Impact of preexisting mental illness on breast cancer endocrine therapy adherence

Cole B Haskins; Bradley D McDowell; Ryan M Carnahan; Jess G Fiedorowicz; Robert B Wallace; Brian J Smith; Elizabeth A Chrischilles

doi:10.1007/s10549-018-5050-1

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Impact of preexisting mental illness on breast cancer endocrine therapy adherence

Journal article

Peer reviewed

Impact of preexisting mental illness on breast cancer endocrine therapy adherence

Cole B Haskins, Bradley D McDowell, Ryan M Carnahan, Jess G Fiedorowicz, Robert B Wallace, Brian J Smith and Elizabeth A Chrischilles

Breast cancer research and treatment, Vol.174(1), pp.197-208

02/2019

DOI: 10.1007/s10549-018-5050-1

PMCID: PMC6426454

PMID: 30465157

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https://www.ncbi.nlm.nih.gov/pmc/articles/6426454View

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Abstract

Patients with estrogen receptor positive (ER+) breast cancer are often non-adherent to endocrine therapies, despite clear survival benefits. We utilized a nationally representative cancer cohort to examine the role of specific mental illnesses on endocrine therapy adherence. Using the SEER-Medicare database, we included 21,894 women aged 68+ at their first surgically treated stage I-IV ER+ breast cancer during 2007-2013. All had continuous fee-for-service Medicare Parts A and B for 36+ months before, 18+ months after diagnosis, and continuous Part D for 4+ months before, 18+ after diagnosis. Mental illness was defined as occurring in the 36 months prior to cancer onset. We analyzed endocrine therapy adherence, initiation, and discontinuation using longitudinal linear and Cox regression models. Unipolar depression (11.0%), anxiety (9.5%), non-schizophrenia psychosis (4.6%), and dementias (4.6%) were the most prevalent diagnoses. Endocrine therapies were initiated by 80.0% of women. Among those with at least one year of use, 28.0% were non-adherent (< 0.80 adherence, mean = 0.84) and 25.7% discontinued. Patients with dementia or bipolar depression/psychotic/schizophrenia disorders had lower adjusted initiation probabilities by year one of follow-up, versus those without these diagnoses [0.74 95% CI (0.73-0.74) and 0.73 (0.72-0.73), respectively, reference 0.76 (0.76-0.77)]. Patients with substance use or anxiety disorders less frequently continued endocrine therapy for at least one year, after adjustment, [0.85 95% CI (0.85-0.86) and 0.88 (0.87-0.88), respectively, reference 0.90 (0.89-0.90)]. Patients with substance use disorders had 2.3% lower adherence rates (p < 0.001). Nearly one-quarter of female Medicare beneficiaries have diagnosed mental illness preceding invasive breast cancer. Those with certain mental illnesses have modestly reduced rates of initiation, adherence, and discontinuation and this may help define patients at higher risk of treatment abandonment. Overall, endocrine therapy adherence remains suboptimal, unnecessarily worsening recurrence and mortality risk.

United States

Medication Adherence - statistics & numerical data

SEER Program

Medication Adherence - psychology

Medicare

Humans

Mental Disorders - complications

Breast Neoplasms - drug therapy

Breast Neoplasms - psychology

Antineoplastic Agents, Hormonal - therapeutic use

Aged, 80 and over

Female

Aged

Retrospective Studies

Cohort Studies

Details

Title: Subtitle: Impact of preexisting mental illness on breast cancer endocrine therapy adherence
Creators: Cole B Haskins - Medical Scientist Training Program, University of Iowa, Iowa City, IA, USA. cole-haskins@uiowa.edu
Bradley D McDowell - Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA, USA
Ryan M Carnahan - Department of Epidemiology, College of Public Health, University of Iowa, CPHB, 145 N Riverside Dr, Iowa City, IA, 52242, USA
Jess G Fiedorowicz - University of Iowa Hospitals and Clinics, Iowa City, IA, USA
Robert B Wallace - Department of Epidemiology, College of Public Health, University of Iowa, CPHB, 145 N Riverside Dr, Iowa City, IA, 52242, USA
Brian J Smith - Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, IA, USA
Elizabeth A Chrischilles - Department of Epidemiology, College of Public Health, University of Iowa, CPHB, 145 N Riverside Dr, Iowa City, IA, 52242, USA
Resource Type: Journal article
Publication Details: Breast cancer research and treatment, Vol.174(1), pp.197-208
DOI: 10.1007/s10549-018-5050-1
PMID: 30465157
PMCID: PMC6426454
NLM abbreviation: Breast Cancer Res Treat
ISSN: 1573-7217
eISSN: 1573-7217
Publisher: Netherlands
Grant note: HHSN261201000035C / NCI NIH HHS U58 DP003862 / NCCDPHP CDC HHS HHSN261201000140C / NCI NIH HHS T32 GM007337 / NIGMS NIH HHS HHSN261201000034C / NCI NIH HHS P30 CA086862 / NCI NIH HHS HHSN261201000035I / NCI NIH HHS
Language: English
Date published: 02/2019
Academic Unit: Pharmacy; Psychiatry; Epidemiology; Iowa Neuroscience Institute; Biostatistics; Injury Prevention Research Center; Holden Comprehensive Cancer Center; Internal Medicine
Record Identifier: 9983995161802771

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