Abstract PO-203: How many breast cancer survivors in America forgo treatment due to cost?
Authors: Chagpar Anees B. 
Published: December 2020

Abstract
INTRODUCTION: Many breast cancer survivors are prescribed medications for at least 5 years to reduce recurrence risk, yet some will forego this treatment due to cost. We sought to elucidate the prevalence of this, and factors contributing to it. METHODS: The National Health Interview Survey is a population-based survey administered annually by the Centers for Disease Control and designed to be representative of the civilian non-institutionalized US population. We identified people diagnosed with breast cancer within the past 5 years and analyzed the proportion of these who did not take their medication as prescribed due to concerns over cost and factors associated with this. RESULTS: 24,858 people met our inclusion criteria in the 2018 survey, representing 244,607,304 people in the population. Of these, 6.32% stated that, within the past 12 months, they needed a prescription medicine but didn’t get it filled because they couldn’t afford it. Of those who had gotten a prescription within the past 12 months, 5.71%, 5.94% and 7.48% had either skipped doses, taken less medication than prescribed or delayed filling a prescription, respectively, to save money. 11.99% of people had done at least one (i.e., not filled the prescription, skipped doses, took less medication, or delayed filling the prescription) thereby foregoing treatment. On bivariate analyses, factors associated with foregoing treatment included age, race, education, family income, and insurance status (p&lt;0.001 for all). On multivariable analysis, age, race, family income and insurance status were all independent predictors of foregoing treatment (p&lt;0.001 for all); education status did not remain significant in the model (p=0.211). Those &gt; 25 years old were roughly twice as likely to forego treatment than those who were &lt; 26 (OR: 2.52; 95% CI: 2.01-3.16 and OR=1.98; 95% CI: 1.54-2.55 for those 26-65 and &gt; 65 years, respectively). Asians were half as likely to forego treatment than either White or Black patients (OR: 0.52, 95% CI: 0.37-0.71); however, Blacks were as likely as Whites to forego treatment in the model (OR=1.04; 95% CI: 0.89- 1.21, p=0.642). There was a negative correlation between income and the odds of foregoing treatment (OR=0.69; 95% CI: 0.60-0.80 and OR=0.30; 95% CI: 0.24-0.36 for those with incomes 2-4x poverty level and &gt; 4x poverty level, respectively, relative to family income &lt; 2x poverty level). Finally, those who had some form of insurance were significantly less likely to forego treatment than their uninsured counterparts (OR=0.44; 95% CI: 0.38-0.51). CONCLUSION: Roughly 12% of breast cancer survivors who are prescribed medications within the first 5 years of their diagnosis will either skip doses, take less medication, delay filling prescriptions or not fill them at all due to cost. Family income and insurance status are key modifiable drivers of this.
Current efforts to ensure drug affordability are inadequate to allow all patients access to needed medications.
Citation Format: Anees B. Chagpar. How many breast cancer survivors in America forgo treatment due to cost? [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-203.