The RESILIENT Study: A Retrospective, Descriptive, Correlational Investigation of Rate and Correlates of Oral Endocrine Therapy Adherence in Older Women with Breast Cancer
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Breast cancer is the most prevalent and costly cancer among females. About 80% of breast cancer patients take oral endocrine therapy (OET), such as anastrozole, letrozole, tamoxifen, and exmestane. These medications increase survival, improve quality-of-life and decrease healthcare costs, yet many patients do not take it properly. The purpose of this study is to identify rates of and multi-level determinants influencing OET non-adherence (NA) among older women with breast cancer enrolled in Medicare Part-D. It is important to consider older women with breast cancer; the medium breast cancer patient age was 62 and more than 20% of newly diagnosed patients were older than 70 in 2021. Most existing research on OET-NA has been conducted on small samples at single sites and has focused predominantly on patient issues rather than exploring multi-level determinants. Despite their unique needs due to aging effects, there are no specific guidelines or known OET-NA determinants for older women with breast cancer. To resolve this, I utilized a large data set with theoretical frameworks (World Health Organization’s five-dimensional-model of factors and Bronfenbrenner’s ecological system theory) to understand multi-level determinants through a secondary data analysis of the Surveillance-Epidemiology-End-Results Medicare database (average age 69). All women in the database with a cancer diagnosis were identified using ICD-9 and ICD-10 codes in Medicare Part-D to identify ten years of OET-NA rates. I then focused on the most recently released data from 2019 to identify up-to-date trends in OET-NA determinants. Results demonstrated that OET-NA was significantly affected by (a) patient-related factors of ethnicity and psychological issues, (b) socioeconomic-related factors of marital status, and lifestyle, (c) therapy-related factors of switching OET medications and increased number of drug therapy experiences, (d) condition-related factors of cancer stage and comorbidities, and (e) health care team/system-related factors of characteristics of healthcare team and system. The first steps in developing interventions for better nursing practice based on strong theoretical frameworks were determining rates and multi-level determinants of OET-NA on older women. This study can also support the implementation of better nursing policies to improve patient education and OET adherence— ultimately decreasing morbidity and mortality, and increasing quality-of-life.
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Introduction -- Literature review -- Methods -- Results -- Discussion
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Ph.D. (Doctor of Philosophy)