Endocrine Therapy Use Among Elderly Hormone Receptor-Positive Breast Cancer Patients Enrolled in Medicare Part D

Riley, Gerald F.; Warren, Joan L.; Harlan, Linda C.; Blackwell, Steven A.

doi:10.5600/mmrr.001.04.a04

Cited by 58 publications

(66 citation statements)

References 17 publications

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“…What has not changed though are consistent differences in overall survival rates by subtype with ER+/PR+ patients having the highest survival rates and ER−/PR− patients have the lowest rates. These differences are likely largely driven by the less aggressive nature of hormone receptor positive tumors as well as the availability of effective adjuvant hormonal therapies that only benefit these patients [19–21]. …”

Section: Discussionmentioning

confidence: 99%

Trends in 5-year survival rates among breast cancer patients by hormone receptor status and stage

Chen

Linden

Anderson

et al. 2014

Breast Cancer Res Treat

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Purpose Improvement in breast cancer survival has been observed in recent decades in the U.S., but it is unclear if similar survival gains are consistent across breast cancer subtypes, especially with regards to more advanced stages of the disease. Methods Data were from 13 population-based cancer registries participating in the Surveillance, Epidemiology and End Results (SEER) program, consisting of women between 20–79 years of age diagnosed with invasive breast cancer between 1992 and 2008. 2-year (1992–2008) and 5-year (1992–2006) breast cancer cause-specific survival rates were calculated and stratified by estrogen receptor (ER)/progesterone receptor (PR) status, stage and race. Annual percent changes in survival rates were assessed. Results From 1992 through 1998–1999, 5-year and 2-year cause specific survival rates significantly improved across ER+/PR+, ER−/PR− and ER+/PR− subtypes, with an annual increase ranging from 0.5%–1.0%. From 1998–1999 to 2006, different patterns were observed by ER/PR subtypes with survival rates slightly improving for ER+/PR+, continuing to improve at a rate of 0.5% per year for ER−/PR−, and dropping 0.3% annually for ER+/PR− No significant survival gains were experienced by patients with ER−/PR+ cancer during the study period. In terms of advanced diseases, greatest annual increases in survival rates were seen for patients with stage III–IV ER+/PR+ and ER−/PR− tumors but less progress was observed for advanced ER+/PR− breast cancers. Conclusion Steady improvements in survival rates for breast cancer have been achieved over the past several decades. However, 5-year survival rates for stage IV disease remained dismally below 20% for most ER/PR subtypes.

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Section: Discussionmentioning

confidence: 99%

Trends in 5-year survival rates among breast cancer patients by hormone receptor status and stage

Chen

Linden

Anderson

et al. 2014

Breast Cancer Res Treat

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“…To complement these searches, we hand-searched bibliographies of key studies and other relevant review articles to identify additional articles that were not captured in the database searches. 9,21,22,34,36–72 …”

Section: Methodsmentioning

confidence: 99%

“…12,13 AI data have shown similar patterns of underutilization; 12 at 5 years, 19% to 25% of women have discontinued their AI, 20,21 and 20% to 31% of women have been nonadherent. 18,22 …”

mentioning

confidence: 99%

“…In several studies of insured women, non-White race 11,12,22,24–28 and low socioeconomic status (SES) 34 have been associated with lower ET initiation, adherence, and persistence; however, reasons for this variation have not been well described. Although previous literature reviews have described factors that are associated with ET utilization broadly, none have detailed racial variation in the use of ET.…”

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confidence: 99%

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Racial/Ethnic and Socioeconomic Disparities in Endocrine Therapy Adherence in Breast Cancer: A Systematic Review

2015

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We examined the current literature to understand factors that influence endocrine therapy (ET) adherence among racial/ethnic and socioeconomic subpopulations of breast cancer patients. We searched PubMed and PsycINFO databases for studies from January 1, 1978, to June 20, 2014, and January 1, 1991, to June 20, 2014, respectively, and hand-searched articles from relevant literature reviews. We abstracted and synthesized results within a social ecological framework. Fourteen articles met all inclusion criteria. The majority of included articles reported significant underuse of ET among minority and low-income women. Modifiable intrapersonal, interpersonal, and community-level factors are associated with ET use, and these factors vary across subgroups. Both race/ethnicity and socioeconomic status are associated with ET use in most settings. Variation in factors associated with ET use across subgroups indicates the need for more nuanced research and targeted interventions among breast cancer patients.

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“…Factors associated with nonadherence to adjuvant hormonal therapy include lack of physician recommendation (32), patient perception of low risk for recurrence (54), adverse effects of therapy (55,56,57), age extremes: older age (23,58) and younger age (23,59), medication costs (60,61,62), low social economic status (63), suboptimal patient-physician communication (64), higher comorbidity (23,59,62), cigarette smoking (50,51), and lack of social support (65; Table 4). Similar factors were associated with adherence in a low-income population in California (66).…”

Section: Factors Associated With Nonadherence To Adjuvant Endocrine Tmentioning

confidence: 99%

Adherence to Endocrine Therapy in Breast Cancer Adjuvant and Prevention Settings

Chlebowski

Kim

Haque

2014

Cancer Prevention Research

153

149

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Adherence to oral endocrine therapy in adjuvant breast cancer settings is a substantial clinical problem. To provide current perspective on adherence to oral endocrine therapies, a comprehensive literature review was conducted. In adjuvant trials, endocrine therapy adherence is relatively high with greater adherence for aromatase inhibitors compared with tamoxifen. In contrast, adherence to adjuvant therapy in clinical practice is relatively poor, with only about 50% of women successfully completing 5-year therapy. Importantly, good adherence (>80% use) has been associated with lower recurrence risk. Endocrine therapy adherence in primary breast cancer prevention trials parallels that seen in adjuvant trials. Factors associated with nonadherence include low recurrence risk perception, side effects, age extremes, medication cost, suboptimal patient-physician communication, and lack of social support. Few prospective studies have evaluated interventions designed to improve adherence. Interventions currently proposed reflect inferences from clinical trial procedures in which clinical contacts are commonly greater than in usual practice settings. In conclusion, for optimal breast cancer outcome, adherence to endocrine therapy must improve. Although general recommendations likely to improve adherence can be made based on clinical trial results and preliminary prospective trial findings, research specifically targeting this issue is needed to establish effective intervention strategies. Cancer Prev Res; 7(4); 378-87. Ó2014 AACR.

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Endocrine Therapy Use Among Elderly Hormone Receptor-Positive Breast Cancer Patients Enrolled in Medicare Part D

Abstract: Many elderly breast cancer patients were not receiving therapy for the recommended five years following diagnosis. Choosing a Part D plan that minimizes out-of-pocket costs is critical to ensuring beneficiary access to essential medications.

Cited by 58 publications

References 17 publications

Trends in 5-year survival rates among breast cancer patients by hormone receptor status and stage

Trends in 5-year survival rates among breast cancer patients by hormone receptor status and stage

Racial/Ethnic and Socioeconomic Disparities in Endocrine Therapy Adherence in Breast Cancer: A Systematic Review

Adherence to Endocrine Therapy in Breast Cancer Adjuvant and Prevention Settings

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