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Medicare program improved breast cancer hormonal therapy adherence
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Women with breast cancer were more likely to adhere to hormonal therapy after surgery regardless of their ethnicity if they received a low-income subsidy from the Medicare Part D Extra Help program, according to study results presented at the ASCO Quality Care Symposium.
The results suggest the Medicare program helps reduce racial and ethnic disparities in breast cancer treatment and outcomes, researchers said.
“Traditionally, breast cancer is thought to be a disease that affects more white women and those with higher income. Though the incidence rate of breast cancer is higher among white women, the death rate due to breast cancer is higher in black women and those with a lower income,” researcher Alana Biggers, MD, MPH, assistant professor of clinical medicine at the University of Illinois-Chicago, said during a press conference. “At this point, the role of cost in unequal breast cancer outcomes is understudied.”
Biggers and colleagues evaluated data from 23,299 women. About half (50.6%) were aged 65 to 74 years, and 40.9% of whom were aged 75 to 84 years. The women underwent mastectomy or breast-conserving surgery between 2006 and 2007, followed by treatment with tamoxifen, anastrozole, letrozole or exemestane (Aromasin, Pfizer).
All women were enrolled on the Medicare Part D medication insurance program, but only 27.2% qualified for the Extra Help program and received a low-income subsidy that eliminated or reduced out-of-pocket costs for their hormonal therapy. A smaller proportion of non-Hispanic white women (20.6%) compared with black women (69.7%) and Hispanic women (56.6%) received the subsidy.
Hormonal therapy adherence rates were slightly higher among black women (62%) and Hispanic women (64%) compared with non-Hispanic white women (58%) during the 3-year study period.
Adherence rates were higher among women who received the low-income subsidy than those who did not among non-Hispanic white (71% vs. 62%), black (67% vs. 55%) and Hispanic (71% vs. 55%) women.
An analysis adjusted for demographics and treatment variables indicated black women (OR=1.09; 95% CI, 0.99-1.19) and Hispanic women (OR=1.18; 95% CI, 1.05-1.33) were more likely to adhere to hormonal therapy. However, when researchers also adjusted for low-income subsidy variables, black women (OR=0.84; 95% CI, 0.77-0.93) and Hispanic women (OR=0.9; 95% CI, 0.8-1.02) were less likely to adhere to their hormonal therapy. These findings suggest the low-income subsidy accounted for higher adherence rates among these women.
“Patients are more likely to take their medications if they are able to afford them,” Biggers said in a press release. “Our study shows that federal policy interventions that help cover out-of-pocket costs have the potential to reduce the breast cancer outcome gap by race and ethnicity.”
For more information:
Biggers A. Abstract #2. Scheduled for presentation at: ASCO Quality Care Symposium; Oct. 17-18, Boston.
Disclosure: The researchers report no relevant financial disclosures.
Perspective
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Gregory Masters, MD
We know that adherence to therapy is a critical factor in providing the best quality of care for these patients, and some of these important government programs — like the low-income subsidy — may help improve care in underserved populations.
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