Ellie J. Coromilas

Household Net Worth, Racial Disparities, and Hormonal Therapy Adherence Among Women With Early-Stage Breast Cancer

PURPOSEnNonadherence to adjuvant hormonal therapy is common and is associated with increased prescription copayment amount and black race. Studies suggest that household wealth may partly explain racial disparities. We investigated the impact of net worth on disparities in adherence and discontinuation.nnnPATIENTS AND METHODSnWe used the OptumInsight insurance claims database to identify women older than age 50 years diagnosed with early breast cancer, from January 1, 2007, to December 31, 2011, who were using hormonal therapy. Nonadherence was defined as a medication possession ratio of ≤ 80% of eligible days over a 2-year period. We evaluated the association of demographic and clinical characteristics, annual household income, household net worth (<

Psychosocial factors related to non-persistence with adjuvant endocrine therapy among women with breast cancer: the Breast Cancer Quality of Care Study (BQUAL)

250,000,

The Influence of Hospital and Surgeon Factors on the Prevalence of Axillary Lymph Node Evaluation in Ductal Carcinoma In Situ

250,000 to

Axillary evaluation and lymphedema in women with ductal carcinoma in situ.

750,000, or >

TCT-177 Comparison of Percutaneous and Surgical Right Ventricular Assist Device Support Following Durable Left Ventricular Assist Device Insertion

750,000), insurance type, and copayments (<

TCT-489 Use of a Percutaneous Left Ventricular Assist Device for Patients with Cardiogenic Shock

10,

Cardiac Recovery in Patients with Adriamycin-Induced Cardiomyopathy After Left Ventricular Assist Device Support

10 to

(667) – Medical Management of Device Thrombosis in Continuous-Flow Left Ventricular Assist Device Patients: Success Rate and Outcomes

20, or >

Successful Use of Temporary Percutaneous Right Ventricular Assist Devices in Acute Right Ventricular Failure After Acute Myocardial Infarction or LVAD Implantation

20) with adherence to hormonal therapy. Logistic regression analyses were conducted by sequentially adding sociodemographic and financial variables to race.nnnRESULTSnWe identified 10,302 patients; 2,473 (24%) were nonadherent. In the unadjusted analyses, adherence was negatively associated with black race (odds ratio [OR], 0.76; P < .001), advanced age, comorbidity, and Medicare insurance. Adherence was positively associated with medium (OR, 1.33; P < .001) and high (OR, 1.66; P < .001) compared with low net worth. The negative association of black race with adherence (OR, 0.76) was reduced by adding net worth to the model (OR, 0.84; P < .05). Correcting for other variables had a minimal impact on the association between race and adherence (OR, 0.87; P = .08). The interaction between net worth and race was significant (P < .01).nnnCONCLUSIONnWe found that net worth partially explains racial disparities in hormonal therapy adherence. These results suggest that economic factors may contribute to disparities in the quality of care.

Combined Renal Risk Score Predicts Post-Implant Renal Failure in Continuous-Flow Left Ventricular Assist Device (CF-LVAD) Patients

Non-adherence to adjuvant endocrine therapy (ET) for breast cancer (BC) is common. Our goal was to determine the associations between psychosocial factors and ET non-persistence. We recruited women with BC receiving care in an integrated healthcare system between 2006 and 2010. Using a subset of patients treated with ET, we investigated factors related to ET non-persistence (discontinuation) based on pharmacy records (≥90xa0days gap). Serial interviews were conducted at baseline and every 6xa0months. The Functional Assessment of Cancer Therapy (FACT), Medical Outcomes Survey, Treatment Satisfaction Questionnaire (TSQM), Impact of Events Scale (IES), Interpersonal Processes of Care measure, and Decision-making beliefs and concerns were measured. Multivariate models assessed factors associated with non-persistence. Of the 523 women in our final cohort who initiated ET and had a subsequent evaluation, 94 (18xa0%) were non-persistent over a 2-year follow-up. The cohort was primarily white (74.4xa0%), stage 1 (60.6xa0%), and on an aromatase inhibitor (68.1xa0%). Women in the highest income category had a lower odds of being non-persistent (OR 0.43, 95xa0% CI 0.23–0.81). Quality of life and attitudes toward ET at baseline were associated with non-persistence. At follow-up, the FACT, TSQM, and IES were associated with non-persistence (pxa0<xa00.001). Most women continued ET. Women who reported a better attitude toward ET, better quality of life, and more treatment satisfaction, were less likely to be non-persistent and those who reported intrusive/avoidant thoughts were more likely to be non-persistent. Interventions to enhance the psychosocial well-being of patients should be evaluated to increase adherence.