Endocrine Therapy Substantially Underutilized Among Low-Income Patients with Breast Cancer

Caroline Helwick

July 2012, Vol 3, No 5 - ASCO Annual Meeting


Chicago, IL—Researchers from the University of North Carolina in Chapel Hill reported at the 2012 American Society of Clinical Oncology meeting that endocrine therapy is substantially underutilized among the low-income breast cancer population.

For women with estrogen receptor (ER)-positive or progesterone receptor (PR)-positive disease, endocrine therapy reduces the 5-year recurrence risk by as much as 40%, but this study showed that low income may be an obstacle to receiving this guideline-recommended treatment.

Using Medicaid claims data matched to North Carolina Central Cancer Registry records, the researchers identified factors that predicted the use of guideline-recommended endocrine therapy among low-income women aged 18 to 64 years who were diagnosed with in situ stage I or stage II breast cancer be tween 2004 and 2007.

Of the 269 ER- or PR-positive women in this sample, only 49% filled a prescription for endocrine therapy within 15 months of diagnosis, reported Racquel E. Kohler, MSPH, Research Associate at the University of North Carolina, and colleagues.

Tamoxifen was the most common therapy among the 132 patients who received adjuvant endocrine therapy (59%). Less common therapies in – cluded anastrozole (18%), letrozole (10%), exemestane (2%), and multiple agents (11%).

In a multivariate analysis, the only factor significantly associated with receiving guideline-recommended en – docrine therapy was involvement in the Breast and Cervical Cancer Control Program (BCCCP; P = .01). On average, participating in the BCCCP was associated with a 29.9% increase in the likelihood of receiving endocrine treatment compared with women who were not in the BCCCP, controlling for other factors, Ms Kohler reported.

The BCCCP provides free or low-cost breast and cervical cancer screenings and follow-up to eligible women, mostly through local health departments, community health centers, hospitals, and private physicians’ offices.

Other independent variables were not significantly associated in the multivariate analysis; however, in the bivariate analysis, women who received endocrine therapy were more likely to receive radiation (64% vs 50% who did not get endocrine therapy) and to be enrolled in the BCCCP (29% vs 10%, respectively).

“Our results suggest that endocrine therapy is substantially underutilized in this low-income, vulnerable population, and that intervention efforts to improve its use may be important,” Ms Kohler pointed out.