Murphy Caitlin C, Tiro Jasmin A, Jean Gary W, Balasubramian Bijal A, Alvarez Carlos A
1 Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center , Dallas, Texas.
2 School of Pharmacy, Texas Tech University Health Sciences Center , Dallas, Texas.
J Womens Health (Larchmt). 2017 Jun;26(6):655-661. doi: 10.1089/jwh.2016.6099. Epub 2017 Mar 15.
Despite benefits of adjuvant hormonal therapy (AHT), many eligible breast cancer patients do not complete therapy as recommended. Patterns of AHT use have not been well studied among uninsured breast cancer patients who fall into coverage gaps or are ineligible for public insurance programs.
We identified 291 patients newly diagnosed with stages I-III hormone receptor-positive breast cancer from January 2008 to December 2012. All patients were treated at a safety-net healthcare system and enrolled in an income-based medical assistance program that fills AHT prescriptions at low cost. We extracted and linked cancer registry, pharmacy claims, and medical record data to assess AHT initiation (defined as a new AHT prescription ≤18 months since diagnosis) and sociodemographic and healthcare utilization variables. Log-binomial regression was used to identify correlates of initiation.
Overall, 239 (82%) patients initiated AHT. Tamoxifen (42%) and anastrozole (55%) were most commonly prescribed. The mean copay was $4.90 for tamoxifen and $6.00 for anastrozole. Although crude analyses revealed small, statistically significant prevalence ratios for race/ethnicity (Hispanic vs. white, other vs. white), year of diagnosis (2008 vs. 2012), primary care visit before diagnosis (any vs. none), and smoking status (current vs. never), there were no significant correlates of initiation in the adjusted model.
Safety-net healthcare systems providing access to AHT (i.e., through reduced copays) could improve the number of eligible patients initiating therapy. Continuity and integration of care in these settings may reduce disparities frequently observed in uninsured, low-income breast cancer populations.
尽管辅助激素治疗（AHT）有诸多益处，但许多符合条件的乳腺癌患者并未按推荐完成治疗。对于那些处于保险覆盖缺口或无资格参加公共保险计划的未参保乳腺癌患者，AHT的使用模式尚未得到充分研究。
我们确定了2008年1月至2012年12月期间新诊断为I - III期激素受体阳性乳腺癌的291例患者。所有患者均在一个安全网医疗系统接受治疗，并参加了一项基于收入的医疗救助计划，该计划以低成本提供AHT处方。我们提取并关联了癌症登记、药房报销和病历数据，以评估AHT的起始情况（定义为自诊断后≤18个月开具新的AHT处方）以及社会人口统计学和医疗保健利用变量。采用对数二项回归来确定起始的相关因素。
总体而言，239例（82%）患者开始接受AHT。最常开具的药物是他莫昔芬（42%）和阿那曲唑（55%）。他莫昔芬的平均自付费用为4.90美元，阿那曲唑为6.00美元。尽管粗略分析显示种族/民族（西班牙裔与白人、其他与白人）、诊断年份（2008年与2012年）、诊断前的初级保健就诊情况（有与无）以及吸烟状况（当前吸烟者与从不吸烟者）的患病率比值存在小的、具有统计学意义的差异，但在调整模型中没有起始的显著相关因素。
提供AHT（即通过降低自付费用）的安全网医疗系统可以增加开始治疗的符合条件患者的数量。这些环境中的医疗连续性和整合可能会减少在未参保的低收入乳腺癌人群中经常观察到的差异。
