Skip to main content
Log in

Socio-demographic and geographic variations in the utilization of hormone therapy in older women with breast cancer after Medicare Part-D coverage

  • Original Paper
  • Published:
Medical Oncology Aims and scope Submit manuscript

Abstract

No study has previously reported the utilization and adherence to hormone therapy for Medicare Part-D beneficiaries with breast cancer. This study was conducted using the Surveillance, Epidemiology, and End Results-Medicare-linked data to assess socio-demographic, geographic, and other variations in the receipt of hormone therapy among patients with hormone receptor-positive breast cancer and to assess adherence to hormone therapy within 1-year follow-up. The percentage of patients who received hormone therapy was calculated and stratified by chemotherapy status (yes or no). Logistic regression models were performed to assess the variations associated with the use of selective estrogen receptor modulators (SERMs), aromatase inhibitors (AIs), and hormone therapy (SERMs or AIs). Of 25,128 women with hormone receptor-positive breast cancer in 2006–2009 who were enrolled in Medicare Part-D program, 70.8 % received hormone therapy, 22.2 % received SERM, and 56.9 % received AIs. Among those receiving chemotherapy, significant predictors of receiving hormone therapy included age, tumor stage, surgery type, radiation therapy; significant predictors of receiving SERM included race, year of diagnosis, and tumor stage; and significant predictors of receiving AI included age, race, socioeconomic status, geographic location, tumor stage, and radiation therapy. For those without receiving chemotherapy, most of the above factors were significant, but differed across each drug class. In conclusion, over two-thirds of hormone receptor-positive breast cancer patients received hormone therapy, and still 29.2 % of patients did not receive it. Tumor and clinical factors are the most significant predictors for the receipt of hormone therapy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. American Cancer Society. Cancer facts & figures. Atlanta: American Cancer Society; 2015.

    Google Scholar 

  2. American Cancer Society. http://www.cancer.org/cancer/breastcancer/detailedguide/breast-cancer-treating-hormone-therapy. Accessed 15 Jan 2015.

  3. Fyles AW, McCready DR, Manchul LA, et al. Tamoxifen with or without breast irradiation in women 50 years of age or older with early breast cancer. N Engl J Med. 2004;351(10):963–70.

    Article  CAS  PubMed  Google Scholar 

  4. Doggrell SA. Adherence to oral endocrine treatments in women with breast cancer: can it be improved? Breast Cancer Res Treat. 2011;129(2):299–308.

    Article  CAS  PubMed  Google Scholar 

  5. Chahine G, Howayek M, Atallah D. (2008). [Adjuvant endocrine therapy in breast cancer. Management of early-risk relapse]. Le Journal medical libanais. The Lebanese medical journal. 2008;57(2):124–129.

  6. Rao RD, Cobleigh MA. Adjuvant endocrine therapy for breast cancer. Oncology. 2012;26(6):541–7.

    PubMed  Google Scholar 

  7. National Cancer Institute. http://www.cancer.gov/cancertopics/factsheet/Therapy/hormone-therapy-breast. Accessed 15 Jan 2015.

  8. Mokbel K. The evolving role of aromatase inhibitors in breast cancer. Int J Clin Oncol. 2002;7(5):279–83.

    CAS  PubMed  Google Scholar 

  9. Hershman DL, Shao T, Kushi LH, et al. Early discontinuation and non-adherence to adjuvant hormone therapy are associated with increased mortality in women with breast cancer. Breast Cancer Res Treat. 2011;126(2):529–37.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  10. Makubate B, Donnan PT, Dewar JA, Thompson AM, McCowan C. Cohort study of adherence to adjuvant endocrine therapy, breast cancer recurrence and mortality. Br J Cancer. 2013;108(7):1515–24.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  11. Barron TI, Connolly R, Bennett K, Feely J, Kennedy MJ. Early discontinuation of tamoxifen. Cancer. 2007;109(5):832–9.

    Article  CAS  PubMed  Google Scholar 

  12. Ma AMT, Barone J, Wallis AE, et al. Noncompliance with adjuvant radiation, chemotherapy, or hormone therapy in breast cancer patients. Am J Surg. 2008;196(4):500–4.

    Article  PubMed  Google Scholar 

  13. McCowan C, Shearer J, Donnan PT, Dewar JA, Crilly M, Thompson AM, Fahey TP. Cohort study examining tamoxifen adherence and its relationship to mortality in women with breast cancer. Br J Cancer. 2008;99(11):1763–8.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  14. Owusu C, Buist DSM, Field TS, et al. Predictors of tamoxifen discontinuation among older women with estrogen receptor–positive breast cancer. J Clin Oncol. 2008;26(4):549–55.

    Article  PubMed  Google Scholar 

  15. van Herk-Sukel MPP, van de Poll-Franse LV, Voogd AC, Nieuwenhuijzen GAP, Coebergh JWW, Herings RMC. Half of breast cancer patients discontinue tamoxifen and any endocrine treatment before the end of the recommended treatment period of 5 years: a population-based analysis. Breast Cancer Res Treat. 2010;122(3):843–51.

    Article  PubMed  Google Scholar 

  16. Ulcickas Yood M, Owusu C, Buist DSM, et al. Mortality impact of less-than-standard therapy in older breast cancer patients. J Am Coll Surg. 2008;206(1):66–75.

    Article  Google Scholar 

  17. Svahn TH, Niland JC, Carlson RW, et al. Predictors and temporal trends of adjuvant aromatase inhibitor use in breast cancer. J Natl Compr Cancer Netw. 2009;7(2):115–21.

    CAS  Google Scholar 

  18. National Cancer Institute. SEER-Medicare Linked Database. http://appliedresearch.cancer.gov/seermedicare/. (Accessed on 5 Dec 2014).

  19. Kimmick G, Anderson R, Camacho F, Bhosle M, Hwang W, Balkrishnan R. Adjuvant hormone therapy use among insured, low-income women with breast cancer. J Clin Oncol. 2009;27(21):3445–51.

    Article  PubMed Central  PubMed  Google Scholar 

  20. Winer EP, Hudis C, Burstein HJ, et al. American Society of Clinical Oncology technology assessment on the use of aromatase inhibitors as adjuvant therapy for postmenopausal women with hormone receptor–positive breast cancer: status report 2004. J Clin Oncol. 2005;23(3):619–29.

    Article  CAS  PubMed  Google Scholar 

  21. Thürlimann B, Keshaviah A, Coates AS, et al. A comparison of letrozole and tamoxifen in postmenopausal women with early breast cancer. N Engl J Med. 2005;353(26):2747–57.

    Article  PubMed  Google Scholar 

  22. Forbes JF, Cuzick J, Buzdar A, Howell A, Tobias JS, Baum M. Effect of anastrozole and tamoxifen as adjuvant treatment for early-stage breast cancer: 100-month analysis of the ATAC trial. Lancet Oncol. 2008;9(1):45–53.

    Article  PubMed  Google Scholar 

  23. Huiart L, Dell’Aniello S, Suissa S. Use of tamoxifen and aromatase inhibitors in a large population-based cohort of women with breast cancer. Br J Cancer. 2011;104:1558–63.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  24. Giordano SH, Hortobagyi GN, Kau SWC, Theriault RL, Bondy ML. Breast cancer treatment guidelines in older women. J Clin Oncol. 2005;23(4):783–91.

    Article  PubMed  Google Scholar 

  25. Levy BT, Ritchie JM, Smith E, Gray T, Zhang W. Physician specialty is significantly associated with hormone replacement therapy use. Obstet Gynecol. 2003;101(1):114–22.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

We acknowledge the efforts of the National Cancer Institute; Center for Medicare and Medicaid Services; Information Management Services, Inc.; and the Surveillance, Epidemiology, and End Results Program tumor registries in the creation of this database. The interpretation and reporting of these data are the sole responsibilities of the authors. This study was supported by a grant from the Agency for Healthcare Research and Quality (R01-HS018956) and in part by a grant from the Cancer Prevention and Research Institute of Texas (RP130051).

Conflict of interest

The authors declare that there are no conflicts of interest.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Xianglin L. Du.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Wang, X., Du, X.L. Socio-demographic and geographic variations in the utilization of hormone therapy in older women with breast cancer after Medicare Part-D coverage. Med Oncol 32, 154 (2015). https://doi.org/10.1007/s12032-015-0599-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s12032-015-0599-6

Keywords

Navigation