Abstract
Purpose
Cancer survivors are delaying or avoiding necessary care due to costs, and medication non-adherence is an important aspect of deferred treatment. This study estimates the prevalence of cost-related medication non-adherence (CRN) by race and ethnicity and examines factors associated with CRN among cancer survivors.
Methods
Using the 2006–2013 National Health Interview Survey, we examine self-reported CRN among cancer survivors compared with cancer-free controls. Descriptive statistics and multiple logistic regression models were used to identify factors associated with CRN among cancer survivors.
Results
In a nationally representative sample of 472,542 adults, 10,998 participants reported a history of cancer and 461,544 did not. Among 10,998 cancer survivors, 1397 (12.70 %) reported CRN. Among older cancer survivors, African-Americans were 2.64 times more likely (95 % confidence interval (CI), 1.73 to 4.01) and Hispanics 2.07 times more likely (95 % CI, 1.32 to 3.24) than whites to report CRN. Among younger cancer survivors, Hispanics were 1.61 times more likely (95 % CI, 1.23 to 2.10) than whites to report CRN.
Conclusions
Significant racial and ethnic disparities in CRN were evident among cancer survivors. Older African-American and Hispanic overall survivors were more likely to report CRN in the past year compared with non-Hispanic whites.
Implications for Cancer Survivors
Given increasing prescription drug expenditure, it is important to closely monitor CRN in high-risk subgroups. Racial and ethnic minority groups at high risk for CRN should be counseled on the importance of medication adherence and offered support services to promote medication adherence. Further studies are warranted to establish effective policies and interventions in vulnerable populations.
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References
Schumock GT, Li EC, Suda KJ, Matusiak LM, Hunkler RJ, Vermeulen LC, et al. National trends in prescription drug expenditures and projections for 2014. Am J Health Syst Pharm. 2014;71(6):482–99. doi:10.2146/ajhp130767.
Zivin K, Ratliff S, Heisler MM, Langa KM, Piette JD. Factors influencing cost-related nonadherence to medication in older adults: a conceptually based approach. Value Health. 2010;13(4):338–45. doi:10.1111/j.1524-4733.2009.00679.x.
Bender E. Seeking value as cancer drug costs soar. Cancer Disc. 2013;3(8):833–4. doi:10.1158/2159-8290.CD-ND2013-018.
Tamblyn R, Laprise R, Hanley JA, Abrahamowicz M, Scott S, Mayo N, et al. Adverse events associated with prescription drug cost-sharing among poor and elderly persons. JAMA. 2001;285(4):421–9.
Bambauer KZ, Safran DG, Ross-Degnan D, Zhang F, Adams AS, Gurwitz J, et al. Depression and cost-related medication nonadherence in Medicare beneficiaries. Arch Gen Psychiatry. 2007;64(5):602–8. doi:10.1001/archpsyc.64.5.602.
Langa KM, Fendrick AM, Chernew ME, Kabeto MU, Paisley KL, Hayman JA. Out-of-pocket health-care expenditures among older Americans with cancer. Value Health. 2004;7(2):186–94. doi:10.1111/j.1524-4733.2004.72334.x.
Davidoff AJ, Erten M, Shaffer T, Shoemaker JS, Zuckerman IH, Pandya N, et al. Out-of-pocket health care expenditure burden for Medicare beneficiaries with cancer. Cancer. 2013;119(6):1257–65. doi:10.1002/cncr.27848.
Gornick ME. A decade of research on disparities in Medicare utilization: lessons for the health and health care of vulnerable men. Am J Public Health. 2008;98(9 Suppl):S162–8.
King CJ, Chen J, Dagher RK, Holt CL, Thomas SB. Decomposing differences in Medical care access among cancer survivors by race and ethnicity. Am J Med Qual. 2014. doi:10.1177/1062860614537676.
Nekhlyudov L, Madden J, Graves AJ, Zhang F, Soumerai SB, Ross-Degnan D. Cost-related medication nonadherence and cost-saving strategies used by elderly Medicare cancer survivors. J Cancer Surviv Res Pract. 2011;5(4):395–404. doi:10.1007/s11764-011-0188-4.
Shin DW, Park JH, Park JH, Park EC, Kim SY, Kim SG, et al. Antihypertensive medication adherence in cancer survivors and its affecting factors: results of a Korean population-based study. Support Care Cancer. 2010;19(2):211–20. doi:10.1007/s00520-009-0802-4.
Sabatino SA, Coates RJ, Uhler RJ, Alley LG, Pollack LA. Health insurance coverage and cost barriers to needed medical care among U.S. adult cancer survivors age < 65 years. Cancer. 2006;106(11):2466–75. doi:10.1002/cncr.21879.
National Center for Health Statistics (U.S.). Design and estimation for the National Health Interview Survey, 1995–2004. Vital and health statistics series 2, data evaluation and methods research, vol. 130. Hyattsville: U.S. Dept. of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics; 2000.
Adams PF, Kirzinger WK, Martinez ME. Summary health statistics for the U.S. population: national health interview survey, 2011. Vital and health statistics series 10, data from the National Health Survey. 2012(255):1–110.
Parsons VL, Moriarity C, Jonas K, Moore TF, Davis KE, Tompkins L. Design and estimation for the national health interview survey, 2006–2015. Vital and health statistics series 2, data evaluation and methods research. 2014(165):1–53.
Andersen RM. Revisiting the behavioral model and access to medical care: does it matter? J Health Soc Behav. 1995;36(1):1–10.
Palmer NR, Geiger AM, Felder TM, Lu L, Case LD, Weaver KE. Racial/ethnic disparities in health care receipt among male cancer survivors. Am J Public Health. 2013;103(7):1306–13. doi:10.2105/AJPH.2012.301096.
Levine DA, Morgenstern LB, Langa KM, Piette JD, Rogers MA, Karve SJ. Recent trends in cost-related medication nonadherence among stroke survivors in the United States. Ann Neurol. 2013;73(2):180–8. doi:10.1002/ana.23823.
Briesacher BA, Gurwitz JH, Soumerai SB. Patients at-risk for cost-related medication nonadherence: a review of the literature. J Gen Intern Med. 2007;22(6):864–71. doi:10.1007/s11606-007-0180-x.
Guy Jr GP, Ekwueme DU, Yabroff KR, Dowling EC, Li C, Rodriguez JL, et al. Economic burden of cancer survivorship among adults in the United States. J Clin Oncol. 2013;31(30):3749–57. doi:10.1200/JCO.2013.49.1241.
Weaver KE, Rowland JH, Bellizzi KM, Aziz NM. Forgoing medical care because of cost: assessing disparities in healthcare access among cancer survivors living in the United States. Cancer. 2010;116(14):3493–504. doi:10.1002/cncr.25209.
Guidry JJ, Aday LA, Zhang D, Winn RJ. Cost considerations as potential barriers to cancer treatment. Cancer Pract. 1998;6(3):182–7.
Jagsi R, Pottow JA, Griffith KA, Bradley C, Hamilton AS, Graff J, et al. Long-term financial burden of breast cancer: experiences of a diverse cohort of survivors identified through population-based registries. J Clin Oncol. 2014;32(12):1269–76. doi:10.1200/JCO.2013.53.0956.
Ell K, Xie B, Wells A, Nedjat-Haiem F, Lee PJ, Vourlekis B. Economic stress among low-income women with cancer: effects on quality of life. Cancer. 2008;112(3):616–25. doi:10.1002/cncr.23203.
Pisu M, Azuero A, Meneses K, Burkhardt J, McNees P. Out of pocket cost comparison between Caucasian and minority breast cancer survivors in the Breast Cancer Education Intervention (BCEI). Breast Cancer Res Treat. 2011;127(2):521–9. doi:10.1007/s10549-010-1225-0.
Shankaran V, Jolly S, Blough D, Ramsey SD. Risk factors for financial hardship in patients receiving adjuvant chemotherapy for colon cancer: a population-based exploratory analysis. J Clin Oncol. 2012;30(14):1608–14. doi:10.1200/JCO.2011.37.9511.
Byers TE, Wolf HJ, Bauer KR, Bolick-Aldrich S, Chen VW, Finch JL, et al. The impact of socioeconomic status on survival after cancer in the United States: findings from the National Program of Cancer Registries Patterns of Care Study. Cancer. 2008;113(3):582–91. doi:10.1002/cncr.23567.
Sabatino SA, Thompson TD, Richardson LC, Miller J. Health insurance and other factors associated with mammography surveillance among breast cancer survivors: results from a national survey. Med Care. 2012;50(3):270–6. doi:10.1097/MLR.0b013e318244d294.
Lash TL, Fox MP, Westrup JL, Fink AK, Silliman RA. Adherence to tamoxifen over the five-year course. Breast Cancer Res Treat. 2006;99(2):215–20. doi:10.1007/s10549-006-9193-0.
Owusu C, Buist DS, Field TS, Lash TL, Thwin SS, Geiger AM, et al. Predictors of tamoxifen discontinuation among older women with estrogen receptor-positive breast cancer. J Clin Oncol. 2008;26(4):549–55. doi:10.1200/JCO.2006.10.1022.
Pezzin LE, O’Niel MB, Nattinger AB. The economic consequences of breast cancer adjuvant hormonal treatments. J Gen Intern Med. 2009;24 Suppl 2:S446–50. doi:10.1007/s11606-009-1079-5.
Kent EE, Forsythe LP, Yabroff KR, Weaver KE, de Moor JS, Rodriguez JL, et al. Are survivors who report cancer-related financial problems more likely to forgo or delay medical care? Cancer. 2013;119(20):3710–7. doi:10.1002/cncr.28262.
Chapman RH, Benner JS, Petrilla AA, Tierce JC, Collins SR, Battleman DS, et al. Predictors of adherence with antihypertensive and lipid-lowering therapy. Arch Intern Med. 2005;165(10):1147–52. doi:10.1001/archinte.165.10.1147.
Steiner JF, Prochazka AV. The assessment of refill compliance using pharmacy records: methods, validity, and applications. J Clin Epidemiol. 1997;50(1):105–16.
Neumann PJ, Palmer JA, Nadler E, Fang C, Ubel P. Cancer therapy costs influence treatment: a national survey of oncologists. Health Aff. 2010;29(1):196–202. doi:10.1377/hlthaff.2009.0077.
Braithwaite D, Tammemagi CM, Moore DH, Ozanne EM, Hiatt RA, Belkora J, et al. Hypertension is an independent predictor of survival disparity between African-American and white breast cancer patients. Int J Cancer. 2009;124(5):1213–9. doi:10.1002/ijc.24054.
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ML developed the research question, performed the analysis, and drafted the manuscript. ML and RGS interpreted the data and participated in the design and planning of the study. Both authors have read and approved the final manuscript.
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Lee, M., Salloum, R.G. Racial and ethnic disparities in cost-related medication non-adherence among cancer survivors. J Cancer Surviv 10, 534–544 (2016). https://doi.org/10.1007/s11764-015-0499-y
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DOI: https://doi.org/10.1007/s11764-015-0499-y