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Medication delivery factors and adjuvant endocrine therapy adherence in breast cancer

  • Epidemiology
  • Published:
Breast Cancer Research and Treatment Aims and scope Submit manuscript

Abstract

Purpose

Over 50% of breast cancer patients prescribed a 5-year course of daily oral adjuvant endocrine therapy (ET) are nonadherent. We investigated the role of costs and cancer medication delivery mode and other medication delivery factors on adherence.

Methods

We conducted a retrospective cohort study of commercially insured and Medicare advantage patients with newly diagnosed breast cancer in 2007–2015 who initiated ET. We examined the association between 12-month ET adherence (proportion of days covered by fills ≥ 0.80) and ET copayments, 90-day prescription refill use, mail order pharmacy use, number of pharmacies, and synchronization of medications. We used regression models to estimate nonadherence risk ratios adjusted for demographics (age, income, race, urbanicity), comorbidities, total medications, primary cancer treatments, and generic AI availability. Sensitivity analyses were conducted using alternative specifications for independent variables.

Results

Mail order users had higher adherence in both commercial and Medicare-insured cohorts. Commercially insured patients who used mail order were more likely to be adherent if they had low copayments (< $5) and 90-day prescription refills. For commercially insured patients who used local pharmacies, use of one pharmacy and better synchronized refills were also associated with adherence. Among Medicare patients who used mail order pharmacies, only low copayments were associated with adherence, while among Medicare patients using local pharmacies both low copayments and 90-day prescriptions were associated with ET adherence.

Conclusion

Out-of-pocket costs, medication delivery mode, and other pharmacy-related medication delivery factors are associated with adherence to breast cancer ET. Future work should investigate whether interventions aimed at streamlining medication delivery could improve adherence for breast cancer patients.

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Data availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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Funding

NIH/Minority Health and Health Disparities MD01-0728.

Author information

Authors and Affiliations

  1. Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, WI, USA

    Joan M. Neuner

  2. Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA

    Joan M. Neuner, Nicole Fergestrom & Purushottam W. Laud

  3. Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI, USA

    Liliana E. Pezzin

  4. Division of Biostatistics, Medical College of Wisconsin, Milwaukee, WI, USA

    Purushottam W. Laud

  5. The Division of Medical Oncology, Mayo Clinic, Rochester, MN, USA

    Kathryn J. Ruddy

  6. School of Pharmacy, Medical College of Wisconsin, Milwaukee, WI, USA

    Aaron N. Winn

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  1. Joan M. Neuner
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  4. Purushottam W. Laud
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Contributions

Conceptualization; JMN, PWL, LEP, KJR, PWL, ANW. Data curation; JMN, NJ, KJR Formal analysis; JMN, NF, LEP, PWL Funding acquisition; JMN. Roles/Writing—original draft; JMN Writing—review & editing; all authors.

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Correspondence to Joan M. Neuner.

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

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This study used only deidentified data and was judged to be exempt by the Medical College of Wisconsin IRB.

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Neuner, J.M., Fergestrom, N., Pezzin, L.E. et al. Medication delivery factors and adjuvant endocrine therapy adherence in breast cancer. Breast Cancer Res Treat 197, 223–233 (2023). https://doi.org/10.1007/s10549-022-06704-2

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