Impact of disease management programs on women with breast cancer in Germany.

Abstract

The aim of the study was to analyze the impact of disease management programs (DMPs) on adherence in women with breast cancer (BC) in Germany. Data on 4915 BC patients [1874 DMP and 3041 standard care (SC)] who started hormone therapy between 2008 and 2013 in 234 gynecological practices in Germany were analyzed retrospectively. The primary outcome measure was the rate of discontinuation of hormone therapy within 3 years of the start of treatment. Discontinuation of therapy was defined as a period of at least 90 days without treatment. A multivariate Cox regression model was created to determine the effect of DMPs on the risk of discontinuation. Region (western vs. eastern Germany), patient age, and concomitant diagnoses (depression, osteoporosis, thrombosis, and diabetes) were included as covariates. There was a significant difference between DMPs and SC in terms of age (63 ± 12 years vs. 64 ± 12 years, p value = 0.0012) and region (79.2% of patients living in western Germany vs. 88.6%, p value < 0.0001), but not initial therapy (51.8% vs. 52%, p value = 0.8696). Depression was also more common in patients in DMPs than those in SC (26.8% vs. 17.3%, p value < 0.0001). Within 3 years of therapy initiation, 32.7% of DMP patients and 39.6% of SC patients had discontinued their treatment (p < 0.001). Women with BC who were enrolled in a DMP had a lower risk of discontinuing therapy (HR = 0.91, 95% CI: 0.85-0.98, p value = 0.0092). This risk was also slightly higher in western Germany (HR = 1.13, 95% CI: 1.02-1.24, p value = 0.0143). Involvement in DMPs has a positive impact on the adherence of BC patients.