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Polypharmacy and medication fill nonadherence in a population-based sample of adolescent and young adult cancer survivors, 2008–2017

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Abstract

Purpose

We examined the association between polypharmacy—an established risk factor for nonadherence in the elderly—and medication fill nonadherence in a large national sample of adolescent and young adult cancer survivors (AYAs) in the USA.

Methods

We pooled data (2008–2017) from the Medical Expenditure Panel Survey. We defined polypharmacy as ≥ 3 unique medications prescribed, based on self-report and pharmacy data, and medication fill nonadherence as self-reported delay or inability to obtain a necessary medication. We estimated prevalence of medication fill nonadherence among AYAs (age 18–39 years with a cancer history). We used logistic regression to estimate the association between (1) polypharmacy and medication fill nonadherence in AYAs, and (2) total number of medications prescribed and medication fill nonadherence, controlling for sex, number of chronic conditions, disability, and survey year.

Results

AYAs (n = 598) were predominantly female (76.2%), age 30–39 years (64.9%), and non-Hispanic White (72.1%). Nearly half were poor (19.0%) or near-poor/low income (21.6%). One in ten AYAs reported medication fill nonadherence (9.75%). Of these, more than 70% cited cost-related barriers as the reason. AYAs with polypharmacy had 2.49 times higher odds of medication fill nonadherence (95%CI 1.11–5.59), compared to those without polypharmacy. Odds of medication fill nonadherence increased by 16% with each additional medication prescribed (AOR 1.16, 95% CI 1.07–1.25).

Conclusions

Polypharmacy may be an important risk factor for medication fill nonadherence in AYAs in the USA.

Implications for Cancer Survivors

Improving AYAs’ medication adherence requires eliminating cost-related barriers, particularly for those with polypharmacy.

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Data availability

The data underlying this article were derived from sources in the public domain: IPUMS Health Surveys, Medical Expenditure Panel Survey, Version 1.1 https://doi.org/10.18128/D071.V1.1, and Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, https://meps.ahrq.gov/mepsweb/.

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Funding

This work was supported by the National Cancer Institute (NCI)/National Institutes of Health (NIH; T32 CA057712 to A.C.B.) and the American Cancer Society (ACS; RSG-21–046 to A.C.B.). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NCI, NIH, or ACS.

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Authors and Affiliations

  1. Department of Health Promotion and Behavioral Sciences, University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Dallas, TX, USA

    Andrea C. Betts & Marlyn Allicock

  2. Department of Health Promotion and Behavioral Sciences, UTHealth School of Public Health, Houston, TX, USA

    Caitlin C. Murphy & Christine Markham

  3. Center for Health Promotion and Prevention Research, UTHealth School of Public Health, Houston, TX, USA

    Caitlin C. Murphy & Christine Markham

  4. Department of Health Promotion and Behavioral Sciences, UTHealth School of Public Health, San Antonio, TX, USA

    L. Aubree Shay

  5. Department of Epidemiology, Human Genetics, and Environmental Sciences, UTHealth School of Public Health, Dallas, TX, USA

    Bijal A. Balasubramanian

  6. Center for Health Promotion and Prevention Research, UTHealth School of Public Health, Dallas, TX, USA

    Bijal A. Balasubramanian & Marlyn Allicock

  7. Division of Pediatrics, University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Michael E. Roth

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Contributions

Conceptualization: A.C.B., C.C.M. Methodology: A.C.B, C.C.M., L.A.S., B.A.B., M.A., C.M. Formal analysis: A.C.B. Writing, original draft: A.C.B. Writing, review, and editing: A.C.B, C.C.M., L.A.S., B.A.B., C.M., M.R., M.A. Supervision: M.A., C.M.

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Correspondence to Andrea C. Betts.

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Ethics approval

The study received an exemption from the Institutional Review Board at the University of Texas Health Science Center (#HSC-SPH-20–0207), as all data used in the study are publicly available.

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Not applicable.

Conflict of interest

A.C.B. reports consulting for Substack, Inc. C.C.M. reports consulting for Freenome. L.A.S., B.A.B., M.A., M.R., and C.M. have no disclosures.

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Betts, A.C., Murphy, C.C., Shay, L. et al. Polypharmacy and medication fill nonadherence in a population-based sample of adolescent and young adult cancer survivors, 2008–2017. J Cancer Surviv 17, 1688–1697 (2023). https://doi.org/10.1007/s11764-022-01274-0

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  • DOI: https://doi.org/10.1007/s11764-022-01274-0

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