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Li Y, Xin J, Fang S, Wang F, Jin Y, Wang L. Development and Validation of a Predictive Model for Early Identification of Cognitive Impairment Risk in Community-Based Hypertensive Patients. J Appl Gerontol 2024:7334648241257795. [PMID: 38832577 DOI: 10.1177/07334648241257795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2024] Open
Abstract
Objective: To investigate the risk factors for the development of mild cognitive dysfunction in hypertensive patients in the community and to develop a risk prediction model. Method: The data used in this study were obtained from two sources: the China Health and Retirement Longitudinal Study (CHARLS) and the Chinese Longitudinal Healthy Longevity Survey (CLHLS). A total of 1121 participants from CHARLS were randomly allocated into a training set and a validation set, following a 70:30 ratio. Meanwhile, an additional 4016 participants from CLHLS were employed for external validation of the model. The patients in this study were divided into two groups: those with mild cognitive impairment and those without. General information, employment status, pension, health insurance, and presence of depressive symptoms were compared between the two groups. LASSO regression analysis was employed to identify the most predictive variables for the model, utilizing 14-fold cross-validation. The risk prediction model for cognitive impairment in hypertensive populations was developed using generalized linear models. The model's discriminatory power was evaluated through the area under the receiver operating characteristic (ROC) curve and calibration curves. Results: In the modeling group, eight variables such as gender, age, residence, education, alcohol use, depression, employment status, and health insurance were ultimately selected from an initial pool of 21 potential predictors to construct the risk prediction model. The area under the curve (AUC) values for the training, internal, and external validation sets were 0.777, 0.785, and 0.782, respectively. All exceeded the threshold of 0.7, suggesting that the model effectively predicts the incidence of mild cognitive dysfunction in community-based hypertensive patients. A risk prediction model was developed using a generalized linear model in conjunction with Lasso regression. The model's performance was evaluated using the area under the receiver operating characteristic (ROC) curve. Hosmer-Lemeshow test values yielded p = .346 and p = .626, both of which exceeded the 0.05 threshold. Calibration curves demonstrated a significant agreement between the nomogram model and observed outcomes, serving as an effective tool for evaluating the model's predictive performance. Discussion: The predictive model developed in this study serves as a promising and efficient tool for evaluating cognitive impairment in hypertensive patients, aiding community healthcare workers in identifying at-risk populations.
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Affiliation(s)
- Yan Li
- Shanxi Medical University, Taiyuan, China
- Department of Epidemiology and Health Statistics, School of Public Health, Shanxi Medical University, Taiyuan, China
| | - Jimei Xin
- Shanxi Medical University, Taiyuan, China
- Department of Epidemiology and Health Statistics, School of Public Health, Shanxi Medical University, Taiyuan, China
| | - Sen Fang
- Shanxi Medical University, Taiyuan, China
- Department of Geriatrics, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China
| | - Fang Wang
- Shanxi Medical University, Taiyuan, China
- Department of Epidemiology and Health Statistics, School of Public Health, Shanxi Medical University, Taiyuan, China
| | - Yufei Jin
- Shanxi Medical University, Taiyuan, China
- Department of Geriatrics, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China
| | - Lei Wang
- Shanxi Medical University, Taiyuan, China
- Department of Geriatrics, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China
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Sultan N, Swinglehurst D. Living with polypharmacy: a narrative interview study with older Pakistanis in East London. BMC Geriatr 2023; 23:746. [PMID: 37968631 PMCID: PMC10652535 DOI: 10.1186/s12877-023-04392-1] [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: 03/30/2023] [Accepted: 10/06/2023] [Indexed: 11/17/2023] Open
Abstract
BACKGROUND Polypharmacy is a growing and major public health issue. It can be burdensome and risky for patients and costly to healthcare systems. Older adults and those from ethnic minority backgrounds are disproportionately affected by polypharmacy. This study focuses on medication practices among Urdu-speaking Pakistani patients, a significant ethnic group in the UK. Most existing research on medication practices within South-Asian communities centres on adherence, leaving the social and moral dimensions of polypharmacy unpacked. Understanding how British Pakistani patients understand and manage polypharmacy in the context of their daily lives is crucial to avoiding harmful polypharmacy. METHODS In-depth narrative interviews were conducted with 15 first-generation Pakistani patients using the Biographical Narrative Interview Method. Participants were recruited from GP practices in East London. All participants were prescribed ten or more regular medications (a pragmatic marker of 'higher risk' polypharmacy) and were aged over 50. Interviews were conducted with a bilingual researcher at home and were designed to elicit narratives of patients' experiences of polypharmacy in the context of their biographies and daily lives. RESULTS Polypharmacy is enacted through networks of interpersonal and socio-material relationships. The doctor-patient relationship and the family network held particular significance to study participants. In addition, participants described emotional bonds between themselves and their medicines, identifying them as 'forces for good'-substances which allowed them to maintain their health through the intercession of God. Meanings attributed to medicines and enacted through these social, emotional, and spiritual relationships contributed to emerging and sustaining polypharmacy. CONCLUSIONS Patients make sense of and manage treatments in culturally specific ways. Developing an understanding of how medication practices in different communities are enacted is important for informing meaningful and effective conversations with patients about their medicines. Our findings contribute to enabling the integration of culturally sensitive approaches to prescribing.
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Affiliation(s)
- Najia Sultan
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK.
| | - Deborah Swinglehurst
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
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Becevic M, Anbari AB, McElroy JA. It's Not Always Easy: Cancer Survivorship Care in Primary Care Settings. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2023; 38:1592-1599. [PMID: 37133797 DOI: 10.1007/s13187-023-02304-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/22/2023] [Indexed: 05/04/2023]
Abstract
By 2040, an anticipated 26.1 million people with a history of cancer will be part of the healthcare system. The purpose of this study was to explore Missouri-based non-oncology clinicians' perspectives on caring for patients with a history of cancer to identify needs of rural-based clinicians to optimize their patients' survivorship care. Using an interpretive qualitative descriptive approach, we conducted semi-structured interviews with 17 non-oncology clinicians. We encouraged clinicians to discuss their approach to caring for patients with a history of cancer and invited them to talk about what might help them increase their knowledge of survivorship care best practices. Through interpretive qualitative descriptive analysis methods including first level coding and constant comparison, we found there is consensus that cancer survivorship care is important; however, training that now guides our clinicians occurred mostly during residency, if at all. Clinicians relied on previous patient encounters and oncology notes combined with their patients' personal account of treatment history to inform the best next steps. Clinicians expressed strong interest in having a simple protocol of their patient's treatment with prompts of known long-term cancer treatment-related effects and a patient-centric follow-up monitoring schedule (mandatory vs recommended vs optional). Clinicians expressed interest in educational opportunities about cancer care and ability for curbside consults with oncologists. They consistently noted the limited resources available in rural areas and that rural patients may have different preferences and approaches to cancer survivorship. There is a clear opportunity to improve non-oncology clinicians' knowledge of the needs of people with a history of cancer as well as their own knowledge base and self-efficacy, especially in rural settings.
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Affiliation(s)
- Mirna Becevic
- Department of Dermatology, School of Medicine, University of Missouri, 1 Hospital Drive, MA111, Columbia, MO, 65212, USA.
- Missouri Telehealth Network, University of Missouri, 4215 Phillips Farm Road, Suite 121, MO, 65212, Columbia, USA.
- Institute for Data Science and Informatics, University of Missouri, 241 Naka Hall, Columbia, MO, 65211, USA.
| | - Allison B Anbari
- Sinclair School of Nursing, University of Missouri, 915 Hitt St., Columbia, MO, 65212, USA
| | - Jane A McElroy
- Family and Community Medicine, University of Missouri, Medical Sciences Building, 1 Hospital Drive, MA306, Columbia, MO, 65212, USA
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Sayed A, Munir M, Addison D, Abushouk AI, Dent SF, Neilan TG, Blaes A, Fradley MG, Nohria A, Moustafa K, Virani SS. The underutilization of preventive cardiovascular measures in patients with cancer: an analysis of the Behavioural Risk Factor Surveillance System, 2011-22. Eur J Prev Cardiol 2023; 30:1325-1332. [PMID: 37158488 PMCID: PMC10516320 DOI: 10.1093/eurjpc/zwad146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 04/25/2023] [Accepted: 05/05/2023] [Indexed: 05/10/2023]
Abstract
AIMS This study aimed to characterize the influence of a cancer diagnosis on the use of preventive cardiovascular measures in patients with and without cardiovascular disease (CVD). METHODS AND RESULTS Data from the Behavioural Risk Factor Surveillance System Survey (spanning 2011-22) were used. Multivariable logistic regression models adjusted for potential confounders were applied to calculate average marginal effects (AME), the average difference in the probability of using a given therapy between patients with and without cancer. Outcomes of interest included the use of pharmacological therapies, physical activity, smoking cessation, and post-CVD rehabilitation. Among 5 012 721 respondents, 579 114 reported a history of CVD (coronary disease or stroke), and 842 221 reported a diagnosis of cancer. The association between cancer and the use of pharmacological therapies varied between those with vs. without CVD (P-value for interaction: <0.001). Among patients with CVD, a cancer diagnosis was associated with a lower use of blood pressure-lowering medications {AME: -1.46% [95% confidence interval (CI): -2.19% to -0.73%]}, lipid-lowering medications [AME: -2.34% (95% CI: -4.03% to -0.66%)], and aspirin [AME: -6.05% (95% CI: -8.88% to -3.23%)]. Among patients without CVD, there were no statistically significant differences between patients with and without cancer regarding pharmacological therapies. Additionally, cancer was associated with a significantly lower likelihood of engaging in physical activity in the overall cohort and in using post-CVD rehabilitation regimens, particularly post-stroke rehabilitation. CONCLUSION Preventive pharmacological agents are underutilized in those with cancer and concomitant CVD, and physical activity is underutilized in patients with cancer in those with or without CVD. LAY SUMMARY •This paper compared the use of preventive cardiovascular measures, both pharmaceutical and non-pharmaceutical, in patients with and without cancer.•In patients with cardiovascular disease and cancer, there is a lower use of preventive cardiovascular medications compared with those with cardiovascular disease but without cancer. This includes a lower utilization of blood pressure-lowering medications, cholesterol-lowering medications, and aspirin.•Patients with cancer reported lower levels of exercise but higher levels of smoking cessation compared with those without cancer.
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Affiliation(s)
- Ahmed Sayed
- Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Malak Munir
- Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Daniel Addison
- Cardio-Oncology Program, Division of Cardiology, Ohio State University, Columbus, OH, USA
| | - Abdelrahman I Abushouk
- Department of Cardiovascular Medicine, Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Susan F Dent
- Duke Cancer Institute, Department of Medicine, Duke University, Durham, NC, USA
| | - Tomas G Neilan
- Cardio-Oncology Program, Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Anne Blaes
- Division of Hematology, Oncology and Transplantation, University of Minnesota, Minneapolis, MN, USA
| | - Michael G Fradley
- Cardio-Oncology Center of Excellence, Division of Cardiology, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Anju Nohria
- Cardio-Oncology Program, Division of Cardiology, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | - Khaled Moustafa
- Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Salim S Virani
- Department of Medicine, Aga Khan University, Stadium Road, Karachi 74800, Pakistan
- Texas Heart Institute and Baylor College of Medicine, Houston, TX, 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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Jung MH, Lee SY, Youn JC, Chung WB, Ihm SH, Kang D, Kyoung DS, Jung HO, Chang K, Youn HJ, Lee H, Kang D, Cho J, Kaneko H, Kim HC. Antihypertensive Medication Adherence and Cardiovascular Outcomes in Patients With Cancer: A Nationwide Population-Based Cohort Study. J Am Heart Assoc 2023:e029362. [PMID: 37421285 PMCID: PMC10382088 DOI: 10.1161/jaha.123.029362] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 06/06/2023] [Indexed: 07/10/2023]
Abstract
Background Hypertension is an important cause of morbidity, which predisposes patients to major cardiovascular events and mortality. The aim of this study was to explore the association between adherence to antihypertensive medication and clinical outcomes in adult patients with cancer. Methods and Results Using the 2002 to 2013 Korean National Health Insurance Service-National Sample Cohort, we extracted adult patients with cancer treated with antihypertensive medications. Based on the medication possession ratio value, participants were divided into 3 groups: good (medication possession ratio ≥0.8), moderate (0.5≤ medication possession ratio <0.8), and poor (medication possession ratio <0.5) adherence groups. The primary outcomes were overall and cardiovascular mortality. The secondary outcome was cardiovascular events requiring hospitalization due to major cardiovascular diseases. Among 19 246 patients with cancer with concomitant hypertension, 66.4% were in the nonadherence group (26.3% were moderate and 40.0% were poor adherence group). Over a median of 8.4 years of follow-up, 2752 deaths and 6057 cardiovascular events occurred. Compared with the good adherence group, the moderate and poor adherence groups had a 1.85-fold and 2.19-fold increased risk for overall mortality, and 1.72-fold and 1.71-fold elevated risk for cardiovascular mortality, respectively, after adjustment for possible confounders. Furthermore, the moderate and poor adherence groups had a 1.33-fold and 1.34-fold elevated risk of new-onset cardiovascular events, respectively. These trends were consistent across cardiovascular event subtypes. Conclusions Nonadherence to antihypertensive medication was common in patients with cancer and was associated with worse clinical outcomes in adult patients with cancer with hypertension. More attention should be paid to improving adherence to antihypertensive medication among patients with cancer.
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Affiliation(s)
- Mi-Hyang Jung
- Division of Cardiology, Department of Internal Medicine Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea Seoul Republic of Korea
- Catholic Research Institute for Intractable Cardiovascular Disease, College of Medicine The Catholic University of Korea Seoul Republic of Korea
| | - So-Young Lee
- Division of Cardiology, Department of Internal Medicine Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea Seoul Republic of Korea
- Catholic Research Institute for Intractable Cardiovascular Disease, College of Medicine The Catholic University of Korea Seoul Republic of Korea
| | - Jong-Chan Youn
- Division of Cardiology, Department of Internal Medicine Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea Seoul Republic of Korea
- Catholic Research Institute for Intractable Cardiovascular Disease, College of Medicine The Catholic University of Korea Seoul Republic of Korea
| | - Woo-Baek Chung
- Division of Cardiology, Department of Internal Medicine Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea Seoul Republic of Korea
- Catholic Research Institute for Intractable Cardiovascular Disease, College of Medicine The Catholic University of Korea Seoul Republic of Korea
| | - Sang-Hyun Ihm
- Catholic Research Institute for Intractable Cardiovascular Disease, College of Medicine The Catholic University of Korea Seoul Republic of Korea
- Division of Cardiology, Department of Internal Medicine Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea Bucheon-si Republic of Korea
| | - Dongwoo Kang
- Data Science Team, Hanmi Pharmaceutical Co., Ltd Seoul Republic of Korea
| | - Dae-Sung Kyoung
- Data Science Team, Hanmi Pharmaceutical Co., Ltd Seoul Republic of Korea
| | - Hae Ok Jung
- Division of Cardiology, Department of Internal Medicine Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea Seoul Republic of Korea
- Catholic Research Institute for Intractable Cardiovascular Disease, College of Medicine The Catholic University of Korea Seoul Republic of Korea
| | - Kiyuk Chang
- Division of Cardiology, Department of Internal Medicine Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea Seoul Republic of Korea
- Catholic Research Institute for Intractable Cardiovascular Disease, College of Medicine The Catholic University of Korea Seoul Republic of Korea
| | - Ho-Joong Youn
- Division of Cardiology, Department of Internal Medicine Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea Seoul Republic of Korea
- Catholic Research Institute for Intractable Cardiovascular Disease, College of Medicine The Catholic University of Korea Seoul Republic of Korea
| | - Hokyou Lee
- Department of Preventive Medicine Yonsei University College of Medicine Seoul Republic of Korea
- Cardiovascular and Metabolic Disease Etiology Research Center Yonsei University College of Medicine Seoul Republic of Korea
| | - Danbee Kang
- Center for Clinical Epidemiology, Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Republic of Korea
- Department of Clinical Research Design and Evaluation SAIHST, Sungkyunkwan University Seoul Republic of Korea
| | - Juhee Cho
- Center for Clinical Epidemiology, Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Republic of Korea
- Department of Clinical Research Design and Evaluation SAIHST, Sungkyunkwan University Seoul Republic of Korea
| | - Hidehiro Kaneko
- Department of Cardiovascular Medicine Graduate School of Medicine The University of Tokyo Tokyo Japan
- Department of Advanced Cardiology Graduate School of Medicine The University of Tokyo Tokyo Japan
| | - Hyeon Chang Kim
- Department of Preventive Medicine Yonsei University College of Medicine Seoul Republic of Korea
- Cardiovascular and Metabolic Disease Etiology Research Center Yonsei University College of Medicine Seoul Republic of Korea
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Hershman DL, Chen BE, Sathe C, Parulekar WR, Lemieux J, Ligibel JA, Gelmon KA, Whelan TJ, Goodwin PJ. Metformin, placebo, and endocrine therapy discontinuation among participants in a randomized double-blind trial of metformin vs placebo in hormone receptor-positive early-stage breast cancer (CCTG MA32). Breast Cancer Res Treat 2023; 200:93-102. [PMID: 37157006 DOI: 10.1007/s10549-023-06922-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 03/18/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND The MA32 study investigated whether 5 years of metformin (versus placebo) improves invasive disease-free survival in early-stage breast cancer (BC). Non-adherence to endocrine therapy (ET) and medications for chronic conditions is common and increases with drug toxicity and polypharmacy. This secondary analysis evaluates rates and predictors of early discontinuation of metformin, placebo, and ET among participants with HR-positive BC. METHODS Patients with high-risk non-metastatic BC were randomized to 60 months of metformin (850 mg BID) or placebo BID. Patients were administered bottles of metformin/placebo every 180 days. Metformin/placebo adherence was defined as a bottle dispensed at month 48 or later. The ET adherence analysis included patients with HR-positive BC who received ET with start and stop date reported, with adherence defined as > 48 months of use. Associations of covariates with study drug and ET adherence were examined using multivariable models. RESULTS Among the 2521 HR-positive BC patients, 32.9% were non-adherent to study drug. Non-adherence was higher among patients on metformin vs placebo (37.1% vs 28.7%, p < 0.001). Reassuringly, ET discontinuation rates were similar between treatment arms (28.4% vs 28.0%, p = 0.86). Patients who were non-adherent to ET were more likely to discontinue study therapy (38.8% vs 30.1%, p < 0.0001). In a multivariable analysis, study drug non-adherence was increased with metformin vs placebo (OR: 1.50, 95% CI 1.25-1.80; p < 0.0001); non-adherence to ET (OR: 1.47, 95% CI 1.20-1.79, p < 0.0001); grade 1 or greater GI toxicity during the first 2 years; lower age; and higher body mass index. CONCLUSION While non-adherence was higher among patients on metformin, it was still considerable among patients on placebo. Reassuringly, treatment arm allocation did not impact ET adherence. Attention to global medication adherence is needed to improve BC and non-oncological outcomes in cancer survivors. TRIAL REGISTRATION ClinicalTrials.gov: NCT01.
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Affiliation(s)
- Dawn L Hershman
- Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY, USA.
| | - Bingshu E Chen
- Canadian Cancer Trials Group, Queen's University, Kingston, ON, Canada
| | - Claire Sathe
- Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY, USA
| | - Wendy R Parulekar
- Canadian Cancer Trials Group, Queen's University, Kingston, ON, Canada
| | | | | | - Karen A Gelmon
- BC Cancer Agency, University of British Columbia, Vancouver, BC, Canada
| | - Timothy J Whelan
- Juravinski Cancer Centre, McMaster University, Hamilton, ON, Canada
| | - Pamela J Goodwin
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
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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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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: 57] [Impact Index Per Article: 19.0] [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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10
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Cho IY, Han K, Shin DW, Park SH, Yoon DW, Shin S, Jeong SM, Cho JH. Cardiovascular risk and undertreatment of dyslipidemia in lung cancer survivors: A nationwide population-based study. Curr Probl Cancer 2020; 45:100615. [PMID: 32636025 DOI: 10.1016/j.currproblcancer.2020.100615] [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: 04/15/2020] [Revised: 06/01/2020] [Accepted: 06/10/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND In lung cancer survivors, cardiovascular diseases (CVDs) are the leading cause of noncancer deaths. Nonetheless, there is lack of information on management of dyslipidemia, a major risk factor for future CVD events, in lung cancer survivors. This study aimed to assess dyslipidemia management and prevalence of statin eligibility in lung cancer survivors. METHODS From the Korean National Health Insurance Service database, we selected 7349 lung cancer survivors who received surgery for lung cancer from 2007 to 2014. We used descriptive statistics for analyses of dyslipidemia management status on the basis of the National Cholesterol Education Program Adult Treatment Panel III guidelines. We also identified those who met the criteria for treatment on the basis of CVD risk according to the 2018 American College of Cardiology and American Heart Association (ACC/AHA) guidelines. RESULTS The overall awareness and treatment rates for lung cancer survivors with dyslipidemia were 31.8% and 29.7%, respectively. The overall control rate for those receiving treatment was 88.7%, but was lowest in the highest risk group (78.1%). Furthermore, undertreatment of dyslipidemia was more prominent in young, male lung cancer survivors and those diagnosed with lung cancer within 3 years. Among those not receiving treatment for dyslipidemia, 61.7% were indicated for statin according to the ACC/AHA guidelines. CONCLUSION Over half of lung cancer survivors were not receiving treatment, although they were eligible for statin under current guidelines. To reduce noncancer mortality, statin use and adequate management of CVD risk factors should be encouraged in lung cancer survivors.
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Affiliation(s)
- In Young Cho
- Department of Family Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kyungdo Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Republic of Korea
| | - Dong Wook Shin
- Department of Family Medicine & Supportive Care Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Department of Digital Health, Samsung Advanced Institute of Health Science and Technology (SAIHST), Sungkyunkwan University, Seoul, Republic of Korea.
| | - Sang Hyun Park
- Department of Biostatistics, The Catholic University of Korea, Seoul, Republic of Korea
| | - Dong Woog Yoon
- Department of Thoracic and Cardiovascular Surgery, Armed Forces Capital Hospital, Seongnam, Republic of Korea
| | - Sujeong Shin
- Department of Family Medicine & Supportive Care Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Su-Min Jeong
- Department of Family Medicine, Boramae Medical Center, Seoul, Republic of Korea
| | - Jong Ho Cho
- Department of Thoracic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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11
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Heo J, Chun M, Oh YT, Noh OK, Kim L. Metabolic comorbidities and medical institution utilization among breast cancer survivors: a national population-based study. Korean J Intern Med 2020; 35:421-428. [PMID: 31480826 PMCID: PMC7061003 DOI: 10.3904/kjim.2018.172] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 09/06/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND/AIMS We investigated metabolic comorbidity status and patterns of medical institution utilization among breast cancer survivors using medical claims data from the Health Insurance Review and Assessment Service (HIRA). METHODS Using claims data obtained from the HIRA, we selected breast cancer survivors between 2010 and 2015. Descriptive statistics were calculated to determine the frequency of metabolic comorbidities, as well as to analyze patterns of medical institution utilization in accordance with disease status. RESULTS A total of 89,953 breast cancer survivors were identified. Among these, 12,364 (13.7%) had hypercholesterolemia, 20,754 (23.1%) had hypertension (HTN), and 11,102 (12.3%) had diabetes mellitus (DM). In particular, more than half of breast cancer survivors older than 60 years had HTN, and other diseases sharply increased beginning at age 50 years. For HTN, a total of 531,292 claims were submitted; more than 80% (n = 473,737) were from primary medical institutions, whereas only 2.4% (n = 12,551) were from tertiary medical institutions. The number of claims submitted for DM was 231,526; those from primary medical institutions accounted for 68.5% (n = 158,566), whereas claims from tertiary medical institutions accounted for 12.0% (n = 27,693). In subgroup analyses, the utilization of secondary and tertiary medical institutions was higher among patients with severe diseases and those diagnosed following their breast cancer diagnosis. CONCLUSION More than 10% of breast cancer survivors were diagnosed with a metabolic comorbidity. Through analysis of medical institution utilization patterns, we ascertained that a communication system linking secondary and tertiary medical institutions with primary medical institutions is needed.
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Affiliation(s)
- Jaesung Heo
- Department of Radiation Oncology, Ajou University School of Medicine, Suwon, Korea
| | - Mison Chun
- Department of Radiation Oncology, Ajou University School of Medicine, Suwon, Korea
- Correspondence to Mison Chun, M.D. Department of Radiation Oncology, Ajou University School of Medicine, 206 World cup-ro, Yeongtong-gu, Suwon 16499, Korea Tel: +82-31-219-5338 Fax: +82-31-219-5894 E-mail:
| | - Young-Taek Oh
- Department of Radiation Oncology, Ajou University School of Medicine, Suwon, Korea
| | - O Kyu Noh
- Department of Radiation Oncology, Ajou University School of Medicine, Suwon, Korea
- Office of Biostatistics, Ajou University School of Medicine, Suwon, Korea
| | - Logyoung Kim
- Health Insurance Review and Assessment Service, Seoul, Korea
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12
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Effects of smoking habit change on hospitalized fractures: a retrospective cohort study in a male population. Arch Osteoporos 2020; 15:29. [PMID: 32108269 DOI: 10.1007/s11657-020-0686-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Accepted: 01/31/2020] [Indexed: 02/03/2023]
Abstract
UNLABELLED We examined effects of smoking habit change on fracture risk in men. Long-term quitters and never smokers showed decreased risk for overall fractures, lumbar fractures, and other site fractures. Short-term quitters did not show decreased risk. Longer time since smoking cessation may lead to decreased fracture risk in men. PURPOSE Cigarette smoking is a well-known modifiable risk factor of osteoporosis and fractures. This study investigated the effects of change in smoking habits on risks of all types of fractures in men using a nationwide health claims database. METHODS Retrospective study was performed using the Korean National Health Insurance Service-National Sample Cohort Data. Cox proportional hazards regression analyses were performed to estimate risks of all types of hospitalized fractures, hip fractures, lumbar fractures, and other site fractures (all other fractures excluding the lumbar and hip areas). RESULTS Compared to continued smokers, long-term quitters and never smokers showed decreased risk for all types of fractures (adjusted hazard ratio (aHR) 0.83, 95% confidence interval (CI) 0.78-0.88 and aHR 0.84, 95% CI 0.80-0.89, respectively). According to skeletal site, long-term quitters and never smokers showed decreased risk for lumbar fractures (aHR 0.82, 95% CI 0.68-0.98 and aHR 0.85, 95% CI 0.73-0.99, respectively) and other site fractures (aHR 0.83, 95% CI 0.78-0.89 and aHR 0.85, 95% CI 0.81-0.90, respectively). Hip fractures were decreased in never smokers (aHR 0.77, 95% CI 0.62-0.94). Short-term quitters did not show decreased risk for fractures. CONCLUSIONS Longer time since smoking cessation in men may lead to decreased risk for fractures, especially lumbar and other site fractures. Physicians should counsel patients at risk for fractures both to quit smoking and to maintain abstinence from smoking. Further studies may be required to help comprehend how smoking cessation can affect fracture risk.
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13
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Shin S, Wook Shin D, Young Cho I, Jeong SM, Jung H. Status of dyslipidemia management and statin undertreatment in Korean cancer survivors: A Korean National Health and Nutrition Examination Survey study. Eur J Prev Cardiol 2020; 28:864-872. [PMID: 34298552 DOI: 10.1177/2047487320905722] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 01/21/2020] [Indexed: 01/06/2023]
Abstract
AIMS Due to improving cancer treatment results, non-cancer mortality is an important issue for cancer survivors. Cardiovascular diseases are the leading causes of death in Korea and globally. In addition to lowering the risk of cardiovascular disease, the use of statins has led to an overall reduction in cancer mortality in recent observational studies. We investigated the status of current dyslipidemia management in cancer survivors with reference to 2018 guidelines. METHODS The study is a cross-sectional analysis of 1460 cancer survivors aged from 40 to 75 years who participated in the Korean National Health and Nutrition Examination Survey from 2007 to 2016. Dyslipidemia management status among cancer survivors was assessed according to 2018 American College of Cardiology/American Heart Association guidelines and Korean Coronary Heart Disease Risk Score guidelines. RESULTS The rate of treatment for dyslipidemia was 8.5% for males, 13.8% for females, and 11.9% overall. Among cancer survivors who were not receiving treatment for dyslipidemia, 59.6% of males, 34.2% of females and 43.9% of total cancer survivors would have been eligible for statin therapy under the 2018 American College of Cardiology/American Heart Association guidelines and Korean Coronary Heart Disease Risk Score guidelines. The rate of undertreatment of dyslipidemia increased with age and length of time since cancer diagnosis. CONCLUSION Nearly 50% of cancer survivors remain untreated although they are eligible for statin therapy. This emphasizes the need for more attention to prevent atherosclerotic cardiovascular disease among cancer survivors.
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Affiliation(s)
- Sujeong Shin
- Department of Family Medicine and Supportive Care Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Republic of Korea
| | - Dong Wook Shin
- Department of Family Medicine and Supportive Care Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Republic of Korea.,Department of Digital Health, Samsung Advanced Institute of Health Science and Technology (SAIHST), Sungkyunkwan University, Republic of Korea
| | - In Young Cho
- Department of Family Medicine and Supportive Care Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Republic of Korea
| | - Su-Min Jeong
- Department of Family Medicine, Seoul National University Health Service Center, Republic of Korea
| | - Hyein Jung
- Endocrinology, Department of Internal Medicine, Yonsei University College of Medicine, Korea
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Kim SJ, Kwon OD, Han EB, Lee CM, Oh SW, Joh HK, Oh B, Kwon H, Cho B, Choi HC. Impact of number of medications and age on adherence to antihypertensive medications: A nationwide population-based study. Medicine (Baltimore) 2019; 98:e17825. [PMID: 31804305 PMCID: PMC6919523 DOI: 10.1097/md.0000000000017825] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
This study tried to investigate the effects of number of medications and age on antihypertensive medication adherence in a real-world setting using a nationwide representative cohort.We obtained data from the National Health Insurance Service-National Sample Cohort (NHIS-NSC) of Korea, which is a sample of 2.2% (N = 1,048,061) of total population (N = 46,605,433). Patients aged 20 years or older (N = 150,550) who took antihypertensive medications for at least 1 year were selected. Medication possession ratio (MPR) was used for measuring adherence. The subjects were divided into 5 subgroups according to total number of medications: 1-2, 3-4, 5-6, 7-8, and 9 or more. The mean age and the mean number of medications were 60.3 ± 12.6 years and 4.1 ± 2.2, respectively. The mean MPR was 80.4 ± 23.9%, and 66.9% (N = 100,645) of total subjects were adherent (MPR ≥ 80%). The overall tendency of antihypertensive medication adherence according to the total number of medications displayed an inverted U-shape with a peak at 3-4 drugs. Adherence consistently increased as the age increased until age 69 and started to decrease from age 70. The proportion of adherent patients (MPR ≥ 80%) according to the total number of medications also showed an inverted U-shape with a peak at 3-4 drugs. When the same number of drugs was taken, the proportion of adherent patients according to age featured an inverted U- shape with a peak at 60 to 69 years. Patients taking 9 or more total drugs had the overall odds ratio (95% CI) of non-adherence (MPR < 80%) with 1.17 (1.11-1.24) compared with those taking 1 to 8 total drugs and the odds ratios in the age subgroups of 40 to 49, 50 to 59, 60 to 69 years were 1.57 (1.31-1.87), 1.21 (1.08-1.36), and 1.14 (1.04-1.25), respectively (P < .05).Association between age, total number of medications, and antihypertensive adherence displayed an inverted U-shape with a peak at 3 to 4 total medications and at age 60 to 69 years. When the total number of drugs was 9 or more, adherence decreased prominently, regardless of age.
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Affiliation(s)
- Seung Jae Kim
- Department of Family Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul
| | - Oh Deog Kwon
- Navy Medical Office, ROK Submarine Force Command, Changwon
| | | | - Cheol Min Lee
- Department of Family Medicine, Healthcare System Gangnam Center, Seoul National University Hospital
| | - Seung-Won Oh
- Department of Family Medicine, Healthcare System Gangnam Center, Seoul National University Hospital
| | - Hee-Kyung Joh
- Department of Family Medicine, Seoul National University Health Service Center
| | - Bumjo Oh
- Department of Family Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Hyuktae Kwon
- Department of Family Medicine, Seoul National University Hospital
| | - BeLong Cho
- Department of Family Medicine, Seoul National University Hospital
| | - Ho Chun Choi
- Department of Family Medicine, Healthcare System Gangnam Center, Seoul National University Hospital
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15
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Kang J, Park EJ, Lee J. Cancer Survivorship in Primary Care. Korean J Fam Med 2019; 40:353-361. [PMID: 31779063 PMCID: PMC6887764 DOI: 10.4082/kjfm.19.0108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 10/25/2019] [Accepted: 10/30/2019] [Indexed: 12/11/2022] Open
Abstract
With the early detection of cancer and improvement in cancer therapy, the number of cancer survivors is rapidly increasing. This number is expected to reach 2 million by the end of 2019. Cancer survivors struggle with not only cancer-related health problems but also diverse acute and chronic diseases. These health issues make cancer survivorship more complex, and proper care coordination is necessary. This study aimed to summarize the definition of cancer experience and management of cancer survivors, specifically focused on gastric, colorectal, lung, breast, thyroid, prostate, and cervical cancers. Furthermore, it aimed to discuss the role of primary care in cancer survivorship and survivorship care models and the National Policy for Cancer Survivors and Future Challenges.
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Affiliation(s)
- Jihun Kang
- Department of Family Medicine, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, Korea
| | - Eun Ju Park
- Department of Family Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Jungkwon Lee
- Department of Family Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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16
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Banegas MP, Emerson MA, Adams AS, Achacoso NS, Chawla N, Alexeeff S, Habel LA. Patterns of medication adherence in a multi-ethnic cohort of prevalent statin users diagnosed with breast, prostate, or colorectal cancer. J Cancer Surviv 2018; 12:794-802. [PMID: 30338462 DOI: 10.1007/s11764-018-0716-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Accepted: 09/11/2018] [Indexed: 01/16/2023]
Abstract
PURPOSE To investigate the implications of a cancer diagnosis on medication adherence for pre-existing comorbid conditions, we explored statin adherence patterns prior to and following a new diagnosis of breast, colorectal, or prostate cancer among a multi-ethnic cohort. METHODS We identified adults enrolled at Kaiser Permanente Northern California who were prevalent statin medication users, newly diagnosed with breast, colorectal, or prostate cancer between 2000 and 2012. Statin adherence was measured using the proportion of days covered (PDC) during the 2-year pre-cancer diagnosis and the 2-year post-cancer diagnosis. Adherence patterns were assessed using generalized estimating equations, for all cancers combined and stratified by cancer type and race/ethnicity, adjusted for demographic, clinical, and tumor characteristics. RESULTS Among 10,177 cancer patients, statin adherence decreased from pre- to post-cancer diagnosis (adjusted odds ratio (ORadj):0.91, 95% confidence interval (95% CI):0.88-0.94). Statin adherence decreased from pre- to post-cancer diagnosis among breast (ORadj:0.94, 95% CI:0.90-0.99) and colorectal (ORadj:0.79, 95% CI:0.74-0.85) cancer patients. No difference in adherence was observed among prostate cancer patients (ORadj:1.01, 95% CI:0.97-1.05). Prior to cancer diagnosis, adherence to statins was generally higher among non-Hispanic whites and multi-race patients than other groups. However, statin adherence after diagnosis decreased only among these two populations (ORadj:0.85, 95% CI:0.85-0.92 and ORadj:0.86, 95% CI:0.76-0.97), respectively. CONCLUSIONS We found substantial variation in statin medication adherence following diagnosis by cancer type and race/ethnicity among a large cohort of prevalent statin users in an integrated health care setting. IMPLICATIONS FOR CANCER SURVIVORS Improving our understanding of comorbidity management and polypharmacy across diverse cancer patient populations is warranted to develop tailored interventions that improve medication adherence and reduce disparities in health outcomes.
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Affiliation(s)
- Matthew P Banegas
- Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate Ave, Portland, OR, 97227-1110, USA.
| | - Marc A Emerson
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Alyce S Adams
- Division of Research, Kaiser Permanente, Oakland, CA, USA
| | | | - Neetu Chawla
- Division of Research, Kaiser Permanente, Oakland, CA, USA
| | | | - Laurel A Habel
- Division of Research, Kaiser Permanente, Oakland, CA, USA
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17
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Cho MH, Shin DW, Chang SA, Lee JE, Jeong SM, Kim SH, Yun JM, Son K. Association between cognitive impairment and poor antihypertensive medication adherence in elderly hypertensive patients without dementia. Sci Rep 2018; 8:11688. [PMID: 30076332 PMCID: PMC6076290 DOI: 10.1038/s41598-018-29974-7] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 07/12/2018] [Indexed: 01/19/2023] Open
Abstract
Adherence to antihypertensive medication is a critical factor to control blood pressure and prevent complications. However, cognitive impairment can negatively affect medication adherence. In this study, we investigated the association between cognitive function and antihypertensive medication adherence among elderly hypertensive patients using the Korean National Health Insurance Service National Sample Cohort Data of the Elderly Cohort. The study included 20,071 elderly hypertensive patients and the prevalence of poor medication adherence to antihypertensive medications was 16.4%. A multivariate logistic regression analysis showed that lower cognitive function was associated with poor medication adherence (adjusted odds ratio 0.980, 95% confidence interval 0.961–0.999). Additionally, high income levels, living in metropolitan areas, and comorbidities (such as stroke, coronary heart disease, diabetes, and dyslipidemia) were positively associated with medication adherence, while patients diagnosed with cancers showed poor medication adherence. Our study demonstrated that cognitive impairment is a possible risk factor for poor antihypertensive medication adherence, even in patients without dementia. Thus, clinicians involved with geriatric care should monitor patients’ cognitive function and medication adherence. And if a patient shows cognitive impairment, clinicians need to educate patients and caregivers about the importance of proper adherence, and consider proper interventions to optimize the cognitive function of elderly patients.
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Affiliation(s)
- Mi Hee Cho
- Department of Family Medicine, Seoul National University Health Service Center, 1, Gwanak-ro, Gwanak-gu, Seoul, 08826, Republic of Korea
| | - Dong Wook Shin
- Department of Family Medicine/Supportive Care Center, Samsung Medical Center, 81, Irwon-Ro, Gangnam-gu, Seoul, 06351, Republic of Korea.
| | - Sung-A Chang
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81, Irwon-Ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Ji Eun Lee
- Department of Family Medicine, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Su-Min Jeong
- Department of Family Medicine, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Sang Hyuck Kim
- Department of Family Medicine, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Jae Moon Yun
- Department of Family Medicine, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Kiyoung Son
- Department of Family Medicine, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
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18
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Cho MH, Lee K, Park SM, Chang J, Choi S, Kim K, Koo HY, Jun JH, Kim SM. Effects of smoking habit change on all-cause mortality and cardiovascular diseases among patients with newly diagnosed diabetes in Korea. Sci Rep 2018; 8:5316. [PMID: 29593229 PMCID: PMC5871763 DOI: 10.1038/s41598-018-23729-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 03/19/2018] [Indexed: 01/15/2023] Open
Abstract
This study aimed to investigate the effects of smoking habit change on the risks of all-cause mortality and cardiovascular diseases (CVDs) among patients with newly diagnosed diabetes using the Korean National Sample Cohort data. Survival regression analyses for the risks of all-cause mortality and CVDs were performed. Quitters without body mass index (BMI) change (adjusted hazard ratio [aHR], 0.68; 95% confidence interval [CI], 0.46-1.00) and quitters with BMI loss (aHR, 1.76; 95% CI, 1.13-2.73) showed significantly reduced and substantially the increased risk of all-cause mortality, respectively, compared with sustained smokers. Smoking reduction after diabetes diagnosis may have potential positive effects. However, definite benefits on the health outcomes were not identified in this study. Participants who started smoking after diabetes diagnosis had higher risks of all-cause mortality and CVDs than those who were never smokers or ex-smokers, although not statistically significant. In conclusion, smoking cessation after diabetes diagnosis could reduce the risks of all-cause mortality and cardiovascular events among patients with newly diagnosed diabetes when accompanied by proper weight management. Therefore, physicians should advice patients with newly diagnosed type 2 diabetes on the importance of smoking cessation in combination with long-term weight management to maximize the benefits of smoking cessation.
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Affiliation(s)
- Mi Hee Cho
- Department of Family Medicine, Seoul National University Hospital, Seoul, 03080, Republic of Korea
| | - Kiheon Lee
- Department of Family Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea.
- Department of Family Medicine, College of Medicine, Seoul National University, Seoul, 03080, Republic of Korea.
| | - Sang Min Park
- Department of Family Medicine, Seoul National University Hospital, Seoul, 03080, Republic of Korea
- Department of Biomedical Sciences, Seoul National University Graduate School, Seoul, 03080, Republic of Korea
| | - Jooyoung Chang
- Department of Biomedical Sciences, Seoul National University Graduate School, Seoul, 03080, Republic of Korea
| | - Seulggie Choi
- Department of Biomedical Sciences, Seoul National University Graduate School, Seoul, 03080, Republic of Korea
| | - Kyuwoong Kim
- Department of Biomedical Sciences, Seoul National University Graduate School, Seoul, 03080, Republic of Korea
| | - Hye-Yeon Koo
- Department of Family Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea
| | - Ji-Hye Jun
- Department of Family Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea
| | - Sung Min Kim
- Department of Biomedical Sciences, Seoul National University Graduate School, Seoul, 03080, Republic of Korea
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19
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Kim JA, Yoon S, Kim LY, Kim DS. Towards Actualizing the Value Potential of Korea Health Insurance Review and Assessment (HIRA) Data as a Resource for Health Research: Strengths, Limitations, Applications, and Strategies for Optimal Use of HIRA Data. J Korean Med Sci 2017; 32:718-728. [PMID: 28378543 PMCID: PMC5383602 DOI: 10.3346/jkms.2017.32.5.718] [Citation(s) in RCA: 447] [Impact Index Per Article: 63.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Accepted: 01/28/2017] [Indexed: 11/20/2022] Open
Abstract
Health Insurance and Review Assessment (HIRA) in South Korea, also called National Health Insurance (NHI) data, is a repository of claims data collected in the process of reimbursing healthcare providers. Under the universal coverage system, having fee-for-services covering all citizens in South Korea, HIRA contains comprehensive and rich information pertaining to healthcare services such as treatments, pharmaceuticals, procedures, and diagnoses for almost 50 million beneficiaries. This corpus of HIRA data, which constitutes a large repository of data in the healthcare sector, has enormous potential to create value in several ways: enhancing the efficiency of the healthcare delivery system without compromising quality of care; adding supporting evidence for a given intervention; and providing the information needed to prevent (or monitor) adverse events. In order to actualize this potential, HIRA data need to actively be utilized for research. Thus understanding this data would greatly enhance this potential. We introduce HIRA data as an important source for health research and provide guidelines for researchers who are currently utilizing HIRA, or interested in doing so, to answer their research questions. We present the characteristics and structure of HIRA data. We discuss strengths and limitations that should be considered in conducting research with HIRA data and suggest strategies for optimal utilization of HIRA data by reviewing published research using HIRA data.
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Affiliation(s)
- Jee Ae Kim
- Pharmaceutical Policy Research Team, Health Insurance Review & Assessment Service, Wonju, Korea
| | - Seokjun Yoon
- Department of Preventive Medicine, College of Medicine, Korea University, Seoul, Korea
| | - Log Young Kim
- Pharmaceutical Policy Research Team, Health Insurance Review & Assessment Service, Wonju, Korea
| | - Dong Sook Kim
- Pharmaceutical Policy Research Team, Health Insurance Review & Assessment Service, Wonju, Korea.
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20
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Cho MH, Shin DW, Yun JM, Shin JH, Lee SP, Lee H, Lim YK, Kim EH, Kim HK. Prevalence and Predictors of Early Discontinuation of Dual-Antiplatelet Therapy After Drug-Eluting Stent Implantation in Korean Population. Am J Cardiol 2016; 118:1448-1454. [PMID: 27645764 DOI: 10.1016/j.amjcard.2016.07.073] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 07/28/2016] [Accepted: 07/28/2016] [Indexed: 11/15/2022]
Abstract
The administration of antiplatelet drugs for months after a drug-eluting stent implantation is critical in decreasing the risk of complications, and premature discontinuation of antiplatelet therapy before the recommended period is the most important predictor for late complications. Therefore, we investigated the prevalence and associated factors of premature discontinuation of antiplatelet therapy in patients in Korea. This retrospective cohort study was conducted using the Korean National Health Insurance Service-National Sample Cohort data. Patients who were treated with dual-antiplatelet therapy (DAPT) were identified with medication prescription data. The Kaplan-Meier failure time plot was used to illustrate the cumulative probability of treatment discontinuation. Cox regression analysis was conducted to compare predictors of early discontinuation of DAPT. The characteristics of the early discontinuation group were not significantly different from the guideline concordance group, except for a higher prevalence of disability and a lower rate of chronic kidney disease. In a Cox regression model, the presence of hypertension was identified as a negative predictor of early discontinuation, and disability was not a statistically significant predictor. The prevalence of early discontinuation was 31.0% and seems to be significantly higher than those reported from prospective studies, which may more accurately reflect the real-world situation. In conclusion, physicians should make more effort to educate patients on the risk associated with premature discontinuation of antiplatelet therapy after percutaneous coronary intervention with drug-eluting stent, and further studies investigating the reasons for nonadherence of DAPT are needed to improve DAPT compliance.
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Affiliation(s)
- Mi Hee Cho
- Department of Family Medicine and Health Promotion Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Dong Wook Shin
- Department of Family Medicine and Health Promotion Center, Seoul National University Hospital, Seoul, Republic of Korea.
| | - Jae Moon Yun
- Department of Family Medicine and Health Promotion Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Joong Hyun Shin
- Department of Family Medicine and Health Promotion Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Seung Pyo Lee
- Department of Cardiology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hyejin Lee
- Department of Family Medicine and Health Promotion Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Yoo Kyoung Lim
- Department of Family Medicine and Health Promotion Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Eun Ha Kim
- Department of Family Medicine and Health Promotion Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hyun Kyoung Kim
- Department of Family Medicine and Health Promotion Center, Seoul National University Hospital, Seoul, Republic of Korea
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21
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Bidwal M, Lor K, Yu J, Ip E. Evaluation of asthma medication adherence rates and strategies to improve adherence in the underserved population at a Federally Qualified Health Center. Res Social Adm Pharm 2016; 13:759-766. [PMID: 27595427 DOI: 10.1016/j.sapharm.2016.07.007] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 06/29/2016] [Accepted: 07/07/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Adherence with asthma medications is less than optimal, measuring approximately 30-50%. Several factors have been shown to contribute to medication non-adherence including low-socioeconomic status, low literacy, medication cost, access to care, and language barriers. Community Health Clinic Ole has attempted to reduce medication adherence barriers associated with cost, access to care, and language by 1) allowing medications to be obtained from the clinic at a reduced cost via the 340B drug pricing program and patient assistance programs, and 2) providing one-on-one consultations from bilingual Spanish-speaking clinicians. Limited evidence is available regarding chronic disease-state medication adherence among Spanish-speaking individuals presenting to a Federally Qualified Health Center (FQHC). OBJECTIVE The purpose of this study is to assess asthma medication adherence and determine predictors of non-adherence in the underserved population at an FQHC. METHODS Adult patients with a diagnosis of persistent asthma receiving medication refills from clinic between October 1, 2011 and October 31, 2012 were identified (N = 121). Individuals with intermittent or seasonal asthma only, exercise-induced asthma only, or mixed asthma/COPD; individuals who have not picked up at least one fill of inhaled corticosteroid in the past one-year; and individuals without active prescriptions for asthma controller medications were excluded. Medication adherence was assessed by using the medication possession ratio (MPR) for asthma controller medications (e.g. inhaled corticosteroids, long-acting beta-2 agonists, leukotriene modifiers, and theophylline). Patients were categorized into two adherence groups: medium-high (MPR ≥ 0.5) and low (MPR < 0.5). RESULTS Approximately one-third of individuals were identified with medium-high adherence to asthma medications, of which only 8.3% of individuals were found to be fully adherent (MPR ≥ 0.8). The majority of individuals (66.1%) were identified with low adherence, despite efforts to reduce medication adherence barriers associated with drug cost, access to care, and language. Patients with low adherence were younger (39.3 vs. 45.4 yo; P < 0.012), had fewer medication refills (2.1 vs. 5.3; P < 0.001), had fewer primary care provider (PCP) visits (3.4 vs. 5.0; P < 0.05), lower baseline Asthma Control Test (ACT) scores (13.1 vs. 17.3; P < 0.001), and lower asthma medication ratios (AMR) (0.7 vs. 0.9; P < 0.001) than patients with medium-high adherence. No significant differences in MPR rates were found between Hispanics and non-Hispanics. The average MPR in both groups was 0.55. CONCLUSION Our findings demonstrate that asthma medication adherence remains poor among all underserved patients despite improved access to care via reduced medication pricing and the provision of Spanish-speaking medication consultations at refill pick-ups. Poor adherence rates remained common among both the Non-Hispanic and Hispanic, younger, and lower-socioeconomic patients in our study. Future studies may wish to explore whether providing a service that encompasses healthcare team support, optimal medication counseling, and utilization of patient-centered communication strategies improves asthma medication adherence in the Hispanic population.
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Affiliation(s)
- Monica Bidwal
- Touro University California College of Pharmacy, 1310 Club Dr., Vallejo, CA 94592, USA.
| | - Kajua Lor
- Touro University California College of Pharmacy, 1310 Club Dr., Vallejo, CA 94592, USA
| | - Junhua Yu
- Touro University California College of Pharmacy, 1310 Club Dr., Vallejo, CA 94592, USA
| | - Eric Ip
- Touro University California College of Pharmacy, 1310 Club Dr., Vallejo, CA 94592, USA
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Yang J, Neugut AI, Wright JD, Accordino M, Hershman DL. Nonadherence to Oral Medications for Chronic Conditions in Breast Cancer Survivors. J Oncol Pract 2016; 12:e800-9. [PMID: 27407167 DOI: 10.1200/jop.2016.011742] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Nonadherence to oral endocrine therapy is common among women with breast cancer (BC). Less is known about nonadherence to medications for other chronic conditions among survivors of BC. METHODS We used the MarketScan Database to identify women older than 18 years who had nonmetastatic BC diagnosed between January 1, 2009, and December 31, 2013. Prescriptions were identified for the following six non-cancer-related conditions: hypertension, thyroid disease, hyperlipidemia, gastroesophageal reflux disease, diabetes, and osteoporosis. The study period was defined as 1 year before BC diagnosis (index date) through 1.5 years after the index date, with a 6-month washout period after the index data to control for adherence during the preoperative period and during chemotherapy if necessary. Adherence was defined as a medication possession ratio ≥ 80%. Change in adherence was defined as a 20% decrease in the medication possession ratio from the time before diagnosis compared with after treatment. Factors associated with change in adherence were evaluated in multivariable logistic models. RESULTS Among 36,149 patients diagnosed with BC, the average adherence to these medications before BC was 91.4%. However, after BC treatment, adherence decreased to 77.9% (P < .001). Looking at drugs for each condition, nonadherence ranged from 15.6% to 38% (P < .001). Factors associated with an increase in nonadherence included older age, insurance type, number of medications, and comorbid conditions. CONCLUSION Decreased adherence to medications for chronic diseases was found in the first year after breast cancer treatment. Breast cancer survivors may need additional interventions to improve their adherence to their medications for chronic conditions.
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Ko SH, Kim DJ, Park JH, Park CY, Jung CH, Kwon HS, Park JY, Song KH, Han K, Lee KU, Ko KS. Trends of antidiabetic drug use in adult type 2 diabetes in Korea in 2002-2013: Nationwide population-based cohort study. Medicine (Baltimore) 2016; 95:e4018. [PMID: 27399082 PMCID: PMC5058811 DOI: 10.1097/md.0000000000004018] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Revised: 05/26/2016] [Accepted: 06/01/2016] [Indexed: 02/03/2023] Open
Abstract
This study investigated trends in the prescription of antidiabetic medications for patients with type 2 diabetes, focusing on changing patterns of prescriptions and the cost of drugs during the last 10 years. Retrospective data on patients with type 2 diabetes aged 30 years or older were analyzed using information from the National Health Information Database collected by the National Health Insurance Service in Korea from January 2002 to December 2013. We identified patients with type 2 diabetes who had at least one service claim in each year during the study period. The prescribing information was collected and fixed-dose combination tablets were counted as each of their constituent classes. The total number of adults with type 2 diabetes who were treated using antidiabetic agents increased from 0.87 million in 2002 to 2.72 million in 2013 in Korea. Among antidiabetic medications in 2002, sulfonylurea (SU) was the most commonly used agent (87.2%), and metformin was the second (52.9%). However, in 2013, the use of metformin increased to 80.4% of the total antidiabetic prescriptions. The use of dipeptidyl peptidase-4 (DPP-4) inhibitor increased remarkably after release in late 2008 and composed one-third of the market share with 1 million prescriptions (38.4%) in 2013. Among the prescriptions for monotherapy, only 13.0% were metformin in 2002, but the amount increased to 53.2% by 2013. In contrast, the use of SU declined dramatically from 75.2% in 2002 to 30.6% in 2013. Dual and triple combinations steadily increased from 35.0% and 6.6% in 2002 to 44.9% and 15.5% in 2013, respectively. In 2013, SU with metformin (41.7%) and metformin with DPP-4 inhibitor (32.5%) combination were most frequently prescribed. The total antidiabetic medication cost increased explosively from U.S. $70 million (82.5 billion won) in 2002 to U.S. $4 billion (480 billion won) in 2013.The use of antidiabetic agents and their costs have been increasing steadily. Metformin is the most commonly used drug recently. The use of DPP-4 inhibitor increased significantly over the past decade, whereas the use of SU decreased. However, SUs still remain the most commonly prescribed second-line agents with metformin in 2013.
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Affiliation(s)
- Seung-Hyun Ko
- Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul
| | - Dae-Jung Kim
- Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon
| | | | - Cheol-Young Park
- Department of Endocrinology and Metabolism, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine
| | - Chang Hee Jung
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine
| | - Hyuk-Sang Kwon
- Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul
| | - Joong-Yeol Park
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine
| | - Kee-Ho Song
- Department of Internal Medicine, Konkuk University School of Medicine
| | - Kyungdo Han
- Department of Biostatistic, The Catholic University of Korea
| | - Ki-Up Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine
| | - Kyung-Soo Ko
- Department of Internal Medicine, Cardiovascular and Metabolic Disease Center, Inje University Sanggye Paik Hospital, Seoul, Republic of Korea
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Shin DW, Lee J. Management of long-term cancer survivors in primary care. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2016. [DOI: 10.5124/jkma.2016.59.4.252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Dong Wook Shin
- Cancer Survivorship Clinic, Department of Family Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jungkwon Lee
- Supportive Care Center, Department of Family Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Shin DW, Yoo SH, Sunwoo S, Yoo MW. Management of long-term gastric cancer survivors in Korea. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2016. [DOI: 10.5124/jkma.2016.59.4.256] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Affiliation(s)
- Dong Wook Shin
- Department of Family Medicine/Cancer Survivorship Clinic, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Seung Hyun Yoo
- Department of Family Medicine/Cancer Prevention Clinic, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sung Sunwoo
- Department of Family Medicine/Cancer Prevention Clinic, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Moon-Won Yoo
- Division of Stomach Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Lee M, Salloum RG. Racial and ethnic disparities in cost-related medication non-adherence among cancer survivors. J Cancer Surviv 2015; 10:534-44. [PMID: 26620816 DOI: 10.1007/s11764-015-0499-y] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 11/17/2015] [Indexed: 11/26/2022]
Abstract
PURPOSE Cancer survivors are delaying or avoiding necessary care due to costs, and medication non-adherence is an important aspect of deferred treatment. This study estimates the prevalence of cost-related medication non-adherence (CRN) by race and ethnicity and examines factors associated with CRN among cancer survivors. METHODS Using the 2006-2013 National Health Interview Survey, we examine self-reported CRN among cancer survivors compared with cancer-free controls. Descriptive statistics and multiple logistic regression models were used to identify factors associated with CRN among cancer survivors. RESULTS In a nationally representative sample of 472,542 adults, 10,998 participants reported a history of cancer and 461,544 did not. Among 10,998 cancer survivors, 1397 (12.70 %) reported CRN. Among older cancer survivors, African-Americans were 2.64 times more likely (95 % confidence interval (CI), 1.73 to 4.01) and Hispanics 2.07 times more likely (95 % CI, 1.32 to 3.24) than whites to report CRN. Among younger cancer survivors, Hispanics were 1.61 times more likely (95 % CI, 1.23 to 2.10) than whites to report CRN. CONCLUSIONS Significant racial and ethnic disparities in CRN were evident among cancer survivors. Older African-American and Hispanic overall survivors were more likely to report CRN in the past year compared with non-Hispanic whites. IMPLICATIONS FOR CANCER SURVIVORS Given increasing prescription drug expenditure, it is important to closely monitor CRN in high-risk subgroups. Racial and ethnic minority groups at high risk for CRN should be counseled on the importance of medication adherence and offered support services to promote medication adherence. Further studies are warranted to establish effective policies and interventions in vulnerable populations.
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Affiliation(s)
- Minjee Lee
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.
| | - Ramzi G Salloum
- Department of Health Outcomes and Policy, College of Medicine, University of Florida, Gainesville, FL, USA
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Lee M, Khan MM. Gender differences in cost-related medication non-adherence among cancer survivors. J Cancer Surviv 2015; 10:384-93. [PMID: 26350680 DOI: 10.1007/s11764-015-0484-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 08/27/2015] [Indexed: 11/25/2022]
Abstract
PURPOSE It has been reported that cancer survivors are delaying or avoiding necessary care due to costs. Medication non-adherence is one of the important aspects of deferred treatment. This study estimates the prevalence of cost-related medication non-adherence (CRN) by gender and factors associated with CRN among cancer survivors. METHODS Using 2006-2013 National Health Interview Survey (NHIS), we examined self-reported CRN among cancer survivors by gender. Descriptive statistics and multiple logistic regression models were used to examine gender differences in CRN. RESULTS In a nationally representative sample of 15,159 cancer survivors, 7.4% of male and 12.5% of female reported CRN. Overall, the prevalence of CRN was found to be the highest for uninsured group and the lowest for Medicare, but gender differences persist for all insurance types, including Medicare. After controlling for relevant covariates, female cancer survivors were 27% more likely (odds ratio (OR) = 1.27, confidence intervals (CI), 1.06-1.53) than male to report CRN. With higher number of comorbidities and activity limitations, CRN rates tend to increase for both male and female cancer survivors. CONCLUSIONS Significant gender differences in CRN were found among cancer survivors after controlling for differences in sociodemographic, health status, and insurance coverage. IMPLICATIONS FOR CANCER SURVIVORS Given the rapid increase in prescription drug costs, it is important to monitor closely the CRN in high-risk subgroups.
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Affiliation(s)
- Minjee Lee
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, 915 Greene St, Suite 357, Columbia, SC, 29208, USA
| | - M Mahmud Khan
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, 915 Greene St, Suite 357, Columbia, SC, 29208, USA.
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Jo SR, Joh JY, Jeong JR, Kim S, Kim YP. Health Behaviors of Korean Gastric Cancer Survivors with Hypertension: A Propensity Analysis of KNHANES III-V (2005-2012). PLoS One 2015; 10:e0126927. [PMID: 26000609 PMCID: PMC4441496 DOI: 10.1371/journal.pone.0126927] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2014] [Accepted: 03/24/2015] [Indexed: 12/13/2022] Open
Abstract
Objective This study provides a comparison of health behaviors between gastric cancer survivors with hypertension and non-cancer subjects in Korea. Methods Data from the Korean National Health and Nutrition Examination Survey (KNHANES) for the period of 2005-2012 were used in this study. A propensity score matching method was used to compare health behaviors. Before the matching of propensity scores, the number of participants was 11034 (102 gastric cancer survivors and 10932 non-cancer participants). A 1:5 propensity score matching procedure yielded a total of 480 participants (80 gastric cancer survivors and 400 non-cancer participants) for the final analysis. Drinking, smoking, physical activity, antihypertensive medication adherence, self-reported diet control, and sodium intake accordance in the two groups were compared. A complex samples logistic regression analysis was conducted to assess any differences between the two groups. Results The group of hypertensive gastric cancer survivors had lower alcohol consumption (OR = 0.30; 95% CI: 0.14-0.66; p-value = 0.003). They were more likely to be on dietary control than the control group (OR = 3.12; 95% CI: 1.60-6.10; p-value = 0.001). However, there was no significant (p > 0.05) difference in sodium intake accordance or other health behaviors (including medication adherence, smoking, and physical activity) between the two groups. Conclusions Our results revealed that gastric cancer survivors with hypertension were more likely to be on dietary control with lower alcohol consumption than the control group. However, there was no significant difference in sodium intake accordance or other health behaviors between the two groups. Therefore, primary care physicians should inform cancer survivors about the appropriate health behaviors to reduce their risk of cardiovascular disease and improve their overall survival rate, even though they say they have been doing health behaviors.
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Affiliation(s)
- So-Ra Jo
- Department of Family Medicine, Hwasun Chonnam National University Hospital, Hwasun-eup, Hwasun-gun Chonnam, Korea
- Clinic of Life After Cancer Treatment (LACT Clinic), Hwasun Chonnam National University Hospital, Hwasun-eup, Hwasun-gun Chonnam, Korea
| | - Ju-Youn Joh
- Department of Family Medicine, Hwasun Chonnam National University Hospital, Hwasun-eup, Hwasun-gun Chonnam, Korea
- Clinic of Life After Cancer Treatment (LACT Clinic), Hwasun Chonnam National University Hospital, Hwasun-eup, Hwasun-gun Chonnam, Korea
| | - Ju-Ri Jeong
- Department of Family Medicine, Hwasun Chonnam National University Hospital, Hwasun-eup, Hwasun-gun Chonnam, Korea
- Clinic of Life After Cancer Treatment (LACT Clinic), Hwasun Chonnam National University Hospital, Hwasun-eup, Hwasun-gun Chonnam, Korea
| | - Sun Kim
- Department of Family Medicine, Hwasun Chonnam National University Hospital, Hwasun-eup, Hwasun-gun Chonnam, Korea
- Clinic of Life After Cancer Treatment (LACT Clinic), Hwasun Chonnam National University Hospital, Hwasun-eup, Hwasun-gun Chonnam, Korea
| | - Yeon-Pyo Kim
- Department of Family Medicine, Hwasun Chonnam National University Hospital, Hwasun-eup, Hwasun-gun Chonnam, Korea
- * E-mail:
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Jeong JR, Kim S, Jo SR, Joh JY, Kim YP. Health Behaviors of Breast Cancer Survivors with Hypertension: A Propensity Analysis of KNHANES III-V (2005-2012). PLoS One 2015; 10:e0127346. [PMID: 25978401 PMCID: PMC4433251 DOI: 10.1371/journal.pone.0127346] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2014] [Accepted: 04/14/2015] [Indexed: 11/18/2022] Open
Abstract
Objective This study examines health behaviors of breast cancer survivors with hypertension and compares them with those of non-cancer individuals with hypertension. Methods In this cross-sectional study, a total of 10,996 hypertensive adults (≥ 19 years) who participated in the 2005-2012 Korean National Health and Nutrition Examination Survey (KNHANES) were considered. Data on alcohol consumption, smoking, physical activity, antihypertensive medication adherence, self-reported diet control, and sodium intake were collected through self-report questionnaire. A total of 64 breast cancer survivors with hypertension and 10,932 non-cancer participants with hypertension were identified. To better compare health behaviors of the two groups, 56 breast cancer survivors and 280 non-cancer participants were selected through the 1:5 nearest available matching based on estimated propensity scores. Multivariate analysis was conducted to determine any differences between the two groups. Results According to multivariate analysis, breast cancer survivors with hypertension (n = 56) were significantly less likely to consume alcohol (odds ratio (OR): 3.75; 95% confidence interval (CI): 1.06-13.29) but significantly more likely to have sodium intake of more than 2400 mg (OR: 2.98; 95% CI: 1.27-6.97) than the propensity-matched control group (n = 280). There was no significant difference in other health behaviors between the two groups. Conclusions Breast cancer survivors require active interventions for healthy behaviors related to the management of comorbid conditions such as hypertension to reduce the risk of cardiovascular disease and improve their overall survival rate.
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Affiliation(s)
- Ju-Ri Jeong
- Department of Family Medicine, Hwasun Chonnam National University Hospital, Hwasun-gun, Korea
- Clinic of Life After Cancer Treatment (LACT Clinic), Hwasun Chonnam National University Hospital, Hwasun-gun, Korea
| | - Sun Kim
- Department of Family Medicine, Hwasun Chonnam National University Hospital, Hwasun-gun, Korea
- Clinic of Life After Cancer Treatment (LACT Clinic), Hwasun Chonnam National University Hospital, Hwasun-gun, Korea
| | - So-Ra Jo
- Department of Family Medicine, Hwasun Chonnam National University Hospital, Hwasun-gun, Korea
- Clinic of Life After Cancer Treatment (LACT Clinic), Hwasun Chonnam National University Hospital, Hwasun-gun, Korea
| | - Ju-Youn Joh
- Department of Family Medicine, Hwasun Chonnam National University Hospital, Hwasun-gun, Korea
- Clinic of Life After Cancer Treatment (LACT Clinic), Hwasun Chonnam National University Hospital, Hwasun-gun, Korea
| | - Yeon-Pyo Kim
- Department of Family Medicine, Hwasun Chonnam National University Hospital, Hwasun-gun, Korea
- * E-mail:
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Shin DW, Sunwoo S, Lee J. Management of cancer survivors in Korea. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2015. [DOI: 10.5124/jkma.2015.58.3.216] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Dong Wook Shin
- Cancer Survivorship Clinic, Department of Family Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Sung Sunwoo
- Cancer Prevention Clinic, Department of Family Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jungkwon Lee
- Supportive Care Center, Department of Family Medicine, Samsung Medical Center, Sungkyunkwan University College of Medicine, Seoul, Korea
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Shin JY, Shim HY, Jun JK. Comparison of diabetes management status between cancer survivors and the general population: results from a Korean population-based survey. PLoS One 2014; 9:e110412. [PMID: 25313795 PMCID: PMC4196996 DOI: 10.1371/journal.pone.0110412] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Accepted: 09/19/2014] [Indexed: 12/03/2022] Open
Abstract
Purpose This study aimed to determine and compare the prevalences of diabetes awareness, treatment, and adequate glycemic control among cancer survivors in a Korean population and two non-cancer control groups, comprising individuals without a history of cancer but with other chronic diseases (non-cancer, chronic disease controls) and individuals without a history of cancer or any other chronic disease (non-cancer, non-chronic disease controls). Methods We analyzed data from 2,660 subjects with prevalent diabetes (aged ≥30 years), who had participated in the 2007–2011 Korea National Health and Nutrition Examination Survey. Awareness was defined as a subject having been diagnosed with diabetes by a clinician. Treatment was defined as a subject who was taking anti-diabetic medicine. Adequate glycemic control was defined as a hemoglobin A1c level of <7%. Multivariable logistic regression and predictive margins were used to evaluate whether awareness, treatment, or adequate glycemic control differed among cancer survivors and the two non-cancer control groups. Results Cancer survivors had greater awareness compared with the non-cancer, chronic disease and non-cancer, non-chronic disease control groups (85.1%, 80.4%, and 60.4%, respectively). Although the prevalences of treatment and adequate glycemic control were higher for survivors compared with the non-cancer, non-chronic disease controls, they were lower compared with the non-cancer, chronic disease controls. The prevalence of diabetes treatment was 67.5% for cancer survivors, 69.5% for non-cancer, chronic disease controls, and 46.7% for non-cancer, non-chronic disease controls; the prevalences of adequate glycemic control in these three groups were 31.7%, 34.6%, and 17.8%, respectively. Conclusions Cancer survivors were less likely than the non-cancer chronic disease subjects to receive diabetes management and to achieve adequate glycemic targets. Special attention and education are required to ensure that this population receives optimal diabetes care, and the systematic roles for primary care and specialist physicians need to be determined.
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Affiliation(s)
- Ji-Yeon Shin
- Department of Preventive Medicine, School of Medicine, Eulji University, Daejeon, Republic of Korea
| | - Hye Young Shim
- National Cancer Control Institute, National Cancer Center, Goyang, Republic of Korea
| | - Jae Kwan Jun
- National Cancer Control Institute, National Cancer Center, Goyang, Republic of Korea
- * E-mail:
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Abstract
OBJECTIVE Despite evidence indicating therapeutic benefit for adhering to a prescribed regimen, many patients do not take their medications as prescribed. Non-adherence often leads to morbidity and to higher health care costs. The objective of the study was to assess patient characteristics associated with medication adherence across eight diseases. DESIGN Retrospective data from a repository within an integrated health system was used to identify patients ≥18 years of age with ICD-9-CM codes for primary or secondary diagnoses for any of eight conditions (depression, hypertension, hyperlipidemia, diabetes, asthma or chronic obstructive pulmonary disease, multiple sclerosis, cancer, or osteoporosis). Electronic pharmacy data was then obtained for 128 medications used for treatment. METHODS Medication possession ratios (MPR) were calculated for those with one condition and one drug (n=15,334) and then for the total population having any of the eight diseases (n=31,636). The proportion of patients adherent (MPR ≥80%) was summarized by patient and living-area (census) characteristics. Bivariate associations between drug adherence and patient characteristics (age, sex, race, education, and comorbidity) were tested using contingency tables and chi-square tests. Logistic regression analysis examined predictors of adherence from patient and living area characteristics. RESULTS Medication adherence for those with one condition was higher in males, Caucasians, older patients, and those living in areas with higher education rates and higher income. In the total population, adherence increased with lower comorbidity and increased number of medications. Substantial variation in adherence was found by condition with the lowest adherence for diabetes (51%) and asthma (33%). CONCLUSIONS The expectation of high adherence due to a covered pharmacy benefit, and to enhanced medication access did not hold. Differences in medication adherence were found across condition and by patient characteristics. Great room for improvement remains, specifically for diabetes and asthma.
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Affiliation(s)
- Sharon J Rolnick
- HealthPartners Research Foundation; 8170 33rd Ave. S.; MS 21111R; Bloomington, MN 55425, USA.
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Shin DW, Cho B, Kim SY, Jung JH, Park JH. Management of cancer survivors in clinical and public health perspectives: current status and future challenges in Korea. J Korean Med Sci 2013; 28:651-7. [PMID: 23678254 PMCID: PMC3653075 DOI: 10.3346/jkms.2013.28.5.651] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2012] [Accepted: 03/04/2013] [Indexed: 12/31/2022] Open
Abstract
The number of cancer survivors is increasing dramatically. Many cancer survivors face lifetime risks associated with their cancer therapy, with a significant proportion at risk for serious morbidity and premature mortality. Concerns regarding the long-term physical, psychosocial, and economic effects of cancer treatment on cancer survivors and their families are increasingly being recognized and addressed by public and private sector. This article summarizes economic burden of cancer survivors, main post-treatment health problems including secondary primary cancer and comorbidities, health behaviors such as smoking, exercise and physical activity, nutrition, and psychosocial problems. Faced with various health and psychosocial problems specific to this population, several healthcare and policy models are being suggested to address these issues, including 'shared care model' and 'integrative supportive care service delivery system for cancer survivors'. More effort is needed to make the cancer survivorship agenda a reality, attended by a wide variety of stakeholders including researchers, patients, providers, and policy makers.
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Affiliation(s)
- Dong Wook Shin
- Department of Family Medicine & Health Promotion Center, Seoul National University Hospital, Seoul, Korea
- Cancer Survivorship Clinic, Seoul National University Cancer Hospital, Seoul, Korea
| | - BeLong Cho
- Department of Family Medicine & Health Promotion Center, Seoul National University Hospital, Seoul, Korea
- Cancer Survivorship Clinic, Seoul National University Cancer Hospital, Seoul, Korea
| | - So Young Kim
- Cancer Policy Branch, National Cancer Control Research Institute, National Cancer Center, Goyang, Korea
| | - Je Hyuck Jung
- Division of Disease Policy, Ministry of Health and Welfare, Seoul, Korea
| | - Jong Hyock Park
- Cancer Policy Branch, National Cancer Control Research Institute, National Cancer Center, Goyang, Korea
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Yang HK, Shin DW, Park JH, Kim SY, Eom CS, Kam S, Choi JH, Cho BL, Seo HG. The association between perceived social support and continued smoking in cancer survivors. Jpn J Clin Oncol 2012; 43:45-54. [PMID: 23166386 DOI: 10.1093/jjco/hys182] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE With the increased survival rate of cancer patients, positive changes in health behaviors, including smoking cessation, are becoming progressively more important. While studies in the general population have demonstrated the beneficial effects of high perceived support of smoking cessation and continuing abstinence, few studies have addressed such issues in cancer survivors. We examined the factors related to continued smoking among cancer survivors with specific attention given to the role of perceived social support. METHODS A nationwide, multicenter survey was conducted with 1956 cancer patients. Smoking status at the time of diagnosis and at the time of survey, and perceived social support, as measured by the Duke-UNC Functional Social Support Questionnaire, were collected by self-reported questionnaire. RESULTS Among 493 participants who were smoking at the time of cancer diagnosis, 131 (26.6%) were continued smokers at the time of survey. In a multivariate logistic regression analysis, current alcohol consumption (odds ratio, 3.29; 95% confidence interval, 1.91-5.65), early cancer stage (P(for trend)< 0.01), lung cancer diagnosis (odds ratio, 0.41; 95% confidence interval, 0.19-0.88), and high perceived social support (odds ratio, 0.59; 95% confidence interval, 0.37-0.96) showed significant associations with continued smoking. CONCLUSIONS Cancer survivors with low perceived social support were more likely to continue smoking. Our study suggests that perceived social support may be an important factor for smoking cessation and maintenance of smoking cessation in this population.
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Affiliation(s)
- Hyung-Kook Yang
- Department of Family Medicine, Seoul National University Hospital, 101 Daehak-ro Jongno-gu, Seoul, South Korea
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Comparison of hypertension management between cancer survivors and the general public. Hypertens Res 2012; 35:935-9. [PMID: 22534522 DOI: 10.1038/hr.2012.54] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Proper management of hypertension is important for better survival and quality of life of cancer survivors who have hypertension. We aimed to compare hypertension management between cancer survivors and the general population. A nationwide, multicenter, cross-sectional survey was administered to adult cancer patients, currently receiving treatment or follow-up, who had been diagnosed with hypertension. Comparison group was selected from among participants in the health behavior survey of the third Korean National Health and Nutrition Examination Survey. Self-reported hypertension management was surveyed, including antihypertensive medication adherence, frequency of blood pressure (BP) monitoring and perceived BP control. Multivariate logistic regression analysis was used to evaluate the relationship between cancer survivorship and each outcome measure. Compared with the general population, cancer survivors were more likely to report full adherence (92.7% vs. 73.0%; adjusted odds ratio (aOR)=3.45; 95% confidence interval (CI), 2.08-5.73), more frequent BP measurement (≥ 24 per year: 50.1% vs. 24.7%; aOR=2.51; 95% CI, 1.83-3.46), and very good perceived BP control (60.8% vs. 26.2%; aOR=4.34; 95% CI, 3.13-6.02). Cancer survivors appear to be better with antihypertensive medication adherence and BP monitoring than those without cancer, and as a result, they appear to be under better BP control. However, several methodological limitations of our study prompt further research on this issue.
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