Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, USA.
Department of Public Health Sciences, School of Medicine, University of Virginia, Charlottesville, VA, USA.
Res Social Adm Pharm. 2020 Apr;16(4):574-582. doi: 10.1016/j.sapharm.2019.08.005. Epub 2019 Aug 1.
Breast cancer is a rampant disease and is highly prevalent among women in the United States. Two out of three breast cancers are hormone receptor positive and hormonal therapies (Tamoxifen and Aromatase Inhibitors) are used to treat this type of breast cancer. However, adherence to these efficacious therapies is relatively low.
The aim of this study was to identify factors that are associated with adherence to hormonal therapy among breast cancer patients, and the extent to which they influence adherence, by looking at data from a nationally representative database.
A retrospective cross-sectional study was conducted using Medical Expenditure Panel Survey (MEPS) for 2011-2015. Individuals ≥18 years diagnosed with breast cancer utilizing Tamoxifen and Aromatase inhibitors were identified. The Proportion of Days Covered (PDC) adherence measure was used to classify individuals as adherent (PDC≥80%) or non-adherent (PDC<80%). Multivariable logistic regression was used to determine factors associated with adherence to hormonal therapy.
Out of the 354 breast cancer respondents utilizing hormonal therapy, 194 (54.8%) were adherent and 160 (45.20%) were non-adherent. From 2011 through 2015, an increase in the usage of hormonal therapy was observed. Individuals having at least a high school diploma or General Equivalency Diploma (GED) had 2.795 (1.081, 6.941) times the odds of being adherent when compared to those who did not have a high school diploma or GED. Race, insurance status, marital status, poverty level, class of drug (aromatase inhibitor/tamoxifen), age, comorbidities, out-of-pocket costs and region were not significantly associated with adherence to hormonal therapy among breast cancer patients.
This study found an association between an individual's level of education and adherence to hormonal therapy among breast cancer patients. These results can be used to help optimize allocation of resources to promote knowledge designed to increase the adherence of breast cancer patients to hormonal therapy.
乳腺癌是一种高发疾病， 在美国女性中极为普遍。三分之二的乳腺癌患者激素受体呈阳性， 荷尔蒙疗法（他莫昔芬和芳香化酶抑制剂）用于治疗此类乳腺癌。然而， 这些有效疗法的依从性相对较低。
本研究旨在通过观察来自全国代表性数据库的数据， 确定与乳腺癌患者激素治疗依从性相关的因素， 以及这些因素对依从性的影响程度。
使用 2011-2015 年的医疗支出面板调查（MEPS）进行回顾性横断面研究。确定利用他莫昔芬和芳香化酶抑制剂诊断为乳腺癌的个体。采用比例天数覆盖（PDC） 依从性测量来将个体分类为依从性（PDC≥80%）或非依从性（PDC<80%）。多变量逻辑回归用于确定与激素治疗依从性相关的因素。
在 354 名接受激素治疗的乳腺癌患者中， 194 名（54.8%）患者依从， 160 名（45.2%）患者不依从。2011 年至 2015 年， 激素治疗的使用率有所增加。与没有高中学历或同等学历（GED）的个体相比， 至少具有高中学历或 GED 的个体具有 2.795 倍（1.081， 6.941）的可能性成为依从者。种族、保险状况、婚姻状况、贫困水平、药物类别（芳香化酶抑制剂/他莫昔芬）、年龄、合并症、自付费用和地区与乳腺癌患者激素治疗的依从性无显著相关性。
本研究发现个体的教育水平与乳腺癌患者激素治疗的依从性之间存在关联。这些结果可用于帮助优化资源分配， 以促进旨在提高乳腺癌患者对激素治疗依从性的知识。
