In spite of its demonstrated benefits, many women do not initiate hormonal therapy, and among those who do, many discontinue it prematurely. We examined whether differences in hormonal therapy adherence may be at least partially explained by the availability of prescription drug coverage. Women aged 20–79 years diagnosed with stage I-III breast cancer between June 2005 and February 2007 were enrolled in the study. Women completed a mailed survey, on average 9 months after diagnosis, and again approximately 4 years later (N = 712). Adjusted logistic regression was used to predict the likelihood of initiating hormonal therapy and hormonal therapy continuation. Women who had prescription drug coverage were more likely to initiate hormonal therapy relative to women without prescription drug coverage (OR 2.91, 95 % CI 1.24–6.84). Women with prescription drug coverage were also more likely to continue hormonal therapy (OR 2.23; 95 % CI 0.99–5.05, p = 0.0543). The lowest income women were also less likely to continue hormonal therapy relative to women with annual household income that exceeded $70,000 (OR 0.55; 95 % CI 0.29–1.04) with a borderline significance of (p = 0.08). This study demonstrates the critical role of prescription drug coverage in hormonal therapy initiation and continuation, independent of health insurance coverage. These findings add to the body of literature that addresses medication adherence. Financial factors must be considered along with behavioral factors that influence adherence, which is becoming increasingly relevant to oncology as treatments are shifted to oral medications, many of which are very expensive.
Hormonal therapy adherence Prescription drug coverage Health insurance
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All authors had full access to the data and participated in the design, analysis, and interpretation of the data. Bradley was responsible for drafting the manuscript. All authors reviewed the manuscript before submission.
This project was funded by Grants R01 CA088370 and R01 CA109696 from the National Cancer Institute to the University of Michigan.
Compliance with ethical standards
Conflict of Interest
None of the authors have any potential conflicts of interest to disclose.
Hershman DL, Greenlee H, Awad D et al (2013) Randomized controlled trial of a clinic-based survivorship intervention following adjuvant therapy in breast cancer survivors. Breast Cancer Res Treat 138(3):795–806CrossRefPubMedGoogle Scholar
Makubate B, Donnan PT, Dewar JA et al (2013) Cohort study of adherence to adjuvant endocrine therapy, breast cancer recurrence and mortality. Br J Cancer 108(7):151–1524CrossRefGoogle Scholar
McCowan C, Shearer J, Donnan PT et al (2008) Cohort study examining tamoxifen adherence and its relationship to mortality in women with breast cancer. Br J Cancer 99(11):1763–1768PubMedCentralCrossRefPubMedGoogle Scholar
Partridge A, Wang P, Winer E et al (2003) Non-adherence to adjuvant tamoxifen therapy in women with primary breast cancer. J Clin Oncol 21(4):602–606CrossRefPubMedGoogle Scholar
Visvanathan K, Hurley P, Bantug E et al (2013) Use of pharmacologic interventions for breast cancer risk reduction: American society of clinical oncology clinical practice guideline. J Clin Oncol 31(23):2942–2962CrossRefPubMedGoogle Scholar
Wu XC, Lund MJ, Kimmick GG et al (2012) Influence of race, insurance, socioeconomic status, and hospital type on receipt of guideline-concordant adjuvant systemic therapy for locoregional breast cancers. J Clin Oncol 30(2):142–150CrossRefPubMedGoogle Scholar
Freedman R, Virgo K, He Y et al (2011) The association of race/ethnicity, insurance status, and socioeconomic factors with breast cancer care. Cancer 117(1):180–189CrossRefPubMedGoogle Scholar
Hershman DL, Tsui J, Wright JD et al (2015) Household net worth, racial disparities, and hormonal therapy adherence among women with early-stage breast cancer. J Clin Oncol 33(9):1053–1059CrossRefPubMedGoogle Scholar
Aizer AA, Falit B, Mendu ML et al (2014) Cancer-specific outcomes among young adults without health insurance. J Clin Oncol 32(19):2025–2030CrossRefPubMedGoogle Scholar
Jagsi R, Pottow JA, Griffith KA et al (2014) Long-term financial burden of breast cancer: experiences of a diverse cohort of survivors identified through population-based registries. J Clin Oncol 32(12):1269–1276PubMedCentralCrossRefPubMedGoogle Scholar
Jagsi R, Hawley ST, Abrahamse P et al (2014) Impact of adjuvant chemotherapy on long-term employment of survivors of early-stage breast cancer. Cancer 120(12):1854–1862PubMedCentralCrossRefPubMedGoogle Scholar
Ekwueme DU, Yabroff KR, Guy GP Jr et al (2014) Medical costs and productivity losses of cancer survivors–United States, 2008–2011. MMWR Morb Mortal Wkly Rep 63(23):505–510PubMedGoogle Scholar
Neugut A, Subar M, Wilde ET et al (2011) Association between prescription co-payment amount ad compliance with adjuvant hormonal therapy in women with early-stage breast cancer. J Clin Oncol 29(18):2534–2542PubMedCentralCrossRefPubMedGoogle Scholar
Richardson L, Tian L, Voti L et al (2006) The roles of teaching hospitals, insurance status, and race/ethnicity in receipt of adjuvant therapy for regional-stage breast cancer in Florida. Am J Public Health 96(1):160–166PubMedCentralCrossRefPubMedGoogle Scholar