(122) Trends and Characteristics Associated with Nonadherence to Antidepressants Among Breast Cancer Survivors with Depression

Saturday, August 27, 2022

8:00 AM – 6:00 PM CEST

Location: Hall C

Publication Number: 796

Presenting Author(s)

Weihsuan Jenny Lo-Ciganic, PhD
– Associate Professor, University of Florida Department of Pharmaceutical Outcomes and Policy, Gainesville, Florida, United States

Co-Author(s)

Ching-Yuan Chang
– Department of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida, United States
Juan Hincapie-Castillo, PharmD, MS, PhD
– Assistant Professor, University of North Carolina at Chapel Hill, Durham, North Carolina, United States
Haesuk Park
– University of Florida, University of Florida, Gainesville, Florida, United States
Coy Heldermon, M.D., Ph.D.
– Associate professor, Department of Medicine, College of Medicine, University of Florida, United States
Vakaramoko Diaby, Ph.D., M.Sc.,
– Assistant Professor, Department of Pharmaceutical Outcomes & Policy, University of Florida, University of Florida, United States
Seonkyeong Yang
– Department of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida, Gainesville, Florida, United States
Debbie Wilson, PhD, RN
– Affiliate Clinical Assistant Professor, Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, United States

Background: Breast cancer (BC) is the most diagnosed cancer in the United States. Over 16% of BC survivors suffer from major depressive disorders. Health Plan Employer Data and Information Set (HEDIS) recommends uninterrupted antidepressant treatment in both acute- and continuation-phases after initiating antidepressants in general populations. Nonadherence to antidepressants may impact adherence to BC treatment, leading to BC recurrence and other adverse outcomes.

Objectives: We examined the trends and characteristics associated with nonadherence to antidepressants among BC survivors with depression.

Methods: We conducted repeated cross-sectional analyses of the Surveillance, Epidemiology and End Results (SEER) linked Medicare data (2010-2019) for women with BC and depression newly initiating antidepressants. Using HEDIS measures of nonadherence (≤84 days of prescription coverage within 114-day acute-phase; ≤180 days of prescription coverage within 231-day continuation-phase), we calculated the annual crude prevalence of antidepressant nonadherence among those initiating antidepressants and examined trends using Cochran-Armitage tests. We used multivariable logistic regression to identify associated characteristics.

Results: Among 9,452 eligible BC survivors with depression (age≥65=84%,White=82%), antidepressant-nonadherence prevalence decreased significantly in acute (2010:49%;2019:40%) and continuation phases (67%;57%) from 2010-2019. Factors significantly associated with higher odds of antidepressant nonadherence included: Black race [odds ratios(ORs) for acute/continuation phases=1.8(95%CI=1.5-2.1)/1.9(95%CI=1.6-2.3)] and Hispanic [ORs=1.3(1.1-1.7)/2.2(1.6-2.9)] compared to Whites, receiving low-income subsidies and having dual Medicaid eligibility [ORs=1.1(1.1-1.3)/1.2(1.1-1.4)], and using antidepressants not recommended for older adults by Beers criteria [ORs=1.9(1.5-2.6)/2.0(1.5-2.8)]. Factors associated with lower odds of antidepressant nonadherence included: receiving endocrine therapy [ORs=0.9(0.8-0.9)/0.8(0.7-0.9)], switching across different antidepressants [ORs=0.8(0.7-0.9)/0.8(0.7-0.8)], and the year initiating antidepressants [2016:ORs=0.8(0.6-0.9)/0.8(0.7-0.9); 2017:ORs=0.7(0.6-0.9)/0.8(0.6-0.9); 2018:ORs=0.7(0.6-0.9)/0.8(0.6-0.9)] compared to 2010.

Conclusions: Despite antidepressant-nonadherence prevalence decreasing from 2010-2019, over half of BC Medicare survivors were nonadherent to antidepressants in the continuation phase over the study period. Patients characterized with identified non-adherence risk factors may benefit from close monitoring and targeted interventions.