Abstract
Abstract Background: One-third to one-half of patients prescribed adjuvant endocrine therapy with tamoxifen or an aromatase inhibitor either discontinue early or skip a substantial number of pills. Research to improve this has been disappointing. We investigated whether poor pharmacy synchronization of medications is an unrecognized barrier to adherence. Methods: A cohort of women aged 66-90 years old with Stage 0-3 hormone receptor-positive breast cancer were identified from the Surveillance, Epidemiology and End Result (SEER)-Medicare claims-linked cancer registry. Women with Medicare pharmacy claims documenting at least one endocrine therapy prescription fill and at least one other medication fill were identified, and the 3-month synchronization of their medication fills was calculated as the quotient of the number of pharmacy visits and the number of filled medications subtracted from one. Logistic regression was used to assess the association between synchronization stratified by the number of medications and adherence to endocrine therapy (defined as medication possession ratio >80%) over the subsequent year. Results: The study cohort included 3,112 women treated with endocrine therapy for breast cancer (Table 1) . Over 31% were age 70 or younger, and 38.0% had stage 2 or 3 disease. During the three months after the first endocrine therapy prescription, the mean number of unique medications was 8.0 (S.D. 6.0) and the mean number of pharmacy visits was 8.6 S.D. 4.7) for a mean synchronization of 0.3 ( (S.D. 0.2) . In adjusted model, compared with the highest synchronization, those in the lowest synchronization quantile were less likely to be adherent (MPR >=80%) (Odds Ratio 0.71 (95% CI 0.57, 0.88)) as were those in the second-lowest (0.81 (0.65, 0.99). Neither age nor race/ethnicity were associated with adherence, and results were unchanged with inclusion of information about duration of fills (30 vs 90 days). Conclusions: Prescription fill synchronization is strongly associated with adherence to endocrine therapy. Research into interventions to improve adherence should include prescription synchronization and other health systems barriers. Citation Format: Neuner JM, Fergestrom N, Nattinger AB, Laud PW, Pezzin L. Pharmacy refill synchronization and oral endocrine therapy adherence [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P1-08-17.
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