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Endocrine therapy initiation among Medicaid-insured breast cancer survivors with hormone receptor-positive tumors

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Abstract

Purpose

Hormone receptor-positive (HR+) cancers account for most breast cancer diagnoses and deaths. Among survivors with HR + breast cancers, endocrine therapy (ET) reduces 5-year risk of recurrence by up to 40 %. Observational studies in Medicare- and privately-insured survivors suggest underutilization of ET. We sought to characterize ET use in a low-income Medicaid-insured population in North Carolina.

Methods

Medicaid claims data were matched to state cancer registry records for survivors aging 18–64 diagnosed with stage 0–II HR + breast cancer from 2003 to 2007, eligible for ET, and enrolled in Medicaid for at least 12 of 15 months post-diagnosis. We used multivariable logistic regression to model receipt of any ET medication during 15 months post-diagnosis controlling for age, race, tumor characteristics, receipt of other treatments, comorbidity, residence, reason for Medicaid eligibility, involvement in the Breast and Cervical Cancer Control Program (BCCCP), and diagnosis year.

Results

Of 222 women meeting the inclusion criteria, only 50 % filled a prescription for ET. Involvement in the BCCCP and earlier year of diagnoses were associated with significantly higher odds of initiating guideline-recommended ET (adjusted odds ratio [AOR] for the BCCCP 3.76, 95 % confidence interval [CI] 1.67–8.48; AOR for 2004 relative to 2007 2.80, 95 % CI 1.03–7.62; AOR for 2005 relative to 2007 2.11, 95 % CI 0.92–4.85).

Conclusions

Results suggest substantial underutilization of ET in this population. Interventions are needed to improve timely receipt of ET and to better support survivors taking ET.

Implications for Cancer Survivors

Low-income survivors should be counseled on the importance of ET and offered support services to promote initiation and long-term adherence.

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Acknowledgments

We would like to thank and recognize our expert advisory committee, consisting of Anne Braswell, Jonathan Fischer, Bo Gamble, Eleanor Greene, Linda Kinney, Patrick Maguire, Brenda McCants, Rachel Raab, LaSonia Roberts-Melvin, and Thea Monet. This research was presented as an abstract to the American Society for Clinical Oncology Annual Research Meeting, held in Chicago on June 1–5, 2012.

Funding

This research was funded by a University Cancer Research Fund Health-e-NC pilot grant (Wheeler) and supported by the Integrated Cancer Information and Surveillance System (ICISS), a UNC Lineberger Comprehensive Cancer Center resource. SW’s time was supported by a NIH Mentored Clinical Scientists Comparative Effectiveness Development Award (1-K-12 HS019468-01 (PI: Weinberger)).

Human subjects and animal studies statement

This research on human subjects was approved by the University of North Carolina at Chapel Hill Institutional Review Board. No animal studies were carried out by the authors for this article.

Conflict of interest statement

The authors have no conflicts to disclose.

Author information

Authors and Affiliations

  1. Department of Health Policy and Management, University of North Carolina at Chapel Hill, 135 Dauer Drive, 1101 McGavran-Greenberg Hall, CB# 741,1, Chapel Hill, NC, 27599, USA

    Stephanie Brooke Wheeler, Racquel Elizabeth Kohler & Kristen Hassmiller Lich

  2. Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, CB# 7295, Chapel Hill, NC, 27599, USA

    Stephanie Brooke Wheeler, Katherine Elizabeth Reeder-Hayes, Ravi K. Goyal, Alexis Moore & Hyman Bernard Muss

  3. Department of Hematology/Oncology, University of North Carolina at Chapel Hill, Physicians Office Building, 3rd Floor, 170 Manning Dr., CB# 7305, Chapel Hill, NC, 27599, USA

    Katherine Elizabeth Reeder-Hayes & Hyman Bernard Muss

  4. Department of Family Medicine, University of North Carolina at Chapel Hill, 590 Manning Dr., Chapel Hill, NC, 27599, USA

    Timothy W. Smith

  5. College of Medicine, Medical University of South Carolina, 96 Jonathan Lucas St., Suite 601, MSC 617, Charleston, SC, 29425, USA

    Cathy L. Melvin

  6. Cecil G Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, 725 Martin Luther King Jr. Blvd, CB# 7590, Chapel Hill, NC, 27599, USA

    Stephanie Brooke Wheeler

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  1. Stephanie Brooke Wheeler
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  2. Racquel Elizabeth Kohler
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Corresponding author

Correspondence to Stephanie Brooke Wheeler.

Additional information

The contents of this manuscript have not been published previously, except as an abstract accepted for the 2012 American Society of Clinical Oncology meeting (Chicago, IL, June 1–5).

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Supplemental Table 1

National Drug Codes used to Identify Endocrine Therapy Prescriptions (DOCX 14 kb)

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Wheeler, S.B., Kohler, R.E., Reeder-Hayes, K.E. et al. Endocrine therapy initiation among Medicaid-insured breast cancer survivors with hormone receptor-positive tumors. J Cancer Surviv 8, 603–610 (2014). https://doi.org/10.1007/s11764-014-0365-3

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  • DOI: https://doi.org/10.1007/s11764-014-0365-3

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