The Association of COVID-19-Related Financial Difficulties and Adjuvant Endocrine Therapy Adherence in Women with Early-Stage Breast Cancer Pubblico

Abstract

The COVID-19 pandemic heightened risks to health and financial stability, particularly for breast cancer patients. Adjuvant endocrine therapy (AET), a daily medication , is highly effective at reducing breast cancer recurrence risk, but burdensome side effects and financial hardship contribute to low AET adherence. We used data from the THRIVE study, a randomized controlled clinical trial examining the effect of a web-based remote monitoring app, and an electronic pillbox to measure real-time AET adherence.  

Amid the pandemic, questions were added about COVID-related financial difficulty (CRFD), including changes/gaps in health insurance and difficulty accessing basic needs 12 months after study participation. Participants who reported any of these difficulties were categorized as having CRFD. Logistic regression analyses were used to estimate the association between sociodemographic characteristics and CRFD, as well as CRFD and AET adherence ( ≥ 80% adherence rate), controlling for sociodemographic and clinical characteristics.  

The analytic sample contained 217 THRIVE participants who completed the 12-month follow-up survey after CRFD questions were added: 52% of patients were AET adherent and 40% reported CRFD. Patients who reported CRFD were more likely to be 50-64 or 65-83 years old (Ref. 31-49 years) and have a household income below the federal poverty level. Adjusted results show that CRFD is associated with a 19.3 percentage-point decrease in the likelihood of being adherent (p=0.006). Black women were 16.9 percentage points less likely to be adherent (p=0.021). The financial and racial disparities in adherence must be addressed in the clinic. Lower AET adherence associated with CRFD may have implications for downstream health outcomes. New approaches are needed to screen and address financial difficulty, particularly in times of widespread economic distress.  

Table of Contents

TABLE OF CONTENTS  

1: INTRODUCTION......................................................................................................................3 2: BACKGROUND & LITERATURE REVIEW..........................................................................3 

3: METHODOLOGY: CONCEPTUAL FRAMEWORK..............................................................5 

Focal Relationship..............................................................................................................5 

Confounders........................................................................................................................5 

Testable hypotheses............................................................................................................7 

Data Description.................................................................................................................7 

Construct Measurement......................................................................................................8 

Analytic Plan.......................................................................................................................9 

Analytic Sample Derivation..............................................................................................10 

4: RESULTS.................................................................................................................................11 

Table 1: Bivariate Analyses..............................................................................................13 

Table 2: Regression of Financial Loss..............................................................................14 

Table 3: Regression of Changes/Gaps in Health Insurance..............................................15 

Table 4: Regression of Difficulty with Basic Supplies.....................................................16 

Table 5: Regression of any COVID-19-Related Financial Difficulties............................17 

Table 6: Regression of Distinct CRFD variables and Adherence.....................................19 

Table 7: Regression of any CRFD and Adherence...........................................................21 

Results Summary..............................................................................................................23 

5: DISCUSSION...........................................................................................................................24 

About this Master's Thesis

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School	Rollins School of Public Health
Department	Health Policy and Management
Degree	M.S.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
Parola chiave	COVID-19 Breast Cancer Adherence Adjuvant Endocrine Therapy Financial Hardship
Committee Chair / Thesis Advisor	Ilana Graetz , Emory University
Committee Members	Peter Joski , Emory University Joseph Lipscomb , Emory University

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