Cancer diagnosis leads to lower medication adherence in patients with glaucoma
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Eye care providers should monitor glaucoma medication compliance in their patients who have cancer, researchers concluded in a study published in the American Journal of Ophthalmology.
The researchers evaluated claims data of 23 million individuals enrolled in Taiwan National Health Insurance from 2005 to 2015. They also used Cancer Registry data from the same period to identify all patients with cancer.
Patients with newly diagnosed glaucoma and no cancer diagnosis were compared to patients with a confirmed glaucoma diagnosis and a new cancer diagnosis within the study period.
The study defined a confirmed glaucoma diagnosis as having at least one outpatient or inpatient visit with a glaucoma drug prescription.
Researchers measured medication adherence using the medication possession ratio (MPR), which is a measure of prescription refill. MPR was measured using three definitions: 1 year before and 1 year after cancer diagnosis, 2-year interval (calculated for 730 days) and a 2-year average.
The study found that a cancer diagnosis significantly reduced medication adherence in patients with glaucoma, with a reduction as high as 17.4% using a 1-year interval. For both patients with and without a cancer diagnosis, MPR was highest when measured at 1-year intervals.
For the group with cancer, MPR was significantly higher before the date of confirmed cancer diagnosis and lower after diagnosis in all three measures of MPR (1-year, 2-year and 2-year average intervals); however, MPR measured using a 1-year interval declined the most.
For the group without cancer, the change in MPR was not significant and varied in the three different measures of MPR.
“Although patients with cancer have increased life expectancy due to advances in medicine, the quality of life of cancer survivors with glaucoma can be decreased by the visual impairment caused by nonadherence to glaucoma treatment,” the authors wrote. “Ophthalmologists should also pay particular attention to their patients with glaucoma if a new major health event such as cancer is known.” – Kaitlin McGee
Disclosures: The authors report no relevant financial disclosures.
Perspective
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Carl H. Jacobsen, OD, FAAO
Let’s play, “Would you treat this patient?” First up, a 90-year-old with pre-perimetric normotensive glaucoma. I probably wouldn’t recommend treatment. Same patient age 60 years. I’d likely recommend treatment due to the patient’s relative youth. Same patient, 60 years old, but with a terminal disease diagnosis. I probably wouldn’t treat due to the sad likelihood that this patient won’t live long enough to suffer vision loss. Our goal in treating glaucoma is to ensure functional vision through a patient’s lifetime.
Hou and colleagues in their population-based cohort study found that patients with cancer are likely less adherent to their glaucoma drop schedule than patients without cancer. This is no surprise; life with cancer is painful, complex and highly disruptive. Treatment of a slow-progressing, often asymptomatic disease is sure to take a back seat. The authors conclude “… the quality of life of cancer survivors with glaucoma can be decreased by the visual impairment caused by nonadherence to glaucoma treatment.” Their quality of life can also be decreased by treating glaucoma. It’s a risk:benefit ratio that we must help our patients understand. Everything in life can affect glaucoma treatment; it’s our job to help each patient understand glaucoma and make informed decisions.
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