Ethnic differences in initiation and timing of adjuvant endocrine therapy among older women with hormone receptor-positive breast cancer enrolled in Medicare Part D.
Ethnic differences in initiation and timing of adjuvant endocrine therapy among older women with hormone receptor-positive breast cancer enrolled in Medicare Part D.
复制标题
DOI：
10.1007/s12032-016-0732-1
复制
发表时间：
2016-02
期刊：
影响因子：
--
通讯作者：
Du XL
中科院分区：
文献类型：
--
作者：
Farias AJ;Du XL
这项研究的目的是确定在联邦医疗保险D部分药物覆盖后，辅助内分泌治疗(AET)的启动和时间是否存在种族/民族差异。我们利用来自监测、流行病学和最终结果-医疗保险相关数据的数据进行了一项回溯性队列研究，以评估种族、社会人口和肿瘤特征在2007年至2009年激素受体阳性乳腺癌患者≥65至2010年参加医疗保险D部分登记时启动AET的差异。使用Logistic回归模型评估种族/民族与诊断前12个月内他莫昔芬、芳香酶抑制剂(AIS)和总体AET(他莫昔芬或AIS)的启动之间的关系。在12,198名激素受体阳性的乳腺癌患者中，74.8%的患者在确诊后12个月内接受了AET治疗，其中17.3%接受了他莫昔芬治疗，82.8%接受了AIS治疗。在控制了所有变量后，只有亚裔女性与非西班牙裔白人女性相比，启动整体AET的几率更大(优势比(OR)：1.28，95%CI：1.03-1.58)。西班牙裔墨西哥人和非西班牙裔黑人患者启动他莫昔芬的几率显著较低(0.70，0.54-0.91；0.25，0.10-0.62)。在人工智能启动方面，西班牙裔墨西哥人和亚洲人比非西班牙裔白人女性有更高的几率(2.06，1.34-3.10；1.33，1.11-1.61)。次优比例的女性(25.2%)在确诊后12个月内没有启动AET，因此没有得到降低乳腺癌复发和死亡率的治疗的全部好处。启动他莫昔芬和人工免疫系统的种族/族裔差异具有重要影响，需要进一步调查。
The aim of this study was to determine whether there are racial/ethnic differences in initiation and timing of adjuvant endocrine therapy (AET) after Medicare Part D drug coverage. We conducted a retrospective cohort study using data from the Surveillance, Epidemiology, and End Results-Medicare-linked data to assess ethnic, socio-demographic, and tumor characteristic variations in the initiation of AET among patients ≥65 with hormone receptor-positive breast cancer in 2007–2009 enrolled in Medicare Part D through 2010. Logistic regression models were performed to assess the association between race/ethnicity and the initiation of tamoxifen, aromatase inhibitors (AIs), and overall AET (tamoxifen or AIs) within the first 12 months of diagnosis. Of the 12,198 women with hormone receptor-positive breast cancer, 74.8 % received AET within 12 months of diagnosis, of which 17.3 % received tamoxifen and 82.8 % received AIs. After controlling for all variables, only Asian women were found to have a greater odds of initiation of overall AET compared to non-Hispanic white women (odds ratio (OR): 1.28, 95 % CI: 1.03–1.58). Hispanic Mexicans and non-Hispanic black patients had a significantly lower odds of tamoxifen initiation (0.70, 0.54–0.91; 0.25, 0.10–0.62). For AI initiation, Hispanic Mexicans and Asians had a higher odds compared to non-Hispanic white women (2.06, 1.34–3.10; 1.33, 1.11–1.61). A suboptimal proportion of women (25.2 %) did not initiate AET within 12 months of diagnosis and therefore did not receive the full benefits of treatment to reduce the risk of breast cancer recurrence and mortality. Racial/ethnic differences in the initiation of tamoxifen and AIs have important implications that require further investigation.