Breast Cancer Treatment Disparities: Study Implicates Out-of-Pocket Costs

For women with breast cancer receiving adjuvant endocrine therapy (AET), adherence may depend on socioeconomic status and out-of-pocket costs.

Researchers from the University of Texas Health Science Center in Houston, Texas observed that disparities in adjuvant endocrine therapy (AET) adherence exist among minority women with breast cancer. They conducted a study to quantify racial/ethnic differences in 1-year adherence to AET and determine if out-of-pocket costs explain the racial/ethnic disparities in adherence.

This retrospective cohort study used the SEER-Medicare linked database to identify women over age 65 with hormone receptor—positive breast cancer who were enrolled in Medicare Part D from 2007 to 2009. The cohort included non-Hispanic whites, blacks, Hispanics, and Asians.

Out-of-pocket costs for AET medications were standardized for a 30-day supply, and adherence to tamoxifen, aromatase inhibitors, and overall AET (tamoxifen or AIs) was assessed during the 12-month study period.

About one-third of the women were found to be nonadherent to AET (3197 of 8688 [37%]), and higher out-of-pocket costs for AET medication were associated with lower odds of adherence.

The researchers concluded that racial/ethnic disparities in AET adherence are largely explained by women's differences in socioeconomic status and out-of-pocket medication costs. The study findings are available here.