March 20, 2015
(REAUTERS HEALTH) — Among early-stage breast cancer patients in the U.S., black women are less likely than white women to take their prescribed hormone medications, according to a new study that partly – but not entirely – blames economic disparities between races.
“If you are forced into a decision where it’s buying the medicine versus buying food for your family, that’s going to put people in a difficult spot.”
Black women are less likely to be diagnosed with breast cancer than white women, but more likely to die from it, a disparity that emerged in the 1980s and has widened ever since, the authors note in the introduction.
When it comes to hormone prescriptions, women with fewer financial resources and higher prescription drug co-pays, which are more common for black women, are less likely to stick to the therapy, according to the new study that was led by Dr. Dawn L. Hershman of Herbert Irving Comprehensive Cancer Center at Columbia University in New York.
For the study, Hershman's team used an insurance claims database including more than 10,000 women over age 50 who were diagnosed with early-stage breast cancer between 2007 and 2011 and given a prescription for aromatase inhibitors or tamoxifen, both hormonal therapies.
“(They) are extremely effective in reducing the risk of recurrence and the risk of new breast cancers in women diagnosed with hormone sensitive breast cancer,” Hershman told Reuters Health by email.
Less than ten percent of the women included were black and about 80 percent were white, according to the report in the Journal of Clinical Oncology.
One in four women were “non-adherent” to hormone therapy, meaning they had a supply of the drugs for less than 80 percent of the days for which they were prescribed.
About 71 percent of black patients maintained their hormone drug supply throughout treatment, compared to almost 77 percent of white patients. Black patients tended to have lower income, lower net worth and higher insurance co-pays, the authors found.
Before adjusting for economic factors, black women were 32 percent less likely to adhere to the hormonal medications. After adjusting for estimated net worth, which was provided by a third party data syndicator, that difference decreased to 19 percent.
Almost all women in the study had commercial insurance, but even with insurance many prescription cancer therapies require the patient to pay a fraction of the total cost out of pocket as a co-payment. About 30 percent of women in this database were paying less than $10 per month out of pocket for their hormones, another 30 percent paid between $10 and $20 per month, and almost 40 percent had to pay more than $20 per month.
“The total costs can range from $185 per month to $400 per month depending on if it is given in the generic or brand name form,” Hershman said.
“For most patients the issue is the co-payment amount which can be anything from $0 to the full cost of the drug, depending on the insurance plan.”
“The more and more that we drive up health care costs, the more we invite income disparities in terms of access to care,” said Dr. Leonard B. Saltz of Memorial Sloan Kettering Cancer Center in New York.
“As cancer care in particular and medical care generally gets more and more expensive, insurance can’t possibly cover everything,” Saltz, who wrote an editorial accompanying the new study, told Reuters Health.
“People are bearing a nontrivial cost themselves,” he said. “If you are forced into a decision where it’s buying the medicine versus buying food for your family, that’s going to put people in a difficult spot.”
The Affordable Care Act, which was implemented after these data were collected, should increase the number of women with health insurance, but the fact that insured women still have to pay these co-pays will not have changed, Hershman said.
Saltz noted that nothing in the Affordable Care Act addressed the rising cost of drugs, since the pharmaceutical lobby is the largest on Capitol Hill.
Beyond economics, insufficient patient education may explain the rest of the racial gap, Hershman said.
“Studies have shown that knowing the medicine works predicts both initiation of the medication and compliance,” Hershman said. “In addition, access may play a role, as patients need to see a physician for follow-up in order to get refills.”
There are many financial assistance programs available, though patients are often unaware of them, she said.
“Pharmaceutical companies have patient assistance programs to help reduce the copayment amount for patients in need,” she said. “In addition, there are some foundations for cancer survivors that can help with these issues.”