Skip to main content

Advertisement

SpringerLink
Log in

Characteristics associated with nonadherence to medications for hypertension, diabetes, and dyslipidemia among breast cancer survivors

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

Abstract

Objective

Comorbidity among breast cancer survivors is prevalent, and adherence to medication management of comorbidities may be important for both chronic disease and cancer-related outcomes. Our objective was to determine characteristics associated with nonadherence to common chronic medications among breast cancer survivors.

Methods

We conducted a retrospective cohort study of 4216 women in an integrated care system diagnosed with early-stage breast cancer between 1990 and 2008 and alive without recurrence or second primary breast cancer in the second-year following diagnosis. Adherence to antihypertensives, oral diabetes medications, and statins was measured during the second-year post-breast cancer diagnosis using medication possession ratios (MPR). Nonadherence was defined as MPR <0.80. We estimated odds ratios (OR) and 95% confidence intervals (CI) for nonadherence to antihypertensives, oral diabetes medications, and statins by various characteristics using multivariable logistic regression.

Results

Among 2308 users of antihypertensives (n = 1779), diabetes medications (n = 499) and/or statins (n = 1072), 37% were nonadherent to antihypertensives; 75% were nonadherent to diabetes medications; 39% were nonadherent to statins. In adjusted models, younger age was associated with nonadherence to all three therapeutic classes. Certain cancer treatments were associated with nonadherence to antihypertensives (radiation: OR 1.21, 95% CI 1.01–1.47; endocrine therapy: OR 1.27, 95% CI 1.03–1.52) and diabetes medications (chemotherapy: OR 1.69, 95% CI 1.17–2.21). Less frequent primary care provider visits were associated with higher odds of nonadherence to antihypertensives (OR 1.70, 95% CI 1.19–2.22); and trends showed higher Charlson comorbidity scores associated with greater adherence to diabetes medications (P < 0.001) and statins (P = 0.032).

Conclusions

Nonadherence to medications is high among breast cancer survivors, particularly diabetes medications, and is associated with cancer treatments and other patient characteristics. Additional research is warranted to understand the needs of cancer patients taking chronic medications and explore patient and provider factors influencing adherence.

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

Access this article

Log in via an institution

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

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Ritchie CS, Kvale E, Fisch MJ (2011) Multimorbidity: an issue of growing importance for oncologists. J Oncol Pract 7(6):371–374. doi:10.1200/JOP.2011.000460

    Article  PubMed  PubMed Central  Google Scholar 

  2. Barone BB, Yeh HC, Snyder CF, Peairs KS, Stein KB, Derr RL, Wolff AC, Brancati FL (2008) Long-term all-cause mortality in cancer patients with preexisting diabetes mellitus: a systematic review and meta-analysis. JAMA 300(23):2754–2764. doi:10.1001/jama.2008.824

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Calip GS, Yu O, Hoskins KF, Boudreau DM (2015) Associations between diabetes medication use and risk of second breast cancer events and mortality. Cancer Causes Control 26(8):1065–1077. doi:10.1007/s10552-015-0599-z

    Article  PubMed  PubMed Central  Google Scholar 

  4. Ahern TP, Pedersen L, Tarp M, Cronin-Fenton DP, Garne JP, Silliman RA, Sorensen HT, Lash TL (2011) Statin prescriptions and breast cancer recurrence risk: a Danish nationwide prospective cohort study. J Natl Cancer Inst 103(19):1461–1468. doi:10.1093/jnci/djr291

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Nickels S, Vrieling A, Seibold P, Heinz J, Obi N, Flesch-Janys D, Chang-Claude J (2013) Mortality and recurrence risk in relation to the use of lipid-lowering drugs in a prospective breast cancer patient cohort. PLoS ONE 8(9):e75088. doi:10.1371/journal.pone.0075088

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Kwan ML, Habel LA, Flick ED, Quesenberry CP, Caan B (2008) Post-diagnosis statin use and breast cancer recurrence in a prospective cohort study of early stage breast cancer survivors. Breast Cancer Res Treat 109(3):573–579. doi:10.1007/s10549-007-9683-8

    Article  CAS  PubMed  Google Scholar 

  7. Chan DC, Shrank WH, Cutler D, Jan S, Fischer MA, Liu J, Avorn J, Solomon D, Brookhart MA, Choudhry NK (2010) Patient, physician, and payment predictors of statin adherence. Med Care 48(3):196–202. doi:10.1097/MLR.0b013e3181c132ad

    Article  PubMed  Google Scholar 

  8. Steiner JF, Ho PM, Beaty BL, Dickinson LM, Hanratty R, Zeng C, Tavel HM, Havranek EP, Davidson AJ, Magid DJ, Estacio RO (2009) Sociodemographic and clinical characteristics are not clinically useful predictors of refill adherence in patients with hypertension. Circ Cardiovasc Qual Outcomes 2(5):451–457. doi:10.1161/CIRCOUTCOMES.108.841635

    Article  PubMed  PubMed Central  Google Scholar 

  9. Osterberg L, Blaschke T (2005) Adherence to medication. N Engl J Med 353(5):487–497. doi:10.1056/NEJMra050100

    Article  CAS  PubMed  Google Scholar 

  10. Peyrot M, McMurry JF Jr, Kruger DF (1999) A biopsychosocial model of glycemic control in diabetes: stress, coping and regimen adherence. J Health Soc Behav 40(2):141–158

    Article  CAS  PubMed  Google Scholar 

  11. Earle CC, Neville BA (2004) Under use of necessary care among cancer survivors. Cancer 101(8):1712–1719. doi:10.1002/cncr.20560

    Article  PubMed  Google Scholar 

  12. Zanders MM, Haak HR, van Herk-Sukel MP, van de Poll-Franse LV, Johnson JA (2015) Impact of cancer on adherence to glucose-lowering drug treatment in individuals with diabetes. Diabetologia 58(5):951–960. doi:10.1007/s00125-015-3497-8

    Article  CAS  PubMed  Google Scholar 

  13. Snyder CF, Frick KD, Peairs KS, Kantsiper ME, Herbert RJ, Blackford AL, Wolff AC, Earle CC (2009) Comparing care for breast cancer survivors to non-cancer controls: a five-year longitudinal study. J Gen Intern Med 24(4):469–474. doi:10.1007/s11606-009-0903-2

    Article  PubMed  PubMed Central  Google Scholar 

  14. Higashi T, Wenger NS, Adams JL, Fung C, Roland M, McGlynn EA, Reeves D, Asch SM, Kerr EA, Shekelle PG (2007) Relationship between number of medical conditions and quality of care. N Engl J Med 356(24):2496–2504. doi:10.1056/NEJMsa066253

    Article  CAS  PubMed  Google Scholar 

  15. Min LC, Wenger NS, Fung C, Chang JT, Ganz DA, Higashi T, Kamberg CJ, MacLean CH, Roth CP, Solomon DH, Young RT, Reuben DB (2007) Multimorbidity is associated with better quality of care among vulnerable elders. Med Care 45(6):480–488. doi:10.1097/MLR.0b013e318030fff9

    Article  PubMed  Google Scholar 

  16. American Cancer Society (2013) Breast cancer facts & figures 2013–2014. American Cancer Society Inc., Atlanta

    Google Scholar 

  17. Calip GS, Hubbard RA, Stergachis A, Malone KE, Gralow JR, Boudreau DM (2015) Adherence to oral diabetes medications and glycemic control during and following breast cancer treatment. Pharmacoepidemiol Drug Saf 24(1):75–85. doi:10.1002/pds.3660

    Article  CAS  PubMed  Google Scholar 

  18. Calip GS, Boudreau DM, Loggers ET (2013) Changes in adherence to statins and subsequent lipid profiles during and following breast cancer treatment. Breast Cancer Res Treat 138(1):225–233. doi:10.1007/s10549-013-2424-2

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Santorelli ML, Steinberg MB, Hirshfield KM, Rhoads GG, Bandera EV, Lin Y, Demissie K (2016) Effects of breast cancer on chronic disease medication adherence among older women. Pharmacoepidemiol Drug Saf 25(8):898–907. doi:10.1002/pds.3971

    Article  CAS  PubMed  Google Scholar 

  20. Yang J, Neugut AI, Wright JD, Accordino M, Hershman DL (2016) Nonadherence to oral medications for chronic conditions in breast cancer survivors. J Oncol Pract. doi:10.1200/JOP.2016.011742

    PubMed  Google Scholar 

  21. Boudreau DM, Yu O, Chubak J, Wirtz HS, Bowles EJ, Fujii M, Buist DS (2014) Comparative safety of cardiovascular medication use and breast cancer outcomes among women with early stage breast cancer. Breast Cancer Res Treat 144(2):405–416. doi:10.1007/s10549-014-2870-5

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Surveillance Epidemiology and End Results (SEER) program overview of the SEER program http://seer.cancer.gov/about/overview.html

  23. Saunders KW, Davis RL, Stergachis A (2005) Group health cooperative. In: Strom BL (ed) Pharmacoepidemiology, 4th edn. Wiley, Chichester, pp 223–239

    Google Scholar 

  24. Washington State Department of Health, Center for Health Statistics. Death Data. http://www.doh.wa.gov/DataandStatisticalReports/VitalStatisticsData/DeathData. Accessed 15 Jun 2011

  25. Andrade SE, Kahler KH, Frech F, Chan KA (2006) Methods for evaluation of medication adherence and persistence using automated databases. Pharmacoepidemiol Drug Saf 15(8):565–574. doi:10.1002/pds.1230

    Article  PubMed  Google Scholar 

  26. Bryson CL, Au DH, Young B, McDonell MB, Fihn SD (2007) A refill adherence algorithm for multiple short intervals to estimate refill compliance (ReComp). Med Care 45(6):497–504. doi:10.1097/MLR.0b013e3180329368

    Article  PubMed  Google Scholar 

  27. Choudhry NK, Shrank WH, Levin RL, Lee JL, Jan SA, Brookhart MA, Solomon DH (2009) Measuring concurrent adherence to multiple related medications. Am J Manag Care 15(7):457–464

    PubMed  PubMed Central  Google Scholar 

  28. Deyo RA, Cherkin DC, Ciol MA (1992) Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol 45(6):613–619

    Article  CAS  PubMed  Google Scholar 

  29. Steiner JF (2016) Measuring adherence with medications: time is of the essence. Pharmacoepidemiol Drug Saf 25(3):333–335. doi:10.1002/pds.3932

    Article  PubMed  Google Scholar 

  30. Lau DT, Nau DP (2004) Oral antihyperglycemic medication nonadherence and subsequent hospitalization among individuals with type 2 diabetes. Diabetes Care 27(9):2149–2153

    Article  CAS  PubMed  Google Scholar 

  31. Hepke KL, Martus MT, Share DA (2004) Costs and utilization associated with pharmaceutical adherence in a diabetic population. Am J Manag Care 10(2 Pt 2):144–151

    PubMed  Google Scholar 

  32. Currie CJ, Peyrot M, Morgan CL, Poole CD, Jenkins-Jones S, Rubin RR, Burton CM, Evans M (2012) The impact of treatment noncompliance on mortality in people with type 2 diabetes. Diabetes Care 35(6):1279–1284. doi:10.2337/dc11-1277

    Article  PubMed  PubMed Central  Google Scholar 

  33. Raebel MA, Ellis JL, Carroll NM, Bayliss EA, McGinnis B, Schroeder EB, Shetterly S, Xu S, Steiner JF (2012) Characteristics of patients with primary non-adherence to medications for hypertension, diabetes, and lipid disorders. J Gen Intern Med 27(1):57–64. doi:10.1007/s11606-011-1829-z

    Article  PubMed  Google Scholar 

  34. Monane M, Bohn RL, Gurwitz JH, Glynn RJ, Levin R, Avorn J (1996) Compliance with antihypertensive therapy among elderly Medicaid enrollees: the roles of age, gender, and race. Am J Public Health 86(12):1805–1808

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. Janz NK, Becker MH (1984) The Health Belief Model: a decade later. Health Educ Q 11(1):1–47

    Article  CAS  PubMed  Google Scholar 

  36. Olson KL, Rasmussen J, Sandhoff BG, Merenich JA, Clinical Pharmacy Cardiac Risk Service Study G (2005) Lipid management in patients with coronary artery disease by a clinical pharmacy service in a group model health maintenance organization. Arch Intern Med 165(1):49–54. doi:10.1001/archinte.165.1.49

    Article  PubMed  Google Scholar 

  37. McCulloch DK, Price MJ, Hindmarsh M, Wagner EH (1998) A population-based approach to diabetes management in a primary care setting: early results and lessons learned. Eff Clin Pract 1(1):12–22

    CAS  PubMed  Google Scholar 

  38. Kantsiper M, McDonald EL, Geller G, Shockney L, Snyder C, Wolff AC (2009) Transitioning to breast cancer survivorship: perspectives of patients, cancer specialists, and primary care providers. J Gen Intern Med 24(Suppl 2):S459–S466. doi:10.1007/s11606-009-1000-2

    Article  PubMed  Google Scholar 

  39. Peairs KS, Wolff AC, Olsen SJ, Bantug ET, Shockney L, Kantsiper ME, Carrino-Tamasi E, Snyder CF (2011) Coordination of care in breast cancer survivors: an overview. J Support Oncol 9(6):210–215. doi:10.1016/j.suponc.2011.06.008

    Article  PubMed  Google Scholar 

  40. Hewitt ME, Ganz PA, Institute of Medicine (U.S.), American Society of Clinical Oncology (U.S.) (2006) From cancer patient to cancer survivor: lost in transition. National Academies Press, Washington

    Google Scholar 

  41. Bayliss EA, Blatchford PJ, Newcomer SR, Steiner JF, Fairclough DL (2011) The effect of incident cancer, depression and pulmonary disease exacerbations on type 2 diabetes control. J Gen Intern Med 26(6):575–581. doi:10.1007/s11606-010-1600-x

    Article  PubMed  PubMed Central  Google Scholar 

  42. Eckel RH, Alberti KG, Grundy SM, Zimmet PZ (2010) The metabolic syndrome. Lancet 375(9710):181–183. doi:10.1016/S0140-6736(09)61794-3

    Article  PubMed  Google Scholar 

  43. Mozumdar A, Liguori G (2011) Persistent increase of prevalence of metabolic syndrome among U.S. adults: NHANES III to NHANES 1999–2006. Diabetes Care 34(1):216–219. doi:10.2337/dc10-0879

    Article  PubMed  Google Scholar 

  44. Esposito K, Chiodini P, Capuano A, Bellastella G, Maiorino MI, Rafaniello C, Giugliano D (2013) Metabolic syndrome and postmenopausal breast cancer: systematic review and meta-analysis. Menopause 20(12):1301–1309. doi:10.1097/GME.0b013e31828ce95d

    Article  PubMed  Google Scholar 

  45. Calip GS, Malone KE, Gralow JR, Stergachis A, Hubbard RA, Boudreau DM (2014) Metabolic syndrome and outcomes following early-stage breast cancer. Breast Cancer Res Treat 148(2):363–377. doi:10.1007/s10549-014-3157-6

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  46. Pasanisi P, Berrino F, De Petris M, Venturelli E, Mastroianni A, Panico S (2006) Metabolic syndrome as a prognostic factor for breast cancer recurrences. Int J Cancer 119(1):236–238. doi:10.1002/ijc.21812

    Article  CAS  PubMed  Google Scholar 

  47. Berrino F, Villarini A, Traina A, Bonanni B, Panico S, Mano MP, Mercandino A, Galasso R, Barbero M, Simeoni M, Bassi MC, Consolaro E, Johansson H, Zarcone M, Bruno E, Gargano G, Venturelli E, Pasanisi P (2014) Metabolic syndrome and breast cancer prognosis. Breast Cancer Res Treat 147(1):159–165. doi:10.1007/s10549-014-3076-6

    Article  PubMed  Google Scholar 

  48. Ambrosius WT, Sink KM, Foy CG, Berlowitz DR, Cheung AK, Cushman WC, Fine LJ, Goff DC Jr, Johnson KC, Killeen AA, Lewis CE, Oparil S, Reboussin DM, Rocco MV, Snyder JK, Williamson JD, Wright JT, Whelton PK Jr, Group SSR (2014) The design and rationale of a multicenter clinical trial comparing two strategies for control of systolic blood pressure: the Systolic Blood Pressure Intervention Trial (SPRINT). Clin Trials 11(5):532–546. doi:10.1177/1740774514537404

    Article  PubMed  Google Scholar 

  49. American Diabetes Association (2015) Standards of medical care in diabetes–2015. Diabetes Care 38(Suppl 1):S1–S98. doi:10.2337/dc15-S001

    Google Scholar 

  50. James PA, Oparil S, Carter BL, Cushman WC, Dennison-Himmelfarb C, Handler J, Lackland DT, LeFevre ML, MacKenzie TD, Ogedegbe O, Smith SC Jr, Svetkey LP, Taler SJ, Townsend RR, Wright JT Jr, Narva AS, Ortiz E (2014) 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA 311(5):507–520. doi:10.1001/jama.2013.284427

    Article  CAS  PubMed  Google Scholar 

  51. Stone NJ, Robinson JG, Lichtenstein AH, Merz CNB, Blum CB, Eckel RH, Goldberg AC, Gordon D, Levy D, Lloyd-Jones DM, McBride P, Schwartz JS, Shero ST, Smith SC, Smith SC Jr, Watson K, Wilson PW, American College of Cardiology/American Heart Association Task Force on Practice G (2014) 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 63(25 Pt B):2889–2934. doi:10.1016/j.jacc.2013.11.002

    Article  PubMed  Google Scholar 

  52. Boudreau DM, Doescher MP, Jackson JE, Fishman PA, Saver BG (2004) Impact of healthcare delivery system on where HMO-enrolled seniors purchase medications. Ann Pharmacother 38(7–8):1317–1318. doi:10.1345/aph.1D569

    Article  PubMed  Google Scholar 

  53. Haynes RB, Ackloo E, Sahota N, McDonald HP, Yao X (2008) Interventions for enhancing medication adherence. Cochrane Database Syst Rev 2(2):CD000011. doi:10.1002/14651858.CD000011.pub3

    Google Scholar 

  54. Group Health Breast Cancer Surveillance Registry. http://www.grouphealthresearch.org/surveillanceproject. Accessed 15 Jun 2011

Download references

Acknowledgements

This work was supported by a Grant from the National Institutes of Health (R01 CA120562) to D.M.B. at Group Health Research Institute. Author G.S.C. was supported by the Cancer Prevention Training Grant in Nutrition, Exercise and Genetics at the University of Washington (R25 CA094880).

Author information

Authors and Affiliations

  1. Center for Pharmacoepidemiology and Pharmacoeconomic Research, University of Illinois at Chicago, 833 South Wood Street MC 781, Chicago, IL, 60612, USA

    Gregory S. Calip

  2. Department of Medicine, University of Washington, Seattle, WA, USA

    Joann G. Elmore

  3. Group Health Research Institute, Seattle, WA, USA

    Denise M. Boudreau

  4. Department of Pharmacy and Department of Epidemiology, University of Washington, Seattle, WA, USA

    Denise M. Boudreau

Authors
  1. Gregory S. Calip
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Joann G. Elmore
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Denise M. Boudreau
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Gregory S. Calip.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This study was approved by the institutional review board of the Group Health Research Institute.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Calip, G.S., Elmore, J.G. & Boudreau, D.M. Characteristics associated with nonadherence to medications for hypertension, diabetes, and dyslipidemia among breast cancer survivors. Breast Cancer Res Treat 161, 161–172 (2017). https://doi.org/10.1007/s10549-016-4043-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10549-016-4043-1

Keywords

Search

Navigation