EFFECTS OF PRIOR MEDICATION REGIMEN FACTORS AND BIPOLAR AND PSYCHOTIC DISORDERS ON BREAST CANCER ENDOCRINE THERAPY ADHERENCE

Details

• Alternative Title:
  Clin Breast Cancer
• Personal Author:
  Haskins, Cole B. ; Neuner, Joan M. ; McDowell, Bradley D. ; Carnahan, Ryan M. ; Fiedorowicz, Jess G. ; Wallace, Robert B. ; Smith, Brian J. ; Chrischilles, Elizabeth A.
• Description:
  Background:
  
  Endocrine therapy adherence remains a barrier to optimal estrogen receptor positive (ER+) breast cancer outcomes. We theorized that experience navigating difficult medication regimen factors, such as route of administration complexity, may improve subsequent adherence following stressful cancer diagnoses, but not in patients with bipolar and psychotic disorders at-risk for poor access and non-adherence.
  
  Methods:
  
  We included 21,894 women aged 68 or older at their first surgically treated stage I-IV ER+ breast cancer (2007-2013) from the SEER-Medicare dataset, 5.8% having bipolar and psychotic disorders. We required continuous fee-for-service Medicare (Parts A and B) for at least 36 months before and 18 after cancer diagnosis. “Medication regimen factors” in the Part D claims four months prior included the number of all medications used, pharmacy visits, and administration complexity (Medication Regimen Complexity Index subscale). Cox regression was used to model time-to-initiation and discontinuation, with longitudinal linear regression for adherence to endocrine therapy.
  
  Results:
  
  Women with more frequent prior medication use and pharmacy visits were more likely to initiate [“4+ Meds & 2+ Visits” vs “No Meds” HR 1.47 (95% CI 1.33-1.63)], adhere [+6.0% (95% CI 4.3-7.6)], and continuously use endocrine therapy [discontinuation HR 0.48 (95% CI 0.39-0.59)]. Medication administration complexity had modest effects. Difficult medication regimens were more common among patients with bipolar and psychotic disorders but had no statistically significant effects.
  
  Conclusions:
  
  Experience with frequent prior medication use and pharmacy visits may increase likelihood of endocrine therapy use in most patients, but not in those with bipolar and psychotic disorders.
  
  
• Subjects:
  Administrative Claims, Healthcare Aged Aged, 80 And Over Antineoplastic Agents, Hormonal Antineoplastic Combined Chemotherapy Protocols Bipolar Disorder Breast Breast Neoplasms Chemotherapy, Adjuvant Comorbidity Datasets As Topic Drug Costs Female Health Expenditures Humans Mastectomy Medicare Part D Medication Adherence Psychotic Disorders Receptors, Estrogen Retrospective Studies SEER Program United States

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• Source:
  Clin Breast Cancer. 20(3):e261-e280
• Pubmed ID:
  32139273
• Pubmed Central ID:
  PMC7103521
• Document Type:
  Journal Article
• Funding:
  HHSN261201000140C/CA/NCI NIH HHSUnited States/ ; HHSN261201000035C/CA/NCI NIH HHSUnited States/ ; P30 CA086862/CA/NCI NIH HHSUnited States/ ; HHSN261201000035I/CA/NCI NIH HHSUnited States/ ; HHSN261201000034C/CA/NCI NIH HHSUnited States/ ; T32 GM007337/GM/NIGMS NIH HHSUnited States/ ; U58 DP003862/DP/NCCDPHP CDC HHSUnited States/ ; R01 MD010728/MD/NIMHD NIH HHSUnited States/
• Volume:
  20
• Issue:
  3
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:41a4516afad66eaf1ee4bf28688d518b5fa97a9382ad1519c1d7e657c43f2d70
• Download URL:
  https://stacks.cdc.gov/view/cdc/86259/cdc_86259_DS1.pdf
• File Type:
  [PDF - 155.59 KB ]