who met our eligibility criteria and who filled at least one prescription for tamoxifen (43%), aromatase inhibitors (26%), or both (30%) within 1 year of diagnosis. Younger or older age, lumpectomy (v mastectomy), and comorbidities were associated with earlier discontinuation, while Asian race, being married, earlier year at diagnosis, receipt of chemotherapy or radiotherapy, and longer prescription refill interval were associated with completion of 4.5 years of therapy. Of those who continued therapy, similar factors were associated with full adherence. Women age younger than 40 years had the highest risk of discontinuation (hazard ratio, 1.51; 95% CI, 1.23 to 1.85). By 4.5 years, 32% discontinued therapy, and of those who continued, 72% were fully adherent. Conclusion Only 49% of patients with BC took adjuvant hormonal therapy for the full duration at the optimal schedule. Younger women are at high risk of nonadherence. Interventions to improve adherence and continuation of hormonal therapy are needed, especially for younger women.

Automated telephone reminders: Potential to improve adherence to adjuvant hormonal therapy among patients with breast cancer.

2012 ◽  
Vol 30 (34_suppl) ◽  
pp. 297-297 ◽  
Author(s):  
Virginia P. Quinn ◽  
Joanne E. Schottinger ◽  
Kelley R. Green ◽  
Craig T. Cheetham
Keyword(s):  
Breast Cancer ◽  
Hormonal Therapy ◽  
Health Care Organization ◽  
Medication Possession Ratio ◽  
Care Organization ◽  
Adjuvant Hormonal Therapy ◽  
Kaiser Permanente ◽  
Telephone Reminder ◽  
The Impact ◽  
Recommended Therapy

297 Background: As the U.S. population ages and life expectancy lengthens, the number of new estrogen receptor positive (ER+) breast cancer (bca) cases is expected to grow substantially from the current 150,000/year. Numerous studies show that adjuvant hormonal therapy (AHT) dramatically reduces bca recurrence (by 50%) and mortality (by 30%) among ER+ women. Daily treatment for 5 years is the recommended therapy. Yet, reports of under-utilization are alarming, ranging from 30% to more than 50%. Methods: We examined utilization of AHT among members of Kaiser Permanente Southern California, a nonprofit prepaid health care organization serving 3.6 million socio-economically diverse members. We identified 10,827 women diagnosed with bca between 2000 and 2007 from the plan’s SEER-affiliated cancer registry who were eligible for AHT. We used automated pharmacy records to assess uptake and utilization of AHT (primarily tamoxifen (TAM) and aromatase inhibitors (AIs)). Results: In this insured population, we found 14% of eligible bca survivors did not begin AHT. Among women who started AHT, over 30% had sub-optimal adherence defined as a medication possession ratio <80%. Discontinuation of AHT, defined as >90 days without medication, began in year 1 (7%) and reached 25% by year 5. To address this threat to quality bca care, the health plan recently initiated an innovative automated telephone reminder (ATR) system among women who filled at least 1 prescription for TAM. Each month, ATR calls are made to about 125 women >18 years, who are overdue between 2 and 6 weeks for a refill, and who have not developed intolerance to TAM or switched to an AI. To date, ATR calls have generated no or few complaints. Next steps include evaluation of the impact of the system on adherence to TAM and, subsequently, AIs, and incorporation of electronic prompts to clinical staff for follow-up with non-responders. Conclusions: Monitoring and intervention for improving adherence to AHT needs to begin at initiation and continue across the 5 years of recommended therapy. AVR can reach large numbers of bca survivors and may have the potential to ensure they receive optimal benefit from these life-saving treatments.

An NCDB analysis of trends in male breast cancer from 2004-2009 and 2010-2014.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 544-544
Author(s):  
Esther Dubrovsky ◽  
Shira Schwartz ◽  
Jennifer Chun ◽  
Amber Guth ◽  
Deborah M. Axelrod ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Male Breast Cancer ◽  
Hormonal Therapy ◽  
Male Breast ◽  
Adjuvant Hormonal Therapy ◽  
Stage At Diagnosis ◽  
Female Patients ◽  
Treatment Type ◽  
To Receive

544 Background: To examine the trends in clinicopathologic features, treatment, and survival of male breast cancer (MBC), utilizing the National Cancer Data Base (NCDB). Methods: MBC patients entered in the NCDB from 2004-2009 were compared with those from 2010-2014 for demographics, stage at diagnosis, tumor characteristics, treatment type, and overall survival (OS). Male patients were also compared to female patients from the same time periods. Statistical analysis included Pearson’s chi-square test. Results: Of 2,047,868 breast cancer cases, a total of 19,409 (0.95%) men were available for analysis. The group of MBC patients from 2004 to 2009 included 9,790 men with a median age of 65. The group from 2010 to 2014 included 9,619 men with a median age of 66. In the later group there was a decreased rate of DCIS, increased rate of invasive ductal carcinoma, and increased rate of hormone positive tumors. Among the earlier and later MBC groups, 24% vs. 27% of patients underwent lumpectomy. Of these, 61% vs 68% received post-lumpectomy radiation, respectively. Patients in the later group (2010-2014) were more likely to receive adjuvant hormonal therapy (61% vs. 84%, p < 0.0001). MBC patients were older than female patients (65 vs. 61 years, p < 0.0001), had larger tumors (20mm vs. 16mm, p < 0.0001), slightly later stage at diagnosis, and more likely to undergo mastectomy (74 vs. 42%, p < 0.0001). MBC patients also had higher rates of hormone positive tumors, but lower rates of adjuvant hormonal therapy (55% vs. 58%, p < 0.0001). The OS for male vs. female patients in the 2004-2009 groups was 66% vs. 77% (median follow-up 73.9m vs 80.4m) respectively. Similarly, in the 2010-2014 groups, survival was 84% vs. 90% (median follow-up 33.85m vs 35.91m), respectively. Conclusions: Although men have higher rates of hormone positive tumors, they are less likely to receive adjuvant hormonal therapy. There was a significant trend over time towards more standard therapies in men, such as post-lumpectomy radiation and hormonal therapy use. There has been an improvement of OS in men which mirrors that in women. The disparities in outcomes between male and female patients, however, still require further investigation.

A retrospective analysis of CDK4/6 inhibitors among adult female patients with metastatic breast cancer.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e13028-e13028
Author(s):  
Silvia Comis ◽  
Thenmozhi Kandasamy ◽  
Alysa J Perrin ◽  
Kelley Kent ◽  
Mahendra Dulawat ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Metastatic Breast Cancer ◽  
Adult Female ◽  
Hormonal Therapy ◽  
Patient Population ◽  
Metastatic Breast ◽  
Prescription Data ◽  
Adjuvant Hormonal Therapy ◽  
Female Patients ◽  
Group 3

e13028 Background: The aim of this study is to examine the behavior pattern of cyclin-dependent kinase (CDK4/6) inhibitor combinations in adult females with de novo metastatic breast cancer as first therapy or following adjuvant hormonal therapy. Methods: Using United States open health claims and prescription data we analyzed metastatic breast cancer from 2015 Q1 to 2019 Q4, adult female patients (age ≥18). Patients were classified into 3 groups based on their first therapy: Group 1-Hormonal, Group 2-CDK4/6 Inhibitor Combinations, and Group 3-Everolimus Combination. Analysis was completed using the Chi-Squared goodness of fit test assessing the patients moving to next therapy by time period. We also compared the overall CDK4/6 group as a base for probability distribution to study the pattern of therapy change in individual groups. Results: Of 37,351 patients on CDK4/6 inhibitors as first therapy or following adjuvant hormonal therapy for advanced/metastatic diseases, the percentage of patients who moved to next therapy was 3.2% (1,200 patients). For most patients, change in therapy occurred within a 2-year period (87%) and those who remained on their first therapy continued for an extended duration. In both Groups 1 and 2 no statistically significant difference was found in the treatment pattern compared to the overall CDK4/6 inhibitor patient population. However, most patients in Group 3 (90%) compared to the overall patient population on CDK4/6 inhibitors moved to Chemotherapy within the first year of treatment (statistically significant at p-value = 0.02). Further analysis of granularity in individual patient pathways showed about 90% of patients with CDK4/6 inhibitors remained on therapy for about 1 year and, interestingly, about 2% extended beyond 2 years up to 4.5 years. Conclusions: The results show most patients on CDK4/6 inhibitors (95%) had progression free survival (PFS) for the period we analyzed. Overall, patients on CDK4/6 inhibitors behaved similarly when used as first therapy or following adjuvant hormonal therapy.

scholarly journals Adjuvant Hormonal Therapy Use Among Insured, Low-Income Women With Breast Cancer

2009 ◽  
Vol 27 (21) ◽  
pp. 3445-3451 ◽  
Author(s):  
Gretchen Kimmick ◽  
Roger Anderson ◽  
Fabian Camacho ◽  
Monali Bhosle ◽  
Wenke Hwang ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Hormonal Therapy ◽  
Low Income ◽  
Hormone Receptor ◽  
Breast Cancer Mortality ◽  
Medication Possession Ratio ◽  
Adjuvant Radiation ◽  
Adjuvant Hormonal Therapy ◽  
Data Set ◽  
Risk Of Cancer

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.

scholarly journals Association Between Prescription Co-Payment Amount and Compliance With Adjuvant Hormonal Therapy in Women With Early-Stage Breast Cancer

2011 ◽  
Vol 29 (18) ◽  
pp. 2534-2542 ◽  
Author(s):  
Alfred I. Neugut ◽  
Milayna Subar ◽  
Elizabeth Ty Wilde ◽  
Scott Stratton ◽  
Corey H. Brouse ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Hormonal Therapy ◽  
Early Stage ◽  
Age Groups ◽  
Medication Possession Ratio ◽  
Adjuvant Hormonal Therapy ◽  
Financial Difficulties ◽  
Life Saving ◽  
Future Policy ◽  
The Impact

Purpose Noncompliance with adjuvant hormonal therapy among women with breast cancer is common. Little is known about the impact of financial factors, such as co-payments, on noncompliance. Patients and Methods We conducted a retrospective cohort study by using the pharmacy and medical claims database at Medco Health Solutions. Women older than age 50 years who were taking aromatase inhibitors (AIs) for resected breast cancer with two or more mail-order prescriptions, from January 1, 2007, to December 31, 2008, were identified. Patients who were eligible for Medicare were analyzed separately. Nonpersistence was defined as a prescription supply gap of more than 45 days without subsequent refill. Nonadherence was defined as a medication possession ratio less than 80% of eligible days. Results Of 8,110 women younger than age 65 years, 1,721 (21.1%) were nonpersistent and 863 (10.6%) were nonadherent. Among 14,050 women age 65 years or older, 3,476 (24.7%) were nonpersistent and 1,248 (8.9%) were nonadherent. In a multivariate analysis, nonpersistence (ever/never) in both age groups was associated with older age, having a non-oncologist write the prescription, and having a higher number of other prescriptions. Compared with a co-payment of less than $30, a co-payment of $30 to $89.99 for a 90-day prescription was associated with less persistence in women age 65 years or older (odds ratio [OR], 0.69; 95% CI, 0.62 to 0.75) but not among women younger than age 65, although a co-payment of more than $90 was associated with less persistence both in women younger than age 65 (OR, 0.82; 95% CI, 0.72 to 0.94) and those age 65 years or older (OR, 0.72; 95% CI, 0.65 to 0.80). Similar results were seen with nonadherence. Conclusion We found that higher prescription co-payments were associated with both nonpersistence and nonadherence to AIs. This relationship was stronger in older women. Because noncompliance is associated with worse outcomes, future policy efforts should be directed toward interventions that would help patients with financial difficulties obtain life-saving medications.

The role of the clinical pharmacist in guiding adjuvant hormonal therapy in patients with breast cancer

2021 ◽  
pp. 107815522110293
Author(s):  
Amanda V Pirolli ◽  
Tatiana Brusamarello ◽  
Stella S Everton ◽  
Vânia M S Andrzejevski
Keyword(s):  
Breast Cancer ◽  
Hormone Therapy ◽  
Hormonal Therapy ◽  
Clinical Pharmacist ◽  
Tertiary Care ◽  
Structured Interview ◽  
Care Hospital ◽  
Adjuvant Hormonal Therapy ◽  
Breast Cancers

Breast cancer is the most prevalent type of cancer among women, affecting about 2.1 million worldwide and is responsible for the highest number of cancer-related deaths among women. Approximately 80% of breast cancers express on the surface of hormone receptor cells, such as progesterone and estrogen. In these cases, Adjuvant Hormonal Therapy (AHT) is indicated for a period of five to ten years and consists of taking a daily oral pill. The two most used drugs in AHT are tamoxifen and Aromatase Inhibitors. One of the issues most faced by individuals who are subjected to long periods of treatment is the lack of medication adherence and, consequently, therapeutic inefficiency. It is believed that the monitoring by the pharmacist can contribute to the reduction of errors inherent to the medication, making the treatment more effective and improving the patient's quality of life. The present study aimed to know the perception of patients who live with breast cancer and who do AHT in relation to the educational performance of the clinical pharmacist. This is a qualitative, descriptive and exploratory study, carried out from March to October 2020, with 15 women undergoing treatment at the oncology unit of a tertiary-care hospital in south of Brazil. The data were obtained through a semi-structured interview using an instrument composed of two parts, one referring to the characterization of the participants and the other with the guiding question of the research: "How do you perceive the role of the pharmacist in relation to the guidelines for the use of adjuvant hormonal therapy?". The method of theoretical saturation was used to perform the sample closure and the thematic analysis was used to analyze the data. The participants were between 32 and 74 years old, seven were on tamoxifen therapy and eight on anastrozole, ten were on the first year of treatment, two on the second and three on the third year. The themes that emerged were: pharmacist-patient interaction as a safety factor in hormone therapy; role of the pharmacist in the development of strategies for self-management of the patients during hormone therapy; and, challenges for the pharmacist in relation to hormone therapy through continued guidance. It was evident that the pharmacist's educational action encouraged the participants to carry out the treatment in a more confident and assertive manner according to their particularities and beliefs.

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