Outcomes associated with adjuvant hormonal therapy: Are there any differences between black and white women with primary breast cancer? .

摘要

Studies have documented that racial disparities exist in breast cancer treatment and delivery in the United States. Medication adherence and persistence to adjuvant hormonal therapies in women with hormone receptor positive breast cancer could be important for optimum benefits and to avoid recurrences. Medication use behavior is associated with improved treatment outcomes and results in lower utilization of medical resources and costs. The objective of this study was to examine the racial differences in medication use behavior and associated healthcare costs and utilization. The conceptual model incorporated modified version of Health Belief Model and Aday-Andersen model for healthcare utilization.;This was a retrospective cohort study of Medicaid enrollees with hormone receptor positive breast cancer newly starting adjuvant hormonal therapy. The study used North Carolina Medicaid data, which was linked to the North Carolina Cancer Registry. The patients were followed for one year after commencing the index medication (tamoxifen or aromatase inhibitor) to collect the data on medication utilization, healthcare costs, hospitalization and emergency department (ED) visits. Demographic, clinical and medication related information was extracted from the linked data. Propensity score (PS) matching technique was used to match white and black patients on their background characteristics. A total of 206 pair matched sample cohort was used for the final analyses.;Adherence levels of this study cohort were significantly lower than the generally accepted level of eighty percent. Black patients were associated with slightly decreased medication adherence as compared to white patients after controlling the type of index therapy. Annual health care costs did not differ significantly between the racial groups. Whites had a higher likelihood of hospitalizations as compared with black patients. The likelihood of ED visits did not differ significantly across the racial groups. Higher medication adherence was associated decreased likelihood of ED visit in this cohort.;Disparities in medication adherence warrant raising awareness of the health care gap among broad sectors, including health care providers, patients, payors, health plan purchasers, and society at large. Multidisciplinary action which entails collaboration of healthcare professionals aiming to improve medication use behavior in black patients may prove to be an important strategy.