While white women are more likely to be diagnosed with breast cancer, more black women die from the disease. Furthermore, when it comes to hormone medication for early-stage breast cancer, black women are less likely to take these medications compared to white women—and economic disparities may partially be to blame.
As many of you know, financial factors play a big role in medical treatment and compliance. This is a time when nurses and social workers can step in to help ensure that breast cancer patients adhere to life-saving treatments—but this is not always possible.
Many studies have demonstrated the impact income disparity has on cancer patients, but researchers at Columbia University Medical Center took it a step further and analyzed the effect of household net worth on quality of care in breast cancer patients.
"We know that oral hormonal therapy can reduce the recurrence of hormone receptor–positive breast cancer by 50%. 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," said lead study author Dawn Hershman, MD, MS, associate professor of medicine at the College of Physicians and Surgeons and associate professor of epidemiology at the Mailman School of Public Health, Columbia University Medical Center.
Using an insurance claims database, Columbia researchers collected prescription and financial information on 2,473 women ages 50 and older with early-stage breast cancer who were prescribed hormonal therapy between 2007 and 2011. Net worth was divided into three categories: low ($250,000 or less), moderate ($250,000 to $750,000), and high ($750,000 or more).
Columbia University researchers found that financial factors, such as income and net worth, were directly associated with adherence to hormonal therapy. They also found that black race was associated with decreased adherence. However, when the researchers controlled for net worth, there was no racial difference in adherence in the moderate and high net worth groups.
"This suggests that income may be an inadequate assessment of financial resources," said Dr. Hershman. "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."
Depending on insurance/prescription coverage and out-of-pocket copays, the average monthly cost of generic aromatase inhibitors may be around $150. While a $30 copay or a $150 drug cost may not seem like a lot of money for some, many of these patients are on other prescription medications as well, which adds to their monthly prescription costs.
Are some of your breast cancer patients non-adherent to hormonal therapy due to cost?