Patterns of medication adherence in a multi-ethnic cohort of prevalent statin users diagnosed with breast, prostate, or colorectal cancer.
Patterns of medication adherence in a multi-ethnic cohort of prevalent statin users diagnosed with breast, prostate, or colorectal cancer.
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DOI：
10.1007/s11764-018-0716-6
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发表时间：
2018-12
期刊：
影响因子：
--
通讯作者：
Habel LA
中科院分区：
文献类型：
--
作者：
Banegas MP;Emerson MA;Adams AS;Achacoso NS;Chawla N;Alexeeff S;Habel LA
为了研究癌症诊断对既存共病患者药物依从性的影响，我们在多种族队列中探索了乳腺癌、结直肠癌或前列腺癌新诊断前后他汀类药物依从性模式。我们确定了在Kaiser Permanente北方加州登记的成人，他们是2000-2012年期间新诊断为乳腺癌、结直肠癌或前列腺癌的他汀类药物的普遍使用者。他汀类药物的依从性是用癌症诊断前两年和癌症诊断后两年的覆盖天数比例（PDC）来衡量的。使用广义估计方程评估所有癌症的依从性模式，并按癌症类型和人种/种族分层，调整人口统计学、临床和肿瘤特征。在10，177例癌症患者中，他汀类药物依从性从癌症诊断前到癌症诊断后下降（校正比值比（ORadj）：0.91，95%置信区间（95% CI）：0.88-0.94）。在乳腺癌（ORadj：0.94，95% CI：0.90-0.99）和结直肠癌（ORadj：0.79，95% CI：0.74-0.85）患者中，他汀类药物依从性从癌症诊断前到癌症诊断后降低。在前列腺癌患者中未观察到依从性差异（ORadj：1.01，95% CI：0.97-1.05）。在癌症诊断之前，非西班牙裔白人和多种族患者对他汀类药物的依从性通常高于其他人群。然而，诊断后他汀类药物依从性仅在这两个人群中降低（ORadj：0.85，95% CI：0.85-0.92和ORadj：0.86，95% CI：0.76-0.97）。我们发现，在一个综合医疗保健环境中，在一个大的流行他汀类药物使用者队列中，根据癌症类型和种族/民族诊断后，他汀类药物治疗依从性存在显著差异。提高我们对不同癌症患者人群的合并用药管理和多药治疗的理解，有必要制定量身定制的干预措施，以提高药物依从性并减少健康结果的差异。
To investigate the implications of a cancer diagnosis on medication adherence for pre-existing comorbid conditions, we explored statin adherence patterns prior to and following a new diagnosis of breast, colorectal or prostate cancer among a multi-ethnic cohort. We identified adults enrolled at Kaiser Permanente Northern California who were prevalent statin medication users, newly diagnosed with breast, colorectal or prostate cancer between 2000–2012. Statin adherence was measured using the proportion of days covered (PDC) during the two years pre-cancer diagnosis and the two years post-cancer diagnosis. Adherence patterns were assessed using generalized estimating equations, for all cancers combined and stratified by cancer type and race/ethnicity, adjusted for demographic, clinical, and tumor characteristics. Among 10,177 cancer patients, statin adherence decreased from pre- to postcancer diagnosis (Adjusted Odds Ratio (ORadj):0.91, 95% Confidence Interval (95% CI):0.88–0.94). Statin adherence decreased from pre- to post-cancer diagnosis among breast (ORadj:0.94, 95% CI:0.90–0.99) and colorectal (ORadj:0.79, 95% CI:0.74–0.85) cancer patients. No difference in adherence was observed among prostate cancer patients (ORadj:1.01, 95% CI:0.97–1.05). Prior to cancer diagnosis, adherence to statins was generally higher among non-Hispanic whites and multi-race patients than other groups. However, statin adherence after diagnosis decreased only among these two populations (ORadj:0.85, 95% CI:0.85–0.92 and ORadj:0.86, 95% CI:0.76–0.97), respectively. We found substantial variation in statin medication adherence following diagnosis by cancer type and race/ethnicity among a large cohort of prevalent statin users in an integrated health care setting. Improving our understanding of comorbidity management and polypharmacy across diverse cancer patient populations is warranted to develop tailored interventions that improve medication adherence and reduce disparities in health outcomes.
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