Objectives

A cancer diagnosis can influence medication adherence for chronic conditions by shifting care priorities or reinforcing disease prevention. This study describes changes in adherence to medications for treating three common chronic conditions – diabetes, hyperlipidemia, and hypertension – among older adults newly diagnosed with non-metastatic breast, colorectal, lung, or prostate cancer.

Methods

We identified Medicare beneficiaries aged ≥66 years newly diagnosed with cancer and using medication for at least one chronic condition, and similar cohorts of matched individuals without cancer. To assess medication adherence, proportion of days covered (PDC) was measured in six-month windows starting six-months before through 24 months following cancer diagnosis or matched index date. Generalized estimating equations were used to estimate difference-in-differences (DID) comparing changes in PDCs across cohorts using the pre-diagnosis window as the referent. Analyses were run separately for each cancer type-chronic condition combination.

Results

Across cancer types and non-cancer cohorts, adherence was highest for anti-hypertensives (90–92%) and lowest for statins (77–79%). In older adults with colorectal and lung cancer, adherence to anti-diabetics and statins declined post-diagnosis compared with the matched non-cancer cohorts, with estimates ranging from a DID of −2 to −4%. In older adults with breast and prostate cancer cohorts, changes in adherence for all medications were similar to non-cancer cohorts.

Conclusion

Our findings highlight variation in medication adherence by cancer type and chronic condition. As many older adults with early stage cancer eventually die from non-cancer causes, it is imperative that cancer survivorship interventions emphasize medication adherence for other chronic conditions.

中文翻译：

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患有癌症的老年人与匹配的无癌症人群相比，长期药物依从性的变化。

 目标

癌症诊断可以通过改变护理重点或加强疾病预防来影响慢性病的药物依从性。这项研究描述了新诊断出患有非转移性乳腺癌、结直肠癌、肺癌或前列腺癌的老年人对治疗三种常见慢性病（糖尿病、高脂血症和高血压）的药物依从性的变化。

 方法

我们确定了年龄 ≥ 66 岁的 Medicare 受益人，他们新近被诊断出患有癌症，并且正在使用药物治疗至少一种慢性病，以及类似的匹配的没有癌症的个体队列。为了评估药物依从性，在六个月窗口内测量覆盖天数比例 (PDC)，从癌症诊断前 6 个月到癌症诊断或匹配索引日期后 24 个月。使用广义估计方程来估计双重差分 (DID)，以预诊断窗口为参考，比较各队列中 PDC 的变化。对每种癌症类型-慢性病组合分别进行分析。

 结果

在癌症类型和非癌症队列中，抗高血压药物的依从性最高（90-92%），他汀类药物的依从性最低（77-79%）。在患有结直肠癌和肺癌的老年人中，与匹配的非癌症队列相比，诊断后对抗糖尿病药物和他汀类药物的依从性下降，估计 DID 为 -2% 至 -4%。在患有乳腺癌和前列腺癌的老年人队列中，所有药物的依从性变化与非癌症队列相似。

 结论

我们的研究结果强调了不同癌症类型和慢性病的药物依从性的差异。由于许多患有早期癌症的老年人最终死于非癌症原因，因此癌症生存干预措施必须强调对其他慢性病的药物依从性。