Longer time to initiate adjuvant endocrine therapy for breast cancer may worsen adherence
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Key takeaways:
- Women with breast cancer enrolled in Medicaid initiated adjuvant endocrine therapy a median 53 days after cancer treatment.
- During the first year of treatment initiation, 77% adhered to and 59.3% continued adjuvant endocrine therapy.
- Interventions that focus on improving timeliness of endocrine therapy initiation may also improve adherence to and continuation of treatment and, therefore, further improve outcomes.
Medicaid-insured women diagnosed with primary hormone receptor-positive breast cancer had lower odds of short- and long-term adherence to adjuvant endocrine therapy if they had a longer time to initiation of the therapy.
The findings, published in JAMA Network Open, suggest early interventions that aim to improve timeliness of adjuvant endocrine therapy initiation could positively impact adherence throughout the course of treatment among this patient population.
Background
Endocrine therapy in combination with long-term adherence to oral medication can reduce the risk for breast cancer recurrence and mortality. However, initiation, adherence and continuation of endocrine therapy remain low and uneven among women with breast cancer, Ying Liu, MD, PhD, associate professor in the department of surgery and the division of public health sciences at Washington University School of Medicine, told Healio.
“Previous research has shown that between 20% and 30% of patients with hormone receptor-positive breast cancer did not initiate endocrine therapy in the first year after diagnosis, and of those who initiated, approximately 75% were adherent for the first year and less than half continued endocrine therapy for the recommended 5 years,” Liu said. “Lack of initiation and continuation is even more pronounced in low-income patients. This nonadherence may lead to unequal distribution of the prognostic benefits of endocrine therapy.”
Liu and colleagues sought to quantify timelines for initiating adjuvant endocrine therapy and evaluate their association with short- and long-term therapy adherence and continuation among 1,711 women (60.1% aged between 50 and 64 years; 74.2% non-Hispanic white; 66.2% unmarried) diagnosed with first primary breast cancer between 2007 and 2013 and enrolled in Medicaid.
Researchers followed women for 5 years after first use of adjuvant endocrine therapy through December 2018, and defined time to initiation as days from the date of last treatment to the first date of adjuvant endocrine therapy prescription fill.
Adherence to adjuvant endocrine therapy, defined as medication possession ratio of 80% or greater, and continuation of therapy, defined as no gap in medication supply for at least 90 days, served as main outcomes. Researchers used logistic regression adjusted for demographic, clinical and neighborhood variables to estimate ORs of adherence and continuation between 1 and 5 years.
Findings
Results showed a median time to initiation of 53 days (interquartile range, 26-117).
Researchers found that 77% of women adhered to treatment and 59.3% continued adjuvant endocrine therapy during the first year after treatment initiation.
Women who experienced longer time to treatment initiation had poorer adherence at every year of treatment, for ORs of 0.97 (95% CI, 0.95-0.99) for 1-year adherence and 0.94 (95% CI, 0.9-0.97) for 5-year adherence for each 1-month increase in time to initiation.
Moreover, researchers observed lower odds of short-term but not long-term continuation with longer time to initiation, for ORs of 0.97 (95% CI, 0.95-0.99) with 1-year continuation and 0.98 (95% CI, 0.96-0.99) with 2-year continuation.
Liu and colleagues reported several limitations of the study, including the fact that they based estimates of time to initiation, adherence and continuation on Medicaid claims, so the estimates may not reflect actual patient behaviors. In addition, further research is needed examining patients aged older than 65 years and those who may not have access to consistent insurance coverage. Factors influencing initiation timeliness could also clarify opportunities for intervention, researchers wrote.
Implications
The findings suggest interventions that focus on improving timeliness of endocrine therapy initiation may also improve adherence to and continuation of treatment and, therefore, further improve outcomes, Liu said.
“Given the lack of success with previous attempts to improve health behaviors, these findings provide a promising new avenue for intervention,” she continued. “We will examine whether timelines of endocrine therapy initiation affect prognosis of breast cancer and whether this contributes to disparities in breast cancer outcomes.”
For more information :
Ying Liu, MD, PhD, can be reached at yliu3@wustl.edu.
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