Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate Ave, Portland, OR, 97227-1110, USA.
Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA.
J Cancer Surviv. 2018 Dec;12(6):794-802. doi: 10.1007/s11764-018-0716-6. Epub 2018 Oct 18.
To investigate the implications of a cancer diagnosis on medication adherence for pre-existing comorbid conditions, we explored statin adherence patterns prior to and following a new diagnosis of breast, colorectal, or prostate cancer among a multi-ethnic cohort.
We identified adults enrolled at Kaiser Permanente Northern California who were prevalent statin medication users, newly diagnosed with breast, colorectal, or prostate cancer between 2000 and 2012. Statin adherence was measured using the proportion of days covered (PDC) during the 2-year pre-cancer diagnosis and the 2-year post-cancer diagnosis. Adherence patterns were assessed using generalized estimating equations, for all cancers combined and stratified by cancer type and race/ethnicity, adjusted for demographic, clinical, and tumor characteristics.
Among 10,177 cancer patients, statin adherence decreased from pre- to post-cancer diagnosis (adjusted odds ratio (OR):0.91, 95% confidence interval (95% CI):0.88-0.94). Statin adherence decreased from pre- to post-cancer diagnosis among breast (OR:0.94, 95% CI:0.90-0.99) and colorectal (OR:0.79, 95% CI:0.74-0.85) cancer patients. No difference in adherence was observed among prostate cancer patients (OR:1.01, 95% CI:0.97-1.05). Prior to cancer diagnosis, adherence to statins was generally higher among non-Hispanic whites and multi-race patients than other groups. However, statin adherence after diagnosis decreased only among these two populations (OR:0.85, 95% CI:0.85-0.92 and OR:0.86, 95% CI:0.76-0.97), respectively.
We found substantial variation in statin medication adherence following diagnosis by cancer type and race/ethnicity among a large cohort of prevalent statin users in an integrated health care setting.
Improving our understanding of comorbidity management and polypharmacy across diverse cancer patient populations is warranted to develop tailored interventions that improve medication adherence and reduce disparities in health outcomes.
为了研究癌症诊断对预先存在的合并症药物治疗依从性的影响，我们在一个多民族队列中，探讨了在新诊断出乳腺癌、结直肠癌或前列腺癌前后，他汀类药物的使用模式。
我们确定了在 Kaiser Permanente Northern California 登记的成年人，他们是普遍的他汀类药物使用者，在 2000 年至 2012 年间新诊断出乳腺癌、结直肠癌或前列腺癌。在癌症诊断前 2 年和癌症诊断后 2 年期间，使用比例天数覆盖（PDC）来衡量他汀类药物的依从性。所有癌症合并分析以及按癌症类型和种族/族裔分层的分析均使用广义估计方程，调整了人口统计学、临床和肿瘤特征。
在 10177 例癌症患者中，他汀类药物的依从性从癌症诊断前到诊断后下降（调整后的比值比（OR）：0.91，95%置信区间（95%CI）：0.88-0.94）。在乳腺癌（OR：0.94，95%CI：0.90-0.99）和结直肠癌（OR：0.79，95%CI：0.74-0.85）患者中，从癌症诊断前到诊断后，他汀类药物的依从性均下降。在前列腺癌患者中，没有观察到依从性的差异（OR：1.01，95%CI：0.97-1.05）。在癌症诊断之前，非西班牙裔白人和多种族患者的他汀类药物依从性普遍高于其他群体。然而，在这些两个群体中，诊断后他汀类药物的依从性下降（OR：0.85，95%CI：0.85-0.92 和 OR：0.86，95%CI：0.76-0.97）。
在一个大型综合医疗保健环境中，我们发现了在普遍使用他汀类药物的患者中，根据癌症类型和种族/族裔，他汀类药物治疗后的药物治疗依从性存在显著差异。
为了制定改善药物依从性和减少癌症患者健康结果差异的针对性干预措施，有必要更好地了解不同癌症患者群体的合并症管理和多药治疗。
