Hormone therapy – who takes it – the rich or the poor?.

Abstract

Abstract Abstract #5093 Introduction: In the UK, hormone therapy is provided to all breast cancer patients for a standard NHS prescription charge (approximately USD13 per month). Previous studies in the USA and the UK have shown that only 60% of patients comply fully with prescribed therapy. This study examines the effects of age, drug type, prognosis and social deprivation on hormone therapy compliance.
 Method: During scheduled outpatient appointments data was collected from patients as part of their routine follow-up. Parameters included: age, name of drug, time on drug, drug compliance (full; deviation – missing <1 pill/week; holiday – missing pills > 1 week; stopped), and side effects (subjective – mild; moderate; severe). Prognostic information was derived using the Nottingham Prognostic Index (NPI). The patients' home postal codes were collected and allocated to the correct electoral ward (small geographical areas with average population of 5500). Using data from the UK National Census in 2000, information on social status was derived from the patients' postal codes and given as the Index of Multiple Deprivation (ID2000). The ID2000 has both an ID2000 score and ID2000 ranking (1 to 8414) for different electoral wards across England & Wales. Low ID2000 scores and high ID2000 rankings correspond to areas of affluence. Patients in ID2000 rankings <4212 were assigned as 'deprived' and >4212 as 'affluent'. The predominant social grade for each ward was recorded (AB, C1, C2, D and E).
 Results: To date, 117 patients have been analysed. The ID2000 ranks ranged from 1033 to 8297. Ninety two (89%) of patients were fully compliant, 5 (5%) deviated, 2 (2%) took a holiday and 4 (4%) stopped taking their hormone treatment. Compliance was significantly better for those taking an aromatase inhibitor (AI) (96.7%) than tamoxifen (80.5%) (Chi2 test Chi2 = 7.147. p = 0.0075). Compliance is unaffected by affluence (92.5%) v deprivation (80.9%) (Chi2 test Chi2 = 2.486, p=0.11). Compliance is also unaffected by NPI (Mann Whitney U test p=0.84) and age (Mann Whitney U test p=0.78).
 Conclusion: These early data suggest that hormone drug compliance in our centre is higher than previously reported. Compliance is significantly higher for aromatase inhibitors than tamoxifen; currently there is no discernable difference between individual AIs. Compliance appears higher in affluent patients; however this is not statistically significant. Compliance appears to be independent of age, duration of therapy and prognosis. This study is ongoing and further work comparing different areas is recommended. Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 5093.