Cost‐Related Medication Underuse and Coping Behaviors in Breast Cancer Survivors Taking Cardiovascular Risk Reduction Medication Enrolled in the National Institutes of Health All of us Research Program
Arnethea L. Sutton, Jian He, Robert A. Perera, Lakeshia Cousin, Keesha Powell‐Roach, Mandy J. Hill, Avirup Guha, Nickolas Stabellini, Paulette Omeaku, Teresa M. Salgado, Vanessa B. Sheppard, Wendy BottinorABSTRACT
Background
Breast cancer survivors are at increased risk of cardiovascular disease throughout survivorship. Recent studies documented suboptimal adherence to cardiovascular risk reduction medications, but studies identifying contributors to this behavior are lacking. The association between sociodemographic characteristics, social drivers of health factors, and cost‐related medication behaviors in survivors who were taking antihyperlipidemics or antihypertensives was evaluated.
Methods
These cross‐sectional analyses utilized data from the National Institutes of Health All of Us Research Program from May 31, 2017 to October 1, 2023. Cohort eligibility included identifying as Black/African American or White, being at least 18 years old, and having a diagnosis of breast cancer. The outcome, cost‐related medication underuse and coping behaviors, was assessed using a seven‐item scale. Bivariable and multivariable logistic regression models were used to evaluate the associations of covariates and the outcome for each of the cardiovascular risk medication classes.
Results
Compared to Black survivors, White survivors had higher odds of asking for lower‐cost medications among antihyperlipidemics users (pooled adjusted OR = 1.69; 95% CI: 1.18–2.40; FDR‐adjusted p = 0.012) and antihypertensives users (pooled adjusted OR = 2.03; 95% CI: 1.50–2.76; FDR‐adjusted p = 0.004). Survivors who reported greater social support were less likely to delay filling their prescription to save money when compared to survivors who reported lower social support.
Conclusions
Some survivors are more likely to engage in cost‐related coping and underuse behaviors than others. Clinicians, including primary care providers, should include discussions and resources about non‐cancer therapy adherence‐related financial challenges with their patients who are cancer survivors.