Cole B Haskins1, Joan M Neuner2, Bradley D McDowell3, Ryan M Carnahan4, Jess G Fiedorowicz5, Robert B Wallace4, Brian J Smith6, Elizabeth A Chrischilles4. 1. Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA; Medical Scientist Training Program, University of Iowa, Iowa City, IA. Electronic address: cole-haskins@uiowa.edu. 2. Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI. 3. Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA. 4. Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA. 5. Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA; University of Iowa Hospitals and Clinics, Iowa City, IA. 6. Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA; Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, IA.
Abstract
BACKGROUND: Endocrine therapy adherence remains a barrier to optimal estrogen receptor-positive breast cancer outcomes. We theorized that experience navigating difficult medication regimen factors, such as route of administration complexity, might improve subsequent adherence after stressful cancer diagnoses but not for patients with bipolar and psychotic disorders at risk of poor access and nonadherence. MATERIALS AND METHODS: We included 21,894 women aged ≥ 68 years at their first surgically treated stage I-IV estrogen receptor-positive breast cancer (2007-2013) from the Surveillance, Epidemiology, and End Results-Medicare data set, of whom 5.8% had bipolar or psychotic disorders. We required continuous fee-for-service Medicare (parts A and B) data for ≥ 36 months before and 18 months after the cancer diagnosis. The medication regimen factors in the part D claims for 4 months before included the number of all medications used, pharmacy visits, and administration complexity (medication regimen complexity index subscale). Cox regression analysis was used to model the time to initiation and discontinuation, with longitudinal linear regression for adherence to endocrine therapy. RESULTS: Women with more frequent previous medication use and pharmacy visits were more likely to initiate, 4+ medications and 2+ visits versus no medication (hazard ratio [HR], 1.47; 95% confidence interval [CI], 1.33-1.63), to adhere (6.0%; 95% CI, 4.3-7.6), and to continuously use their endocrine therapy (discontinuation HR, 0.48; 95% CI, 0.39-0.59). Medication administration complexity had modest effects. Difficult medication regimens were more common for patients with bipolar and psychotic disorders but had no statistically significant effects. CONCLUSIONS: Experience with frequent previous medication use and pharmacy visits might increase the likelihood of endocrine therapy use for most patients but not for those with bipolar and psychotic disorders.
BACKGROUND: Endocrine therapy adherence remains a barrier to optimal estrogen receptor-positive breast cancer outcomes. We theorized that experience navigating difficult medication regimen factors, such as route of administration complexity, might improve subsequent adherence after stressful cancer diagnoses but not for patients with bipolar and psychotic disorders at risk of poor access and nonadherence. MATERIALS AND METHODS: We included 21,894 women aged ≥ 68 years at their first surgically treated stage I-IV estrogen receptor-positive breast cancer (2007-2013) from the Surveillance, Epidemiology, and End Results-Medicare data set, of whom 5.8% had bipolar or psychotic disorders. We required continuous fee-for-service Medicare (parts A and B) data for ≥ 36 months before and 18 months after the cancer diagnosis. The medication regimen factors in the part D claims for 4 months before included the number of all medications used, pharmacy visits, and administration complexity (medication regimen complexity index subscale). Cox regression analysis was used to model the time to initiation and discontinuation, with longitudinal linear regression for adherence to endocrine therapy. RESULTS: Women with more frequent previous medication use and pharmacy visits were more likely to initiate, 4+ medications and 2+ visits versus no medication (hazard ratio [HR], 1.47; 95% confidence interval [CI], 1.33-1.63), to adhere (6.0%; 95% CI, 4.3-7.6), and to continuously use their endocrine therapy (discontinuation HR, 0.48; 95% CI, 0.39-0.59). Medication administration complexity had modest effects. Difficult medication regimens were more common for patients with bipolar and psychotic disorders but had no statistically significant effects. CONCLUSIONS: Experience with frequent previous medication use and pharmacy visits might increase the likelihood of endocrine therapy use for most patients but not for those with bipolar and psychotic disorders.
Authors: Gabriel S Tajeu; Shia T Kent; Ian M Kronish; Lei Huang; Marie Krousel-Wood; Adam P Bress; Daichi Shimbo; Paul Muntner Journal: Hypertension Date: 2016-07-18 Impact factor: 10.190
Authors: Elizabeth Chrischilles; Kathleen Schneider; June Wilwert; Gregory Lessman; Brian O'Donnell; Brian Gryzlak; Kara Wright; Robert Wallace Journal: Med Care Date: 2014-03 Impact factor: 2.983
Authors: Elizabeth A Chrischilles; Kathleen M Schneider; Mary C Schroeder; Elena Letuchy; Robert B Wallace; Jennifer G Robinson; John M Brooks Journal: J Am Geriatr Soc Date: 2016-03-01 Impact factor: 5.562
Authors: Christopher R Friese; T May Pini; Yun Li; Paul H Abrahamse; John J Graff; Ann S Hamilton; Reshma Jagsi; Nancy K Janz; Sarah T Hawley; Steven J Katz; Jennifer J Griggs Journal: Breast Cancer Res Treat Date: 2013-03-31 Impact factor: 4.872
Authors: Dawn L Hershman; Lawrence H Kushi; Theresa Shao; Donna Buono; Aaron Kershenbaum; Wei-Yann Tsai; Louis Fehrenbacher; Scarlett Lin Gomez; Sunita Miles; Alfred I Neugut Journal: J Clin Oncol Date: 2010-06-28 Impact factor: 44.544
Authors: Troyen A Brennan; Timothy J Dollear; Min Hu; Olga S Matlin; William H Shrank; Niteesh K Choudhry; William Grambley Journal: Health Aff (Millwood) Date: 2012-01 Impact factor: 6.301
Authors: Timothy L Lash; Matthew P Fox; Jennifer L Westrup; Aliza K Fink; Rebecca A Silliman Journal: Breast Cancer Res Treat Date: 2006-03-16 Impact factor: 4.872