Adjuvant hormonal therapy adherence at 5 years are low among commercially insured patients with breast cancer, according to a recent study (JCO Oncol Pract. 2021;OP2000248. doi:10.1200/OP.20.00248).
“Tamoxifen and aromatase inhibitors are used as adjuvant hormonal therapy for early-stage hormone receptor-positive (HR+) breast cancer,” wrote Hui Zhao, PhD, Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, and colleagues.
“Treatment for 5 years reduces cancer mortality by 30%. Despite this benefit, adherence to [adjuvant hormonal therapy] has been suboptimal,” they continued.
This study examined adherence to adjuvant hormonal therapy in patients with breast cancer who have private health insurance.
The IBM MartketScan Research Database was used to identify adult patients with breast cancer who underwent mastectomy or lumpectomy between 1999 and 2015. Rates of adjuvant hormonal therapy initiation and adherence were calculated for all patients no matter their HR+ status.
The Surveillance, Epidemiology, and End Results (SEER) program was used to standardize initiation rate. Adherence was defined as medication possession ratio ≥80%.
A total of 80,224 patients were included in the study. The raw initiation rate was 71.8% and the standardized rate was 87.5%.
Overall, 61.2% of patients initiated treatment with aromatase inhibitors and 38.8% initiated treated with tamoxifen. The 1-year adherence rate was 84.4% and 5-year adherence rate was 65.2%.
Factors associated with better adherence included prescription by mail-in order, treatment with a single adjuvant hormonal therapy regimen, age 50-69 years, monthly out-of-pocket treatment cost ≤$11, no depression or comorbidity, residence in the Northeast, treatment in recent years, and receipt of a combination of chemotherapy, radiation, and surgery.
“Five-year [adjuvant hormonal therapy] adherence rates are low among female patients with breast cancer with private health insurance. Effective approaches to improve AHT adherence are needed,” concluded Dr Zhao and colleagues.—Janelle Bradley