ArticleResearch in social & administrative pharmacy : RSAP
Geographic disparities in adherence to adjuvant endocrine therapy in Appalachian women with breast cancer.
Article in Research in social & administrative pharmacy : RSAP. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers.
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Who cites it
14 citing papers in PubMed.
- The RESILIENT Study: A Retrospective, Descriptive, Correlational Investigation of Correlates of Oral Endocrine Therapy Adherence in Older Women With Breast Cancer.Cancer medicine · 2026Article
- Principles to promote social equality across the cancer trajectory: A group concept mapping study.Acta oncologica (Stockholm, Sweden) · 2025Article
- Geographic Access to Cancer Care and Breast Cancer Treatment in Low-Income Women.Medical care · 2025Article
- Investigation of Factors Affecting Adherence to Adjuvant Hormone Therapy in Early-Stage Breast Cancer Patients: A Comprehensive Systematic Review.Journal of breast cancer · 2023Article
- Association of Endocrine Therapy Initiation Timeliness With Adherence and Continuation in Low-Income Women With Breast Cancer.JAMA network open · 2022Article
- Geographic variation in and contextual factors related to biguanide adherence amongst medicaid enrolees with type 2 Diabetes Mellitus.SSM - population health · 2022Article
- Race and Patient-reported Symptoms in Adherence to Adjuvant Endocrine Therapy: A Report from the Women's Hormonal Initiation and Persistence Study.Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology · 2021Article
- Sociodemographic, clinical, psychosocial, and healthcare-related factors associated with beliefs about adjuvant endocrine therapy among breast cancer survivors.Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer · 2020Article
- Article
- Determinants of Primary Nonadherence to Medications Prescribed by General Practitioners Among Adults in Hungary: Cross-Sectional Evaluation of Health Insurance Data.Frontiers in pharmacology · 2019Article
- Oncologists' perspectives on adherence/non-adherence to adjuvant endocrine therapy and management strategies in women with breast cancer.Patient preference and adherence · 2019Article
- Promise of Mobile Health Technology to Reduce Disparities in Patients With Cancer and Survivors.JCO clinical cancer informatics · 2018Review
- Observational
- The Association of Oncology Provider Density With Black-White Disparities in Cancer Mortality in US Counties.Cancer control : journal of the Moffitt Cancer CenterArticle
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6 authors.
Funding
Abstract
backgroundAppalachia is a largely rural, mountainous, poor and underserved region of the United States. Adherence to adjuvant endocrine therapy among Appalachian women with breast cancer is suboptimal.
objectivesTo explore small-area geographic variations and clustering patterns of breast cancer patient adherence to adjuvant endocrine therapy and associated factors in Appalachia.
methodsIn this retrospective study, we analyzed Medicare claims data linked with cancer registries from four Appalachian states (PA, OH, KY, and NC) in 2006-2008. We included adult women who were diagnosed with stage I-III, hormone-receptor positive, primary breast cancer and who newly started adjuvant endocrine therapy after the primary treatment for breast cancer. Hot spot analysis was conducted to explore geographic variations in adjuvant endocrine therapy adherence. Geographically weighted logistic regression (GWLR) was used to examine whether the impacts of factors associated with adherence varied across the region.
resultsBreast cancer patients living in PA and OH showed higher adherence to adjuvant endocrine therapy than those living in KY and NC. We identified clusters of high adherence in most of PA but poor adherence in Erie County, PA and in Buncombe, Transylvania, Henderson, and Polk Counties, NC. Adherence to adjuvant endocrine therapy was significantly associated with the Health Professional Shortage Area designation, catastrophic coverage, dual-eligibility status of Medicaid and Medicare, adjuvant endocrine therapy drug class, and side effects. And among these factors, the impacts of dual-eligibility status and the use of pain medications to treat side effects on adherence were more pronounced in KY and NC than in PA.
conclusionsThere were significant geographic disparities in adherence to adjuvant endocrine therapy in the Appalachian counties in PA, OH, KY, and NC. This study explored these geographic areas with poor adherence as well as geographically varying effects of predictors on adherence; our results may provide more localized information that may be used to improve adjuvant therapy use and breast cancer care in these high-risk and underserved areas.
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