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Survival benefits associated with being adherent and having longer persistence to adjuvant hormone therapy across up to five years among U.S. Medicare population with breast cancer

  • Epidemiology
  • Published:
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Abstract

Purpose

To assess associations between adherence to and persistence with adjuvant hormone therapy and mortality among older women with breast cancer.

Methods

The surveillance, epidemiology, and end results data linked with U.S. Medicare claims was used. This study included older women diagnosed with stage I–III hormone receptor-positive breast cancer from 2009 through 2017. Adherence was defined as having proportion of days covered (PDC) ≥ 0.80. Persistence was defined as having no discontinuation, i.e., no break of ≥ 180 continuous days. Length of persistence was calculated as time from therapy initiation to discontinuation. Cox models with time-dependent covariates were used to assess associations between adherence and persistence with mortality.

Results

This study included 25,796 women. Adherence rates were 78.1 percent, 75.2 percent, 72.4 percent, 70.0 percent, and 61.5 percent from year 1 to year 5 after hormone therapy initiation. Persistence rates were 87.5 percent, 81.7 percent, 77.1 percent, 72.9 percent, and 68.9 percent through cumulative intervals of 1 year up to 5 years. Adherence was associated with all-cause mortality but not associated with breast cancer-specific mortality. Persistent women had lower risk of all-cause mortality and breast cancer-specific mortality. Each additional year of persistence had additional contributions to survival benefits (11% decreased risk of all-cause mortality and 37% decreased risk of breast cancer-specific mortality).

Conclusion

This study confirms the detrimental effect of nonadherence to adjuvant hormone therapy across up to 5 years on all-cause survival in older U.S. women. It also reveals the survival benefits associated with having longer persistence across up to 5 years.

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Data availability

The data that support the findings of this study came from the SEER-Medicare data. Restrictions apply to the availability of these data, which were used under a data use agreement with the National Cancer Institute. The public may obtain data from the National Cancer Institute through individual data use agreements.

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Acknowledgements

This study used the linked SEER-Medicare database. The interpretation and reporting of these data are the sole responsibility of the authors. The authors acknowledge the efforts of the National Cancer Institute; Information Management Services (IMS), Inc.; and the surveillance, epidemiology, and end results (SEER) Program tumor registries in the creation of the SEER-Medicare database. The collection of cancer incidence data used in this study was supported by the California Department of Public Health pursuant to California Health and Safety Code Section 103885; Centers for Disease Control and Prevention’s (CDC) National Program of Cancer Registries, under cooperative agreement 1NU58DP007156; the National Cancer Institute’s Surveillance, Epidemiology and End Results Program under contract HHSN261201800032I awarded to the University of California, San Francisco, contract HHSN261201800015I awarded to the University of Southern California, and contract HHSN261201800009I awarded to the Public Health Institute. The ideas and opinions expressed herein are those of the author(s) and do not necessarily reflect the opinions of the State of California, Department of Public Health, the National Cancer Institute, and the Centers for Disease Control and Prevention or their Contractors and Subcontractors.

Funding

This work was supported in part by a grant from the Lilly Endowment, Inc., to the Purdue University College of Pharmacy.

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Authors and Affiliations

  1. Department of Pharmacy Practice, College of Pharmacy, Purdue University, West Lafayette, IN, 47907, USA

    Dandan Zheng & Joseph Thomas III

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  1. Dandan Zheng
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Correspondence to Dandan Zheng.

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The authors have no relevant financial or non-financial interests to disclose.

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This study was approved by Purdue University’s Institutional Review Board as exempt.

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This study was approved by Purdue University’s Institutional Review Board as exempt, waiving participant written informed consent for limited data set.

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Zheng, D., Thomas, J. Survival benefits associated with being adherent and having longer persistence to adjuvant hormone therapy across up to five years among U.S. Medicare population with breast cancer. Breast Cancer Res Treat 201, 89–104 (2023). https://doi.org/10.1007/s10549-023-06992-2

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