Journal article
Breast cancer endocrine therapy adherence in health professional shortage areas: Unique effects on patients with mental illness
Journal of psychosomatic research, Vol.140, pp.110294-110294
01/2021
DOI: 10.1016/j.jpsychores.2020.110294
PMID: 33232903
Abstract
Evaluate whether breast cancer endocrine therapy adherence is affected by access to primary and mental health care, particularly among at-risk patients with mental illness.
The study included 21,892 SEER-Medicare women aged 68 or older with stage I-IV ER+ breast cancer, 2007 to 2013. Patient home counties during breast cancer diagnosis, if evaluated for HPSA care shortage status, were categorized as least, moderate, or highest shortage; unevaluated counties (no known shortage) were a fourth category. Endocrine therapy initiation and discontinuation were analyzed with Cox regression, and daily adherence with longitudinal linear regression.
After multivariate adjustment, patients in high primary care shortage counties were less likely to initiate endocrine therapy, reference least shortage [HR 0.92 (95% CI 0.86–0.97)]. Unevaluated counties had more oncologists per capita, fewer residents below the federal poverty level, and higher incomes. Mental health shortages were not associated with outcomes, however subgroups living in unevaluated counties were less likely to discontinue: patients with bipolar and psychotic disorders [discontinuation HR 0.35 (95% CI 0.17–0.73)], substance use [HR 0.48 (95% CI 0.24–0.95)], anxiety disorders [HR 0.56 (95% CI 0.35–0.90)].
Poor primary care access was associated with a lower likelihood of initiating endocrine therapy but living in counties without established mental health shortages may reduce the harmful association between mental illness and incomplete treatment receipt. Patients with mental illness may be more equipped to complete cancer treatment if given better mental health care access, suggesting a need for care coordination between primary and mental health care.
•Breast cancer endocrine therapy (ET) adherence can be worsened by mental illness.•ET adherence may be worsened by poor access to primary and mental health (MH) care.•Primary care shortages were associated with ET non-initiation.•Those with mental illness not living in MH shortage areas had improved outcomes.•Efforts to improve ET adherence should consider access to both primary and MH care.
Details
- Title: Subtitle
- Breast cancer endocrine therapy adherence in health professional shortage areas: Unique effects on patients with mental illness
- Creators
- Cole B Haskins - Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA, United States of AmericaBradley D McDowell - Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA, United States of AmericaRyan M Carnahan - Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA, United States of AmericaJess G Fiedorowicz - Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA, United States of AmericaRobert B Wallace - Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA, United States of AmericaBrian J Smith - Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA, United States of AmericaElizabeth A Chrischilles - Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA, United States of America
- Resource Type
- Journal article
- Publication Details
- Journal of psychosomatic research, Vol.140, pp.110294-110294
- DOI
- 10.1016/j.jpsychores.2020.110294
- PMID
- 33232903
- NLM abbreviation
- J Psychosom Res
- ISSN
- 0022-3999
- eISSN
- 1879-1360
- Publisher
- Elsevier Inc
- Grant note
- DOI: 10.13039/100016939, name: Myriad Genetics; name: University of Iowa Holden Comprehensive Cancer Center Population Research Core, award: P30 CA086862, R50 CA243692; name: University of Iowa Medical Scientist Training Program, award: T32 GM007337; name: National Cancer Institute's Surveillance, Epidemiology and End Results Program, award: HHSN261201000140C; name: Cancer Prevention Institute of California, award: HHSN261201000035C; DOI: 10.13039/100001808, name: Public Health Institute, award: HHSN261201000034C; name: Centers for Disease Control and Prevention's National Program of Cancer, award: U58DP003862-01
- Language
- English
- Date published
- 01/2021
- Academic Unit
- Pharmacy; Psychiatry; Epidemiology; Iowa Neuroscience Institute; Biostatistics; Nursing; Injury Prevention Research Center; Holden Comprehensive Cancer Center; Internal Medicine
- Record Identifier
- 9984070676502771
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