Breast Cancer Hormonal Therapy Persistence and Adherence Better in Black, Hispanic, and White Women With vs Without Medicare D Prescription Subsidies
In a study reported in the Journal of Clinical Oncology, Biggers et al found that persistence and adherence with hormonal therapy for breast cancer were greater among black, Hispanic, and white women with vs without low-income prescription subsidies in Medicare Part D.
The study involved 25,111 women aged ≥ 65 years with breast cancer surgery between 2006 and 2007 and at least 1 prescription filled for oral hormonal therapy identified from among all Medicare D enrollees. The association of race/ethnicity with nonpersistence (90 consecutive days with no claims for hormonal therapy prescription) and nonadherence (medication possession rate < 80%) was examined. Survival analyses accounted for potential differences in age, comorbidity, and intensity of other treatments.
Persistence Rates
Among the 25,111 women, 77% of Hispanic, 70% of black women, and 21% of white women received a subsidy. At 2 years, 69% of black women, 70% of Hispanic women, and 61% of white women were persistent with regard to hormone therapy use. In adjusted analyses, unsubsidized patients were more likely to have discontinuation among black patients (hazard ratio [HR] = 2.09, 95% confidence interval [CI] = 1.73–2.51), Hispanic patients (HR = 3.00, 95% CI = 2.37–3.89), and white patients (HR = 1.83, 95% CI = 1.70–1.95). Among unsubsidized women, black women were more likely to discontinue therapy during the first 5 months (HR = 1.31, 95% CI = 1.02–1.68) and Hispanic women, between 5 and 35 months (HR = 1.32, 95% CI = 1.10–1.58) compared with white women. The disparities were not evident among subsidized women, with the disparity reversed for Hispanic vs white women (HR = 0.80, 95% CI = 0.58–0.95), between 5 to 35 months.
Adherence
Subsidized women had higher adherence than unsubsidized women (odds ratio = 1.30, 95% CI = 1.25–1.35), with the adherence rate being higher in subsidized women in each of the three groups. The size of the effect varied by race (P = .02 for interaction), with the smallest effect observed among black women.
The investigators concluded: “Receipt of a prescription subsidy was associated with substantially improved persistence to breast cancer hormonal therapy among white, black, and Hispanic women and lack of racial or ethnic disparities in persistence. Given high subsidy enrollment among black and Hispanic women, policies targeted at low-income patients have the potential to also substantially reduce racial and ethnic disparities.”
The study was supported by grants from the National Institutes of Health and American Cancer Society.
Alana Biggers, MD, MPH, of the University of Illinois at Chicago, is the corresponding author of the Journal of Clinical Oncology article.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
