Adherence to Hormonal Therapy Linked to Disparities in Household Net Worth

Economic variables impact breast cancer treatment, study finds.

Adherence to hormonal therapy during the treatment of breast cancer is directly impacted by income, according to the results of a recent study.

Published recently online in the Journal of Clinical Oncology, the study finds that the net worth of a household is a major and overlooked factor in adherence and plays a role in the racial disparities that exist in quality of care.

As a result, health care providers, insurers, and policy makers need to be cognizant of economic variables to ensure that patients have access to potentially life-saving therapies.

"We know that oral hormonal therapy can reduce the recurrence of hormone receptor-positive breast cancer by 50%,” lead author Dawn Hershman, MD, MS, said in a press release. “Yet up to 10% of patients discontinue therapy annually, and only about half finish the recommended five-year course of therapy. Thus, it's imperative that we understand what is preventing women from taking their medications and what we can do to improve adherence.”

Prior studies have indicated that income disparity contributes to gaps in health care between racial and ethnic groups. The current study was the first to specifically evaluate the impact of household net worth on the quality of care received by breast cancer patients, the authors noted.

The researchers evaluated prescription and financial data on 2473 women who were 50 years of age and older with early-stage breast cancer. The women were prescribed aromatase inhibitors between 2007 and 2011. The patients were divided into three categories to determine household net worth, with the low group at $250,000 or less, the moderate group at $250,000 to $750,000, and the high group at $750,000 or more.

A direct association was found between adherence to hormonal therapy and financial factors such as income and net worth. There was also an association found between African Americans and decreased adherence.

When the data was controlled for net worth, there was found to be no racial difference in adherence among the moderate and high net worth groups.

"This suggests that income may be an inadequate assessment of financial resources," Dr. Hershman said. "This is particularly true for the elderly, for whom net worth seems to be a more accurate measure of socioeconomic differences in use of health care services."

The researchers found that as the cost of cancer therapies increase, quality of care will likely decrease due to low net worth.

"It's important that physicians ask patients whether they are able to pay for their medications," Dr. Hershman said. "Many patients aren't comfortable raising this issue and just discontinue therapy if they can't afford it. By engaging patients in conversation, we may be able to come up with a solution, perhaps by finding less expensive alternatives or by asking pharmaceutical companies to assist patients with co-payments."