Arshad Sara, Hu Xin, Krukowski Rebecca A, Waters Teresa M, Vidal Gregory A, Schwartzberg Lee, Lipscomb Joseph, Graetz Ilana
Department of Health Policy & Management, Emory University, Rollins School of Public Health, Atlanta, Georgia, USA.
Department of Radiation Oncology, Emory University, School of Medicine, Atlanta, Georgia, USA.
Health Serv Res. 2025 Jun 17:e14658. doi: 10.1111/1475-6773.14658.
To examine the association between COVID-19-related hardship and 1-year adjuvant endocrine therapy (AET) adherence among women with early-stage hormone-receptor-positive breast cancer.
This post hoc analysis utilized data from the THRIVE trial, which tested a 6-month remote monitoring intervention on 1-year AET adherence, measured using an electronic pillbox. The 1-year follow-up survey included questions about pandemic-related hardship, including financial loss, changes/gaps in health insurance, and difficulty accessing basic needs. Participants reporting any of these were categorized as experiencing pandemic-related hardship. Logistic regressions estimated the association between patient characteristics and pandemic-related hardship, and between hardship and AET adherence (≥ 80% proportion of days covered), controlling for patient characteristics and randomization group.
We included 217 women diagnosed with early-stage breast cancer prescribed AET at a large cancer center who enrolled in THRIVE between April 2019 and June 2021.
Overall, 39.6% of participants reported any pandemic-related hardship: 34.6% reported financial loss, 10.6% reported changes/gaps in insurance, and 11.1% reported difficulty accessing basic needs. In adjusted analyses, having an income ≤ 100% of federal poverty level or prior chemotherapy or radiation was associated with a 41.4 (95% CI: 9.8-73.0) and 13.8 (95% CI: 0.3-27.2) percentage-point higher likelihood, respectively, of having any pandemic-related hardship. Over half (52%) of participants were AET adherent. In adjusted analyses, 40.1% of those with any pandemic-related hardship were AET adherent, compared with 59.5% of those without hardship, a 19.3 percentage-point lower likelihood (95% CI: -33.0 to -5.7).
Pandemic-related hardship was more common among individuals with lower income or prior radiation or chemotherapy, and was associated with lower AET adherence, with possible impacts on cancer progression and survival. These findings highlight the need for routine financial screening and targeted support, particularly among lower-income patients on long-term AET.
NCT03592771.
探讨早期激素受体阳性乳腺癌女性中与2019冠状病毒病（COVID-19）相关的困境与1年辅助内分泌治疗（AET）依从性之间的关联。
这项事后分析利用了THRIVE试验的数据，该试验测试了一项为期6个月的远程监测干预对1年AET依从性的影响，AET依从性通过电子药盒进行测量。1年随访调查包括了与疫情相关的困境问题，如经济损失、医疗保险的变化/缺口以及获取基本生活需求的困难。报告有上述任何一项情况的参与者被归类为经历了与疫情相关的困境。逻辑回归分析估计了患者特征与与疫情相关的困境之间的关联，以及困境与AET依从性（覆盖天数比例≥80%）之间的关联，同时控制了患者特征和随机分组情况。
我们纳入了2019年4月至2021年6月期间在一家大型癌症中心被诊断为早期乳腺癌并接受AET治疗且参加了THRIVE试验的217名女性。
总体而言，39.6%的参与者报告了与疫情相关的任何困境：34.6%报告有经济损失，10.6%报告有保险方面的变化/缺口，11.1%报告有获取基本生活需求的困难。在调整分析中，收入≤联邦贫困水平的100%或曾接受过化疗或放疗分别与出现任何与疫情相关困境的可能性高出41.4（95%置信区间：9.8 - 73.0）和13.8（95%置信区间：0.3 - 27.2）个百分点相关。超过一半（52%）的参与者AET治疗依从。在调整分析中，有任何与疫情相关困境的参与者中40.1% AET治疗依从，而无困境的参与者中这一比例为59.5%，可能性低19.3个百分点（95%置信区间：-33.0至-5.7）。
与疫情相关的困境在收入较低或曾接受过放疗或化疗的个体中更为常见，并且与较低的AET依从性相关，可能对癌症进展和生存产生影响。这些发现凸显了进行常规财务筛查和针对性支持的必要性，尤其是在接受长期AET治疗的低收入患者中。
NCT03592771。
