Association of Endocrine Therapy Initiation Timeliness With Adherence and Continuation in Low-Income Women With Breast Cancer.

Autor:	Sood N; Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine in St Louis, Missouri., Liu Y; Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine in St Louis, Missouri.; Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital, St Louis, Missouri.; Washington University School of Medicine in St Louis, Missouri., Lian M; Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital, St Louis, Missouri.; Washington University School of Medicine in St Louis, Missouri.; Division of General Medical Sciences, Department of Medicine, Washington University School of Medicine in St Louis, Missouri., Greever-Rice T; Center for Health Policy, University of Missouri, Columbia, Missouri., Lucht J; Center for Health Policy, University of Missouri, Columbia, Missouri., Schmaltz C; Department of Health Management and Informatics, University of Missouri School of Medicine, Columbia, Missouri., Colditz GA; Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine in St Louis, Missouri.; Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital, St Louis, Missouri.; Washington University School of Medicine in St Louis, Missouri.
Jazyk:	angličtina
Zdroj:	JAMA network open [JAMA Netw Open] 2022 Aug 01; Vol. 5 (8), pp. e2225345. Date of Electronic Publication: 2022 Aug 01.
DOI:	10.1001/jamanetworkopen.2022.25345
Abstrakt:	Importance: Though adjuvant endocrine therapy (AET) has proven efficacy in treating hormone receptor-positive (HR-positive) breast cancer, patient adherence to AET and continuation of treatment as recommended by guidelines remain suboptimal, especially for low-income patients. Objective: To quantify timelines for initiating AET and assess their association with short- and long-term adherence and continuation of AET in low-income women with breast cancer. Design, Setting, and Participants: This population-based retrospective cohort study included women younger than 65 years diagnosed with first primary HR-positive breast cancer between January 1, 2007, and December 31, 2013, followed up for 5 years after the first use of AET through December 2018, and identified from the linked Missouri Cancer Registry and Medicaid claims data set. Exposures: Time to initiation (TTI) as days from the date of last treatment (surgery, radiotherapy, or chemotherapy) to the first date of AET prescription fill. Main Outcomes and Measures: The main outcomes were adherence to AET as medication possession ratio of 80% or greater and continuation of AET as no gap in medication supply for at least 90 days. Odds ratios (ORs) of adherence and continuation over 1 to 5 years were estimated using logistic regression adjusted for demographic, clinical, and neighborhood variables. Analyses were performed between September 1, 2020, and May 31, 2022. Results: Among 1711 patients, median TTI was 53 (IQR, 26-117) days. A total of 1029 patients (60.1%) were aged 50 to 64 years old, 1270 (74.2%) were non-Hispanic White, and 1133 (66.2%) were unmarried. In the first year after initiation, 1317 (77.0%) were adherent and 1015 (59.3%) continued AET. Over the full 5 years, 376 (22.0%) were adherent and 409 (23.9%) continued AET. Longer TTI was significantly associated with poorer adherence at every year, with an OR of 0.97 (95% CI, 0.95-0.99) for 1-year adherence and an OR of 0.94 (95% CI, 0.90-0.97) for 5-year adherence per 1-month increase in TTI. Longer TTI was also associated with lower odds of short-term, but not long-term, continuation (OR, 0.97 [95% CI, 0.95-0.99] for 1-year continuation and 0.98 [95% CI, 0.96-0.99] for 2-year continuation). Conclusions and Relevance: In this cohort study, longer time to AET initiation was associated with lower odds of short-term and long-term adherence to AET in Medicaid-insured patients with breast cancer. Therefore, early interventions targeting treatment initiation timelines may positively impact adherence throughout the course of treatment and, therefore, outcomes.
Databáze:	MEDLINE
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