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Kwan ML, Pimentel N, Izano M, Iribarren C, Rana JS, Nguyen-Huynh M, Cheng R, Laurent CA, Lee VS, Roh JM, Rillamas-Sun E, Hershman DL, Kushi LH, Greenlee H, Neugebauer R. Adherence to cardiovascular medications and risk of cardiovascular disease in breast cancer patients: A causal inference approach in the Pathways Heart Study. PLoS One 2024; 19:e0310531. [PMID: 39298390 DOI: 10.1371/journal.pone.0310531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2024] [Accepted: 09/03/2024] [Indexed: 09/21/2024] Open
Abstract
PURPOSE Women with breast cancer (BC) are at high risk of developing cardiovascular disease (CVD). We examined adherence to CVD medications and their association with major CVD events over 14 years of follow-up in the Pathways Heart Study, a prospective study of 4,776 stage I-III BC patients diagnosed from 2005-2013. METHODS Eligibility included being alive 6 months post-BC diagnosis, with dyslipidemia, hypertension, or diabetes at diagnosis along with ≥1 prior outpatient order or dispensing for a statin, anti-hypertensive, or diabetes medication, respectively, in the 30 months prior. Medication adherence was measured from pharmacy data to calculate cumulative average adherence (CAA). Incident heart failure (HF), ischemic heart disease (IHD), and stroke were determined via validated diagnosis and procedure codes. Working marginal structural models (MSM) fitted with inverse probability weighting evaluated the effect of adherence regimens on the hazards for each CVD event, while controlling for baseline and time-varying confounders. MSM parameterizations included: 1) CAA<100% versus CAA = 100% (ref), 2) CAA<80% versus CAA≥80% (ref) and 3) CAA<80% versus 80%≤CAA<100% versus CAA = 100%. RESULTS Poor statin adherence (CAA<80%) was associated with higher risk of composite CVD (HR = 2.54; 95% CI: 1.09, 5.94) versus CAA≥80%. Poor statin adherence was also associated with a higher risk of stroke (HR = 8.13; 95% CI: 2.03, 32.51) but not risk of IHD and HF. Further, compared with perfect adherence (CAA = 100%), good adherence (80%≤CAA<100%) was associated with lower risk (HR = 0.35; 95% CI: 0.13, 0.92) while poor adherence (CAA<80%) was associated with higher risk of composite CVD (HR = 2.45; 95% CI: 1.05, 5.70). Levels of adherence to anti-hypertensives and diabetes medications had mixed or null associations with risk of CVD. CONCLUSIONS Maintaining good adherence (≥80%) to statins after BC treatment is beneficial for cardiovascular health in patients with dyslipidemia. Future studies should determine factors associated with lower adherence to statins and ways to improve adherence.
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Affiliation(s)
- Marilyn L Kwan
- Division of Research, Kaiser Permanente Northern California, Pleasanton, California, United States of America
| | - Noel Pimentel
- Division of Research, Kaiser Permanente Northern California, Pleasanton, California, United States of America
| | - Monika Izano
- Insights Epidemiology and Analytics, Syapse, San Francisco, California, United States of America
| | - Carlos Iribarren
- Division of Research, Kaiser Permanente Northern California, Pleasanton, California, United States of America
| | - Jamal S Rana
- Division of Research, Kaiser Permanente Northern California, Pleasanton, California, United States of America
- Cardiology, Oakland Medical Center, Kaiser Permanente Northern California, Oakland, California, United States of America
| | - Mai Nguyen-Huynh
- Division of Research, Kaiser Permanente Northern California, Pleasanton, California, United States of America
- Neurology, Walnut Creek Medical Center, Kaiser Permanente Northern California, Walnut Creek, California, United States of America
| | - Richard Cheng
- Division of Cardiology, University of Washington Medical Center, Seattle, Washington, United States of America
| | - Cecile A Laurent
- Division of Research, Kaiser Permanente Northern California, Pleasanton, California, United States of America
| | - Valerie S Lee
- Division of Research, Kaiser Permanente Northern California, Pleasanton, California, United States of America
| | - Janise M Roh
- Division of Research, Kaiser Permanente Northern California, Pleasanton, California, United States of America
| | - Eileen Rillamas-Sun
- Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, Washington, United States of America
| | - Dawn L Hershman
- Medical Oncology, Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, New York, United States of America
| | - Lawrence H Kushi
- Division of Research, Kaiser Permanente Northern California, Pleasanton, California, United States of America
| | - Heather Greenlee
- Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, Washington, United States of America
| | - Romain Neugebauer
- Division of Research, Kaiser Permanente Northern California, Pleasanton, California, United States of America
- Department of Health System Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California, United States of America
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2
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Vasa D, Guerra L, Goel MS, Harris YT, Lin JJ. The Impact of Depression on Adherence to Diabetes Self-Management Behaviors in Breast Cancer Survivors. Psychooncology 2024; 33:e9309. [PMID: 39267253 DOI: 10.1002/pon.9309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 06/28/2024] [Accepted: 08/31/2024] [Indexed: 09/17/2024]
Abstract
OBJECTIVE Breast cancer survivors (BCS) have higher rates of depression which is associated with lower adherence to medications, diet, and physical activity. Managing diabetes (DM) requires adherence to several of these self-management behaviors (SMB), and BCS have an increased risk of DM. We investigated whether depressive symptoms were associated with adherence to DM SMB in a cohort of BCS. METHODS BCS with DM were surveyed semiannually for 2 years. Depression was assessed with the Hospital Anxiety and Depression Scale (HADS). Adherence to DM medication, diet, and physical activity was self-reported using the Medication Adherence Report Scale (MARS), Summary of Diabetes Self-Care Activities Assessment (SDSCA), and International Physical Activity Questionnaire (IPAQ), respectively. Using generalized linear equation modeling, the association of depressive symptoms with nonadherence to SMB was assessed, adjusting for age, race, marital status, education level, and beliefs about cancer and DM risk. RESULTS Among 244 BCS with DM, those who were nonadherent to medication, diet, and/or physical activity had higher depression scores (p < 0.01). In adjusted analyses, higher depression scores were independently associated with dietary (OR = 1.16, p < 0.001) and physical activity nonadherence (OR = 1.18, p < 0.001) but not with medication nonadherence. Concerns about medications was independently associated with medication nonadherence (OR = 1.17, p = 0.024). CONCLUSIONS Higher depression scores are associated with nonadherence to DM SMB in this cohort of BCS. These findings highlight the importance of addressing depressive symptoms in BCS to help improve adherence to DM medications, diet, and physical activity.
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Affiliation(s)
- Devarshi Vasa
- Department of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Lauren Guerra
- Department of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Mita S Goel
- Department of General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Yael Tobi Harris
- Department of Internal Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Jenny J Lin
- Department of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Vallakati A, Konda B. Secondary prevention of cardiovascular disease: unrecognized opportunity to improve survival in cancer patients. Eur J Prev Cardiol 2023; 30:1323-1324. [PMID: 37235727 DOI: 10.1093/eurjpc/zwad183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 05/24/2023] [Indexed: 05/28/2023]
Affiliation(s)
- Ajay Vallakati
- Division of Cardiology, Department of Medicine, Ohio State University, 473 W 12th Avenue, Suite 200, Columbus, OH 43210, USA
| | - Bhavana Konda
- Division of Medical Oncology, Department of Medicine, Ohio State University, 473 W 12th Avenue, Columbus, OH 43210, USA
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Zullig LL, Sung AD, Khouri MG, Jazowski S, Shah NP, Sitlinger A, Blalock DV, Whitney C, Kikuchi R, Bosworth HB, Crowley MJ, Goldstein KM, Klem I, Oeffinger KC, Dent S. Cardiometabolic Comorbidities in Cancer Survivors. JACC CardioOncol 2022; 4:149-165. [PMID: 35818559 PMCID: PMC9270612 DOI: 10.1016/j.jaccao.2022.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 03/16/2022] [Accepted: 03/18/2022] [Indexed: 12/28/2022] Open
Abstract
There are nearly 17 million cancer survivors in the United States, including those who are currently receiving cancer therapy with curative intent and expected to be long-term survivors, as well as those with chronic cancers such as metastatic disease or chronic lymphocytic leukemia, who will receive cancer therapy for many years. Current clinical practice guidelines focus on lifestyle interventions, such as exercise and healthy eating habits, but generally do not address management strategies for clinicians or strategies to increase adherence to medications. We discuss 3 cardiometabolic comorbidities among cancer survivors and present the prevalence of comorbidities prior to a cancer diagnosis, treatment of comorbidities during cancer therapy, and management considerations of comorbidities in long-term cancer survivors or those on chronic cancer therapy. Approaches to support medication adherence and potential methods to enhance a team approach to optimize care of the individual with cancer across the continuum of disease are discussed. Cancer survivors are at increased risk for several chronic conditions, including hypertension, dyslipidemia, and diabetes. Determining optimal management of comorbidities for patients with cancer is critical. A multidisciplinary care approach is recommended throughout the continuum of active cancer treatment and survivorship. Survivorship research should focus on medication adherence and coordination of care.
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Affiliation(s)
- Leah L. Zullig
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, North Carolina, USA
- Address for correspondence: Dr Leah Zullig, Duke University, 411 West Chapel Hill Street, Suite 600, Durham, North Carolina 27701, USA. @LeahZullig
| | - Anthony D. Sung
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Michel G. Khouri
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Shelley Jazowski
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Nishant P. Shah
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Andrea Sitlinger
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Dan V. Blalock
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, North Carolina, USA
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, North Carolina, USA
| | - Colette Whitney
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, North Carolina, USA
- Cascades East–Oregon Health and Science University, Klamath Falls, Oregon, USA
| | - Robin Kikuchi
- Keck School of Medicine, University of California-Los Angeles, Los Angeles, California, USA
| | - Hayden B. Bosworth
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, North Carolina, USA
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, North Carolina, USA
| | - Matthew J. Crowley
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, North Carolina, USA
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Karen M. Goldstein
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, North Carolina, USA
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Igor Klem
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Kevin C. Oeffinger
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Susan Dent
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
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5
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Adherence to cardiovascular disease risk factor medications among patients with cancer: a systematic review. J Cancer Surviv 2022; 17:595-618. [PMID: 35578150 PMCID: PMC9923500 DOI: 10.1007/s11764-022-01212-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 04/13/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE The most common cause of mortality for many cancer survivors is cardiovascular disease (CVD). This requires a shift in thinking where control of CVD risk factor-related comorbidity is paramount. Our objective was to provide an understanding of adherence to medications for the management of CVD risk factor-related comorbidities among cancer survivors. METHODS We systematically searched for articles indexed in MEDLINE (via PubMed), Embase, Cochrane (Wiley), PsycINFO, and Scopus (via Elsevier) for articles published from inception to October 31, 2019, and updated the search on June 7, 2021. English language, original research that assessed medication adherence to common CVD risk factor-related comorbidities among cancer survivors was included. We assessed risk of bias using the Mixed Methods Appraisal Tool. RESULTS Of the 21 studies included, 57% focused on multiple cancer types. Seventy-one percent used pharmacy-based adherence measures. Two were prospective. Adherence was variable across cancer types and CVD risk factor-related comorbidities. Among the studies that examined changes in comorbid medication adherence, most noted a decline in adherence following cancer diagnosis and throughout cancer treatment. There was a focus on breast cancer populations. CONCLUSIONS CVD risk factor-related medication adherence is low among cancer survivors and declines over time. Given the risk for CVD-mortality among cancer survivors, testing of interventions aimed at improving adherence to non-cancer medications is critically needed. IMPLICATIONS FOR CANCER SURVIVORS For many cancer survivors, regularly taking medications to manage CVD risk is important for longevity. Engaging with primary care throughout the cancer care trajectory may be important to support cardiovascular health.
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Trogdon JG, Amin K, Gupta P, Urick BY, Reeder-Hayes KE, Farley JF, Wheeler SB, Spees L, Lund JL. Providers' mediating role for medication adherence among cancer survivors. PLoS One 2021; 16:e0260358. [PMID: 34843550 PMCID: PMC8629272 DOI: 10.1371/journal.pone.0260358] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 11/08/2021] [Indexed: 11/23/2022] Open
Abstract
Background We conducted a mediation analysis of the provider team’s role in changes to chronic condition medication adherence among cancer survivors. Methods We used a retrospective, longitudinal cohort design following Medicare beneficiaries from 18-months before through 24-months following cancer diagnosis. We included beneficiaries aged ≥66 years newly diagnosed with breast, colorectal, lung or prostate cancer and using medication for non-insulin anti-diabetics, statins, and/or anti-hypertensives and similar individuals without cancer from Surveillance, Epidemiology, and End Results-Medicare data, 2008–2014. Chronic condition medication adherence was defined as a proportion of days covered ≥ 80%. Provider team structure was measured using two factors capturing the number of providers seen and the historical amount of patient sharing among providers. Linear regressions relying on within-survivor variation were run separately for each cancer site, chronic condition, and follow-up period. Results The number of providers and patient sharing among providers increased after cancer diagnosis relative to the non-cancer control group. Changes in provider team complexity explained only small changes in medication adherence. Provider team effects were statistically insignificant in 13 of 17 analytic samples with significant changes in adherence. Statistically significant provider team effects were small in magnitude (<0.5 percentage points). Conclusions Increased complexity in the provider team associated with cancer diagnosis did not lead to meaningful reductions in medication adherence. Interventions aimed at improving chronic condition medication adherence should be targeted based on the type of cancer and chronic condition and focus on other provider, systemic, or patient factors.
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Affiliation(s)
- Justin G. Trogdon
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- * E-mail:
| | - Krutika Amin
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Parul Gupta
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Benjamin Y. Urick
- Division of Practice Advancement and Clinical Education, Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Katherine E. Reeder-Hayes
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- Division of Hematology/Oncology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Joel F. Farley
- Department of Pharmaceutical Care and Health Systems, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Stephanie B. Wheeler
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Lisa Spees
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Jennifer L. Lund
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
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Foley L, Larkin J, Lombard-Vance R, Murphy AW, Hynes L, Galvin E, Molloy GJ. Prevalence and predictors of medication non-adherence among people living with multimorbidity: a systematic review and meta-analysis. BMJ Open 2021; 11:e044987. [PMID: 34475141 PMCID: PMC8413882 DOI: 10.1136/bmjopen-2020-044987] [Citation(s) in RCA: 65] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES This systematic review aimed to describe medication non-adherence among people living with multimorbidity according to the current literature, and synthesise predictors of non-adherence in this population. METHODS A systematic review was conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses. PubMed, EMBASE, CINAHL and PsycINFO were searched for relevant articles published in English language between January 2009 and April 2019. Quantitative studies reporting medication non-adherence and/or predictors of non-adherence among people with two or more chronic conditions were included in the review. A meta-analysis was conducted with a subgroup of studies that used an inclusive definition of multimorbidity to recruit participants, rather than seeking people with specific conditions. Remaining studies reporting prevalence and predictors of non-adherence were narratively synthesised. RESULTS The database search produced 10 998 records and a further 75 were identified through other sources. Following full-text screening, 178 studies were included in the review. The range of reported non-adherence differed by measurement method, at 76.5% for self-report, 69.4% for pharmacy data, and 44.1% for electronic monitoring. A meta-analysis was conducted with eight studies (n=8949) that used an inclusive definition of multimorbidity to recruit participants. The pooled prevalence of non-adherence was 42.6% (95% CI: 34.0 - 51.3%, k=8, I2=97%, p<0.01). The overall range of non-adherence was 7.0%-83.5%. Frequently reported correlates of non-adherence included previous non-adherence and treatment-related beliefs. CONCLUSIONS The review identified a heterogeneous literature in terms of conditions studied, and definitions and measures of non-adherence used. Results suggest that future attempts to improve adherence among people with multimorbidity should determine for which conditions individuals require most support. The variable levels of medication non-adherence highlight the need for more attention to be paid by healthcare providers to the impact of multimorbidity on chronic disease self-management. PROSPERO REGISTRATION NUMBER CRD42019133849.
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Affiliation(s)
- Louise Foley
- School of Psychology, National University of Ireland Galway, Galway, Ireland
| | - James Larkin
- HRB Centre for Primary Care Research, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Richard Lombard-Vance
- Department of Psychology, National University of Ireland Maynooth, Maynooth, Ireland
| | - Andrew W Murphy
- Discipline of General Practice, National University of Ireland Galway, Galway, Ireland
- HRB Primary Care Clinical Trials Network Ireland, National University of Ireland Galway, Galway, Ireland
| | - Lisa Hynes
- Health Programmes, Croí Heart & Stroke Centre, Galway, Ireland
| | - Emer Galvin
- School of Pharmacy & Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Gerard J Molloy
- School of Psychology, National University of Ireland Galway, Galway, Ireland
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8
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Lund JL, Gupta P, Amin KB, Meng K, Urick BY, Reeder-Hayes KE, Farley JF, Wheeler SB, Spees L, Trogdon JG. Changes in chronic medication adherence in older adults with cancer versus matched cancer-free cohorts. J Geriatr Oncol 2021; 12:72-79. [PMID: 32423699 PMCID: PMC7666657 DOI: 10.1016/j.jgo.2020.04.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 03/13/2020] [Accepted: 04/26/2020] [Indexed: 01/07/2023]
Abstract
OBJECTIVES A cancer diagnosis can influence medication adherence for chronic conditions by shifting care priorities or reinforcing disease prevention. This study describes changes in adherence to medications for treating three common chronic conditions - diabetes, hyperlipidemia, and hypertension - among older adults newly diagnosed with non-metastatic breast, colorectal, lung, or prostate cancer. METHODS We identified Medicare beneficiaries aged ≥66 years newly diagnosed with cancer and using medication for at least one chronic condition, and similar cohorts of matched individuals without cancer. To assess medication adherence, proportion of days covered (PDC) was measured in six-month windows starting six-months before through 24 months following cancer diagnosis or matched index date. Generalized estimating equations were used to estimate difference-in-differences (DID) comparing changes in PDCs across cohorts using the pre-diagnosis window as the referent. Analyses were run separately for each cancer type-chronic condition combination. RESULTS Across cancer types and non-cancer cohorts, adherence was highest for anti-hypertensives (90-92%) and lowest for statins (77-79%). In older adults with colorectal and lung cancer, adherence to anti-diabetics and statins declined post-diagnosis compared with the matched non-cancer cohorts, with estimates ranging from a DID of -2 to -4%. In older adults with breast and prostate cancer cohorts, changes in adherence for all medications were similar to non-cancer cohorts. CONCLUSION Our findings highlight variation in medication adherence by cancer type and chronic condition. As many older adults with early stage cancer eventually die from non-cancer causes, it is imperative that cancer survivorship interventions emphasize medication adherence for other chronic conditions.
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Affiliation(s)
- Jennifer L Lund
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, United States of America; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, United States of America.
| | - Parul Gupta
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, United States of America
| | - Krutika B Amin
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, United States of America
| | - Ke Meng
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, United States of America
| | - Benjamin Y Urick
- Division of Practice Advancement and Clinical Education, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, United States of America
| | - Katherine E Reeder-Hayes
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, United States of America; Division of Hematology/Oncology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, United States of America
| | - Joel F Farley
- Department of Pharmaceutical Care and Health Systems, University of Minnesota, Minneapolis, MN 55455, United States of America
| | - Stephanie B Wheeler
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, United States of America; Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, United States of America
| | - Lisa Spees
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, United States of America; Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, United States of America
| | - Justin G Trogdon
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, United States of America; Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, United States of America
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9
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Spees LP, Wheeler SB, Zhou X, Amin KB, Baggett CD, Lund JL, Urick BY, Farley JF, Reeder-Hayes KE, Trogdon JG. Changes in chronic medication adherence, costs, and health care use after a cancer diagnosis among low-income patients and the role of patient-centered medical homes. Cancer 2020; 126:4770-4779. [PMID: 32780539 DOI: 10.1002/cncr.33147] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 07/09/2020] [Accepted: 07/18/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Approximately 40% of patients with cancer also have another chronic medical condition. Patient-centered medical homes (PCMHs) have improved outcomes among patients with multiple chronic comorbidities. The authors first evaluated the impact of a cancer diagnosis on chronic medication adherence among patients with Medicaid coverage and, second, whether PCMHs influenced outcomes among patients with cancer. METHODS Using linked 2004 to 2010 North Carolina cancer registry and claims data, the authors included Medicaid enrollees who were diagnosed with breast, colorectal, or lung cancer who had hyperlipidemia, hypertension, and/or diabetes mellitus. Using difference-in-difference methods, the authors examined adherence to chronic disease medications as measured by the change in the percentage of days covered over time among patients with and without cancer. The authors then further evaluated whether PCMH enrollment modified the observed differences between those patients with and without cancer using a differences-in-differences-in-differences approach. The authors examined changes in health care expenditures and use as secondary outcomes. RESULTS Patients newly diagnosed with cancer who had hyperlipidemia experienced a 7-percentage point to 11-percentage point decrease in the percentage of days covered compared with patients without cancer. Patients with cancer also experienced significant increases in medical expenditures and hospitalizations compared with noncancer controls. Changes in medication adherence over time between patients with and without cancer were not determined to be statistically significantly different by PCMH status. Some PCMH patients with cancer experienced smaller increases in expenditures (diabetes) and emergency department use (hyperlipidemia) but larger increases in their inpatient hospitalization rates (hypertension) compared with non-PCMH patients with cancer relative to patients without cancer. CONCLUSIONS PCMHs were not found to be associated with improvements in chronic disease medication adherence, but were associated with lower costs and emergency department visits among some low-income patients with cancer.
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Affiliation(s)
- Lisa P Spees
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Stephanie B Wheeler
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Xi Zhou
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Krutika B Amin
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Christopher D Baggett
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Jennifer L Lund
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Benjamin Y Urick
- Division of Practice Advancement and Clinical Education, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Joel F Farley
- Department of Pharmaceutical Care and Health Systems, University of Minnesota, Minneapolis, Minnesota
| | - Katherine E Reeder-Hayes
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Division of Hematology/Oncology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Justin G Trogdon
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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10
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Hou CH, Lin KK, Lee JS, Pu C. Medication Adherence in Patients With Glaucoma After Cancer Diagnosis. Am J Ophthalmol 2020; 213:88-96. [PMID: 31945329 DOI: 10.1016/j.ajo.2020.01.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 12/20/2019] [Accepted: 01/03/2020] [Indexed: 01/20/2023]
Abstract
PURPOSE To determine the association between cancer diagnosis and medication adherence in patients with glaucoma. DESIGN Cohort study. METHODS Setting: Population-based. StudyPopulation: All patients with confirmed glaucoma in one or both eyes. All patients were aged 20 years or older. Patients who developed cancer within 2 year of a confirmed glaucoma diagnosis or who were dead within 2 year after a confirmed cancer diagnosis were excluded. Intervention orObservationProcedure(s): Individuals without cancer but with a confirmed glaucoma diagnosis were followed until they received a confirmed cancer diagnosis. They were then matched with a group of patients with confirmed glaucoma who did not develop cancer during the study period. MainOutcomeMeasure(s): Secondary adherence measured using medication possession ratio (MPR) at 1-year, 2-year, and 2-year-average intervals. RESULTS For both patients with cancer and their matches, MPR was the highest when measured at 1-year intervals. MPR was 0.379 (95% CI: 0.370-0.388) for the cancer group and 0.313 (95% CI: 0.308-0.319) for the cancer-free group. MPR measured using 1-year intervals decreased by 17.4% after cancer diagnosis (P < .001). MPR measured using 2-year and 2-year-average intervals decreased by 10.4% (P < .001) and 9.21% (P < .001), respectively. CONCLUSIONS Cancer diagnosis leads to lower medication adherence in patients with glaucoma. To improve medication adherence in patients with glaucoma who also have cancer, policies should directly target the burden associated with having cancer that tends to create barriers for medication refills, rather than targeting risk factors that are also applicable to patients with glaucoma but without cancer.
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11
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Dashputre AA, S Gatwood K, Schmidt J, Gatwood J. Impact of oral oncolytic initiation on medication adherence for pre-existing comorbid chronic conditions. J Oncol Pharm Pract 2019; 26:835-845. [PMID: 31575355 DOI: 10.1177/1078155219875206] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE Oral oncolytics have improved survival in hematological cancers like chronic myeloid leukemia, chronic lymphocytic leukemia/small lymphocytic lymphoma, and multiple myeloma; however, it is unclear of the extent to which initiating these treatments might impact adherence to oral therapies for pre-existing comorbid chronic conditions. METHODS Adults diagnosed with and prescribed oral oncolytics for chronic myeloid leukemia, chronic lymphocytic leukemia/small lymphocytic lymphoma, or multiple myeloma between 2013 and 2016 and with continuous eligibility six months before and after oral oncolytic initiation were identified from the Truven Health MarketScan databases. Among those identified, patients with pre-existing diabetes, hypertension, and/or hyperlipidemia with ≥1 fill for oral comorbid therapies were selected. Adherence to oral oncolytics and comorbid therapies was measured using the proportion of days covered metric. Wilcoxon signed-rank tests assessed changes in adherence for comorbid therapies after initiation of an oral oncolytic. Unadjusted difference-in-difference models assessed the impact of adherence to oral oncolytics on changes in adherence to comorbid therapies. RESULTS Significant reductions in adherence after oncolytic initiation were observed across the comorbid therapies and were highest for patients taking lipid-lower agents (10.7-15.6%). Unadjusted difference-in-difference models revealed consistent and significantly lower reductions in adherence for those taking antihypertensives (chronic myeloid leukemia: p = 0.03; chronic lymphocytic leukemia/small lymphocytic lymphoma: p = 0.007; multiple myeloma: p = 0.09) and adherent to oral oncolytics. CONCLUSION Initiation of oral oncolytics may negatively impact adherence to oral therapies for chronic comorbid conditions, necessitating the need for medication management strategies to help patients adhere to their entire medication regimen.
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Affiliation(s)
- Ankur A Dashputre
- Institute for Health Outcomes and Policy, College of Graduate Health Sciences, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Katie S Gatwood
- Department of Pharmacy, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jillian Schmidt
- College of Pharmacy, University of Tennessee Health Science Center, TN, USA
| | - Justin Gatwood
- College of Pharmacy, University of Tennessee Health Science Center, TN, USA
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12
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Zullig LL, Smith VA, Lindquist JH, Williams CD, Weinberger M, Provenzale D, Jackson GL, Kelley MJ, Danus S, Bosworth HB. Cardiovascular disease-related chronic conditions among Veterans Affairs nonmetastatic colorectal cancer survivors: a matched case-control analysis. Cancer Manag Res 2019; 11:6793-6802. [PMID: 31413631 PMCID: PMC6659791 DOI: 10.2147/cmar.s191040] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 05/29/2019] [Indexed: 01/13/2023] Open
Abstract
Purpose The growing number of colorectal cancer (CRC) survivors often have multiple chronic conditions. Comparing nonmetastatic CRC survivors and matched noncancer controls, our objectives were to determine the odds of CRC survivors being diagnosed with cardiovascular disease (CVD)-related chronic conditions and their likelihood of control during the year after CRC diagnosis. Patients and methods We retrospectively identified patients diagnosed with nonmetastatic CRC in the Veterans Affairs health care system from fiscal years 2009 to 2012 and matched each with up to 3 noncancer control patients. We used logistic regression to assess differences in the likelihood of being diagnosed with CVD-related chronic conditions and control between nonmetastatic CRC survivors and noncancer controls. Results We identified 9,758 nonmetastatic CRC patients and matched them to 29,066 noncancer controls. At baseline, 69.4% of CRC survivors and their matched controls were diagnosed with hypertension, 52.4% with hyperlipidemia, and 36.7% with diabetes. Compared to matched noncancer controls, CRC survivors had 57% higher odds of being diagnosed with hypertension (OR=1.57, 95% CI=1.49–1.64) and 7% higher odds of controlled blood pressure (OR=1.07, 95% CI 1.02, 1.13) in the subsequent year. Compared to matched noncancer control patients, CRC survivors had half the odds of being diagnosed with hyperlipidemia (OR=0.50, 95% CI=0.48–0.52) and lower odds of low-density lipoprotein (LDL) control (OR 0.88, 95% CI 0.81–0.94). There were no significant differences between groups for diabetes diagnoses or control. Conclusion Compared to noncancer controls, nonmetastatic CRC survivors have 1) greater likelihood of being diagnosed with hypertension and worse blood pressure control in the year following diagnosis; 2) lower likelihood of being diagnosed with hyperlipidemia or LDL control; and 3) comparable diabetes diagnoses and control. There may be a need for hypertension control interventions targeting cancer survivors.
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Affiliation(s)
- Leah L Zullig
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Health Care System, Durham, NC, USA.,Department of Population Health Sciences, Duke University, Durham, NC, USA
| | - Valerie A Smith
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Health Care System, Durham, NC, USA.,Department of Population Health Sciences, Duke University, Durham, NC, USA
| | - Jennifer H Lindquist
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Health Care System, Durham, NC, USA
| | - Christina D Williams
- Division of Medical Oncology, Department of Medicine, Duke University, Durham, NC, USA.,Cooperative Studies Program Epidemiology Center , Durham, NC, USA
| | - Morris Weinberger
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Health Care System, Durham, NC, USA.,Department of Health Policy and Management, University of North Carolina, Chapel Hill, NC, USA
| | - Dawn Provenzale
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Health Care System, Durham, NC, USA.,Cooperative Studies Program Epidemiology Center , Durham, NC, USA
| | - George L Jackson
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Health Care System, Durham, NC, USA.,Department of Population Health Sciences, Duke University, Durham, NC, USA
| | - Michael J Kelley
- Office of Specialty Care Services, Department of Veterans Affairs , Washington, DC, USA.,Hematology-Oncology Service, Durham Veterans Affairs Medical Center , Durham, NC, USA.,Department of Medicine, Duke University, Durham, NC, USA
| | - Susanne Danus
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Health Care System, Durham, NC, USA
| | - Hayden B Bosworth
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Health Care System, Durham, NC, USA.,Department of Population Health Sciences, Duke University, Durham, NC, USA.,Departments of Psychiatry and School of Nursing, Duke University, Durham, NC, USA
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13
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Griffiths RI, Keating NL, Bankhead CR. Quality of diabetes care in cancer: a systematic review. Int J Qual Health Care 2019; 31:75-88. [PMID: 29912446 PMCID: PMC6419905 DOI: 10.1093/intqhc/mzy124] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 04/09/2018] [Accepted: 05/22/2018] [Indexed: 11/18/2022] Open
Abstract
PURPOSE Overlooking other conditions during cancer could undermine gains associated with early detection and improved cancer treatment. We conducted a systematic review on the quality of diabetes care in cancer. DATA SOURCES Systematic searches of Medline and Embase, from 1996 to present, were conducted to identify studies on the quality of diabetes care in patients diagnosed with cancer. STUDY SELECTION Studies were selected if they met the following criteria: longitudinal or cross-sectional observational study; population consisted of diabetes patients; exposure consisted of cancer of any type and outcomes consisted of diabetes quality of care indicators, including healthcare visits, monitoring and testing, control of biologic parameters, or use of diabetes and other related medications. DATA EXTRACTION Structured data collection forms were developed to extract information on the study design and four types of quality indicators: physician visits, exams or diabetes education (collectively 'healthcare visits'); monitoring and testing; control of biologic parameters; and medication use and adherence. RESULTS OF DATA SYNTHESIS There were 15 studies from five countries. There was no consistent evidence that cancer was associated with fewer healthcare visits, lower monitoring and testing of biologic parameters or poorer control of biologic parameters, including glucose. However, the weight of the evidence suggests cancer was associated with lower adherence to diabetes medications and other medications, such as anti-hypertensives and cholesterol-lowering agents. CONCLUSION Evidence indicates cancer is associated with poorer adherence to diabetes and other medications. Further primary research could clarify cancer's impact on other diabetes quality indicators.
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Affiliation(s)
- Robert I Griffiths
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Nancy L Keating
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
- Division of General Internal Medicine and Primary Care Research, Department of Medicine Research, Brigham and Women’s Hospital, Boston, MA, USA
| | - Clare R Bankhead
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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14
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Slade AN. Prostate cancer and subsequent nutritional outcomes: the role of diagnosis and treatment. J Cancer Surviv 2019; 13:171-179. [PMID: 30734156 DOI: 10.1007/s11764-019-00739-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 01/22/2019] [Indexed: 12/15/2022]
Abstract
PURPOSE To comprehensively explore the role of a prostate cancer diagnosis and its treatment to several outcomes including diet, Hemoglobin A1c, and weight status, in a large, nationally representative, cross-sectional study. METHODS This analysis used five cross sections from the publicly available National Health and Nutrition Evaluation Survey (NHANES) from 2001 to 2010. A sample of 289 men with a history of prostate cancer was matched to a comparison group of 655 men with elevated prostate-specific antigen (> 4 ng/mL) but no reported diagnosis of prostate cancer. Analyses were stratified by diabetic or pre-diabetes status and treatment including surgery, radiotherapy, or both. Outcomes of interest included several broad macronutrient categories, HbA1c, body mass index, and obesity status. Multivariate regression analyses were conducted to clarify the associations of a prostate cancer diagnosis with these outcomes. Demographic and socioeconomic factors, including age, education, race, income, and marital status, were controlled for in all models. RESULTS The clinical and demographic characteristics were relatively well balanced between the "at risk" comparison group and the group of men diagnosed with prostate cancer. Diabetic or pre-diabetic men diagnosed with prostate cancer were more likely to be obese (p < 0.05) and have a higher BMI (p < 0.10). On multivariate analysis, compared to controls, men with prostate cancer treated with surgery and radiation therapy were predicted to have a higher BMI (p < 0.01) and were more likely to be obese (p < 0.05). These findings were largely driven by the diabetic and pre-diabetic sample. Further diabetics and pre-diabetics with prostate cancer treated with both radiation and surgery were predicted to consume an average of 72 and 59 more daily grams of carbohydrates and sugar, respectively, compared to controls (p < 0.05). CONCLUSION Men with prostate cancer report fewer behaviors and outcomes consistent with optimal glycemic management including a higher BMI, and in diabetics and pre-diabetics, increased carbohydrate sugar consumption. Men with more intense treatment including surgery and radiotherapy appeared to be more likely to be obese and make poorer dietary carbohydrate and sugar choices compared to men without prostate cancer. IMPLICATIONS FOR CANCER SURVIVORS Men treated for prostate cancer have, on average, very long survivorship periods and are susceptible to diabetes and its complications. Interventions designed to improve diabetes awareness and self-management, especially weight and dietary sugar control, may be useful in this population.
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Affiliation(s)
- Alexander N Slade
- Massey Cancer Center, Department of Radiation Oncology, Virginia Commonwealth University Health System, Box 980058, Richmond, VA, 23298, USA.
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15
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Drzayich Antol D, Waldman Casebeer A, Khoury R, Michael T, Renda A, Hopson S, Parikh A, Stein A, Costantino M, Stemkowski S, Bunce M. The relationship between comorbidity medication adherence and health related quality of life among patients with cancer. J Patient Rep Outcomes 2018; 2:29. [PMID: 30294709 PMCID: PMC6091619 DOI: 10.1186/s41687-018-0057-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Accepted: 06/22/2018] [Indexed: 11/12/2022] Open
Abstract
Background Studies have demonstrated that comorbidities compound the adverse influence of cancer on health-related quality of life (HRQoL). Comorbidities adversely impact adherence to cancer treatment. Additionally, adherence to medications for comorbidities is positively associated with HRQoL for various diseases. This study used the Center for Disease Control and Prevention's Healthy Days measure of HRQoL to explore the association between HRQoL and adherence to comorbidity medication for elderly patients with cancer and at least one comorbid condition. Methods We conducted a cross-sectional survey combined with retrospective claims data. Patients with metastatic breast, lung or colorectal cancer were surveyed regarding their HRQoL, comorbidity medication adherence and cancer-related symptoms. Patients reported the number of physical, mental and total unhealthy days in the prior month. The Morisky Medication Adherence 8-point scale was differentiated into moderate/high (> 6) and low (≤ 6) comorbidity medication adherence. Results Of the 1847 respondents, the mean age was 69.2 years, most were female (66.8%) and the majority of the sample had Medicare coverage (88.2%). Low comorbidity medication adherence was associated with significantly more total, mental and physical unhealthy days. Low comorbidity medication adherence was associated with the presence of patient-reported cancer-related symptoms. Patients reporting low, as compared to moderate/high, comorbidity medication adherence had 23.4% more unhealthy days in adjusted analysis, P = 0.007. Conclusion The positive association between low comorbidity medication adherence and the number of unhealthy days suggests that addressing barriers to comorbidity medication adherence during cancer treatment may be an avenue for improving or maintaining HRQoL for older patients with cancer and comorbid conditions.
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Antol DD, Casebeer AW, DeClue RW, Stemkowski S, Russo PA. An Early View of Real-World Patient Response to Sacubitril/Valsartan: A Retrospective Study of Patients with Heart Failure with Reduced Ejection Fraction. Adv Ther 2018; 35:785-795. [PMID: 29777521 DOI: 10.1007/s12325-018-0710-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Sacubitril/valsartan has been established as an effective treatment for heart failure (HF) with reduced ejection fraction based on clinical trial data; however, little is known about its use or impact in real-world practice. METHODS This study included data from medical and pharmacy claims and medical records review for patients (n = 200) who initiated sacubitril/valsartan between August 2015 and March 2016 preceding issuance of American College of Cardiology (ACC)/American Heart Association (AHA)/Heart Failure Society of America (HFSA) focused update on new pharmacological therapy for HF (May 2016), which included recommendations for sacubitril/valsartan. A within-subject analysis compared symptoms and healthcare resource utilization before and after treatment initiation. RESULTS Patients treated with sacubitril/valsartan had multiple comorbidities, and nearly all had previous treatment for HF. Most patients initiated sacubitril/valsartan at the lowest dose of 24/26 mg twice a day (BID), which remained unchanged during the observation period for half of the patients. During the first 6 weeks of treatment, few patients discontinued sacubitril/valsartan treatment (5.5%), and only 17% achieved the target dose of 97/103 mg BID after 4 months of treatment. The proportion of patients with ≥ 1 all-cause inpatient stay decreased significantly between the pre-initiation period (27.5%) and the post-initiation period (17.0%), P = 0.009. Fatigue was noted in 51.8% of patients pre-initiation and 39.5% post-initiation, P = 0.027. Shortness of breath was documented for 66.7% of patients pre-initiation and 51.8% post-initiation, P = 0.008. CONCLUSION The findings of this real-world investigation suggest sacubitril/valsartan is associated with symptom improvements and a reduction in hospitalizations within 4 months of treatment for patients with HF and reduced ejection fraction. FUNDING Novartis Pharmaceuticals Corporation.
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Létinier L, Mansiaux Y, Pariente A, Fourrier-Réglat A. Impact of cancer diagnosis on persistence of oral antidiabetic drugs. Diabetes Res Clin Pract 2018. [PMID: 29526679 DOI: 10.1016/j.diabres.2018.03.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
AIMS The purpose of this study was to determine the effects of cancer occurrence on persistence of oral antidiabetic drugs (OAD) in France. METHODS A retrospective cohort including incident OAD users between 2006 and 2011 was set up using a permanent sample of health insurance beneficiaries (Echantillon Généraliste de Bénéficiaires, EGB). A Cox model was used to assess the association between cancer occurrence and OAD persistence. Non-persistence was defined as a gap in OAD treatment coverage between the end of a given prescription and a new one greater than or equal to 90 days. Cancer occurrence was studied as a time-dependent variable. RESULTS The study included 13,943 OAD users. Median follow-up was 760 days. After adjustment for age, sex, first OAD used, type of prescriber and polypharmacy, non-persistence risk was higher after a diagnosis of cancer: (HR: 1.93 and IC 95% 1.69; 2.21). Subgroup analyses according to cancer localization found a higher risk of non-persistence for lung cancer (HR: 2.66 and IC 95% 1.68; 4.23) and colorectal cancer (HR: 2.02 and IC 95% 1.40; 2.91). CONCLUSIONS Our findings indicate there is an association between cancer diagnosis and OAD non-persistence. Additional studies of this type would be useful to evaluate the association between cancer diagnosis and persistence of treatment of other chronic diseases.
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Affiliation(s)
- Louis Létinier
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, Team Pharmacoepidemiology, UMR 1219, F-33000 Bordeaux, France; CHU de Bordeaux, Pôle de santé publique, Service de pharmacologie médicale, F-33000 Bordeaux, France.
| | - Yohann Mansiaux
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, Team Pharmacoepidemiology, UMR 1219, F-33000 Bordeaux, France
| | - Antoine Pariente
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, Team Pharmacoepidemiology, UMR 1219, F-33000 Bordeaux, France; CHU de Bordeaux, Pôle de santé publique, Service de pharmacologie médicale, F-33000 Bordeaux, France
| | - Annie Fourrier-Réglat
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, Team Pharmacoepidemiology, UMR 1219, F-33000 Bordeaux, France; CHU de Bordeaux, Pôle de santé publique, Service de pharmacologie médicale, F-33000 Bordeaux, France
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James J, Harris YT, Kronish IM, Wisnivesky JP, Lin JJ. Exploratory study of impact of cancer-related posttraumatic stress symptoms on diabetes self-management among cancer survivors. Psychooncology 2017; 27:648-653. [DOI: 10.1002/pon.4568] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2016] [Revised: 07/24/2017] [Accepted: 10/05/2017] [Indexed: 01/06/2023]
Affiliation(s)
- Janey James
- School of Public Health; Icahn School of Medicine at Mount Sinai; New York NY USA
| | - Yael T. Harris
- Division of Endocrinology; Diabetes and Metabolism, Hofstra Northwell School of Medicine; Hempstead NY USA
| | - Ian M. Kronish
- Center for Behavioral Cardiovascular Health; Columbia University Medical Center; New York NY USA
| | - Juan P. Wisnivesky
- Division of General Internal Medicine; Icahn School of Medicine at Mount Sinai; New York NY USA
| | - Jenny J. Lin
- Division of General Internal Medicine; Icahn School of Medicine at Mount Sinai; New York NY USA
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Characteristics associated with nonadherence to medications for hypertension, diabetes, and dyslipidemia among breast cancer survivors. Breast Cancer Res Treat 2016; 161:161-172. [PMID: 27826756 DOI: 10.1007/s10549-016-4043-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Accepted: 11/01/2016] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Comorbidity among breast cancer survivors is prevalent, and adherence to medication management of comorbidities may be important for both chronic disease and cancer-related outcomes. Our objective was to determine characteristics associated with nonadherence to common chronic medications among breast cancer survivors. METHODS We conducted a retrospective cohort study of 4216 women in an integrated care system diagnosed with early-stage breast cancer between 1990 and 2008 and alive without recurrence or second primary breast cancer in the second-year following diagnosis. Adherence to antihypertensives, oral diabetes medications, and statins was measured during the second-year post-breast cancer diagnosis using medication possession ratios (MPR). Nonadherence was defined as MPR <0.80. We estimated odds ratios (OR) and 95% confidence intervals (CI) for nonadherence to antihypertensives, oral diabetes medications, and statins by various characteristics using multivariable logistic regression. RESULTS Among 2308 users of antihypertensives (n = 1779), diabetes medications (n = 499) and/or statins (n = 1072), 37% were nonadherent to antihypertensives; 75% were nonadherent to diabetes medications; 39% were nonadherent to statins. In adjusted models, younger age was associated with nonadherence to all three therapeutic classes. Certain cancer treatments were associated with nonadherence to antihypertensives (radiation: OR 1.21, 95% CI 1.01-1.47; endocrine therapy: OR 1.27, 95% CI 1.03-1.52) and diabetes medications (chemotherapy: OR 1.69, 95% CI 1.17-2.21). Less frequent primary care provider visits were associated with higher odds of nonadherence to antihypertensives (OR 1.70, 95% CI 1.19-2.22); and trends showed higher Charlson comorbidity scores associated with greater adherence to diabetes medications (P < 0.001) and statins (P = 0.032). CONCLUSIONS Nonadherence to medications is high among breast cancer survivors, particularly diabetes medications, and is associated with cancer treatments and other patient characteristics. Additional research is warranted to understand the needs of cancer patients taking chronic medications and explore patient and provider factors influencing adherence.
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