Initiation of adjuvant hormone therapy by Medicaid insured women with nonmetastatic breast cancer.
Initiation of adjuvant hormone therapy by Medicaid insured women with nonmetastatic breast cancer.
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医疗补助计划为患有非转移性乳腺癌的女性启动辅助激素治疗。
DOI：
10.1093/jnci/djs273
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发表时间：
2012
期刊：
影响因子：
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通讯作者：
Schrag,Deborah
中科院分区：
文献类型：
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作者：
Yung,RachelL;Hassett,MichaelJ;Chen,Kun;Gesten,FosterC;Roohan,PatrickJ;Boscoe,FrancisP;Sinclair,AmberH;Schymura,MariaJ;Schrag,Deborah
激素治疗是激素受体阳性(HR阳性)非转移性乳腺癌的主要辅助治疗手段。我们评估了21-年间接受医疗补助的女性在I-III期HR阳性乳腺癌患者中开始辅助激素治疗的情况。我们使用多变量Logistic回归来确定AHT启动的独立预测因素。在确诊的1年内，68%(1049/1538)的患者启动了AHT；到18个月时，80%(1168/1461)启动了AHT。在多变量分析中，不太可能发起AHT2的女性有更多的共病(≥2与无：调整后的优势比(AOR)=0.55；95%CI=90.32至0.97)，更晚期的疾病(III期VS I：AOR=90.27；95%CI=90.18至0.39)，以及保乳手术后未进行放射治疗(AOR=90.15；95%CI=90.10至0.22)。种族、年龄和精神健康障碍史与AHT的发生没有独立的关联。在AHT的发起者中，58%(604/1049)的患者在开始治疗后一年内坚持治疗。尽管有全面的处方覆盖，但只有39%(604/1538)的患者在治疗后一年内接受了最佳的AHT治疗，包括立即启动和坚持治疗。医疗补助计划和癌症登记处之间的伙伴关系可能有助于识别高危妇女，并促进质量改进战略的实施。
Hormone therapy is the mainstay of adjuvant treatment for hormone receptor positive (HR-positive) nonmetastatic breast cancer. We evaluated adjuvant hormone therapy (AHT) initiation among Medicaid-insured women aged 21–64 years with stage I–III HR-positive breast cancer. We used multivariable logistic regression to identify independent predictors of AHT initiation. Within 1 year of diagnosis, 68% (1049/1538) initiated AHT; by 18 months, 80% (1168/1461) initiated AHT. In multivariable analysis, women less likely to initiate AHT had more comorbidity (≥2 vs none: adjusted odds ratio (AOR) = 0.55; 95% CI = 0.32 to 0.97), more advanced disease (stage III vs I: AOR = 0.27; 95% CI = 0.18 to 0.39), and no radiation after breast conserving surgery (AOR = 0.15; 95% CI = 0.10 to 0.22). Race, age, and history of mental health disorders were not independently associated with initiation of AHT. Among initiators of AHT, 58% (604/1049) were adherent to treatment for the year after initiation. Despite comprehensive prescription coverage, only 39% (604/1538) received optimal AHT including prompt initiation and adherence for the year after treatment. Partnerships between Medicaid programs and cancer registries may help identify at-risk women and facilitate the implementation of quality improvement strategies.