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 (Reuters Health) - For overweight and obese older men and women,
adding calorie restriction to a resistance training schedule
improves at least some metabolic markers, according to a new study.
Researchers analyzed data on about 25,000 women who had breast
cancer surgery and at least one prescription for pills to curb
production of the hormone estrogen - which can fuel tumor growth -
or pills to stop estrogen from attaching to cancer cells.
Overall, 27 percent of these women received subsidies through a
Medicare program for low-income patients that eliminates or
substantially reduces out-of-pocket costs for premiums, co-payments,
deductibles and medications.
“We found that women with the subsidy (which also means they have
fewer financial resources) are more likely to take their medications
and continue treatment,” said lead study author Dr. Alana Biggers of
the University of Illinois- Chicago College of Medicine.
“Women who prematurely stop these therapies are at a higher risk for
the recurrence of breast cancer,” Biggers added by email.
All of the women in the study were at least 65 years old and
enrolled in a Medicare prescription drug plan known as Part D.
Researchers followed at least half of the women for more than two
years.
Overall, more than 77 percent of the women in the study continued on
hormone therapy one year after getting the first prescription and 64
percent were still taking the pills after two years, researchers
report in the Journal of Clinical Oncology.
About 77 percent of Hispanic women, 70 percent of black women and 21
percent of white women got a subsidy.
Without subsidies, Hispanic women were three times more likely to
discontinue their medication than their counterparts who got
financial assistance. Among black women, patients without subsidies
were slightly more than twice as likely to stop taking medicine,
while white women had 83 percent higher odds of stopping.
This is based on what researchers call “persistence,” or how often
prescriptions get filled.
Among unsubsidized women, black women were 31 percent more likely
than white women to discontinue medication within the first five
months. Hispanic women were 32 percent more likely than white women
to stop using the pills between 5 and 35 months.
But with subsidies, there wasn’t a meaningful difference between
black and white women. Hispanic women, meanwhile, became 20 percent
less likely than white women to discontinue medication.
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Limitations of the study include its observational design, which
means it’s possible other factors in addition to subsidies may have
influenced whether women stayed on their drugs, the authors note.
Even so, the results suggest that subsidies can help reduce
disparities in medication use and make it more likely that women
stick with their pills, the authors conclude.
“Black and Hispanic women were much more likely to have low-income
subsidies, and were also more likely to continue these important
medications,” said Dr. Nancy Keating, a health policy researcher at
Brigham and Women’s Hospital and Harvard University in Boston who
wasn’t involved in the study.
“This suggests that such subsidies might be helpful in lessening
disparities,” Keating added by email.
With subsidies, women may pay only a few dollars for a 90-day supply
of pills that might otherwise cost $100 to $200 out-of-pocket, noted
Stacie Dusetzina, a pharmacy researcher at the University of North
Carolina at Chapel Hill who wasn’t involved in the study.
Because women are encouraged to stay on these pills for at least
five years, stopping treatment early can result in worse outcomes
and lower survival odds, Dusetzina added by email.
Instead of stopping medication, women should see if they could
switch drugs or insurance plans, she advised.
“If costs are the primary reason for stopping therapy early then
women should be encouraged to talk with their doctors about
alternative treatments since the costs for these drugs vary widely,”
Dusetzina said. “They could also check with their health insurance
plans (Part D plans on Medicare) to find out if there is a cheaper
option available.”
SOURCE: http://bit.ly/2el8E8G Journal of Clinical Oncology, online
October 17, 2016.
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