Financial Distress, Use of Cost-Coping Strategies, and Adherence to Prescription Medication Among Patients With Cancer

• Copyright © 2013 by American Society of Clinical Oncology

Financial Distress, Use of Cost-Coping Strategies, and Adherence to Prescription Medication Among Patients With Cancer

1. Leah L. Zullig, PhD, MPH,
2. Jeffrey M. Peppercorn, MD,
3. Deborah Schrag, MD,
4. Donald H. Taylor Jr, PhD,
5. Ying Lu,
6. Gregory Samsa, PhD,
7. Amy P. Abernethy, MD and
8. S. Yousuf Zafar, MD, MHS⇑

+ Author Affiliations

1. University of North Carolina, Chapel Hill; Durham Veterans Affairs Medical Center; Duke Cancer Institute; Duke Clinical Research Institute; Duke University, Durham, NC; Dana-Farber Cancer Institute, Boston, MA

1. Corresponding author: S. Yousuf Zafar, MD, MHS, Duke Cancer Institute, DUMC 3505, Durham, NC 27710; e-mail: Yousuf.zafar@duke.edu.

Abstract

Purpose: The relationship between prescription medication adherence and financial burden is understudied, particularly in patients seeking financial assistance.

Methods: We conducted a cross-sectional survey to examine the association between patient-reported prescription medication nonadherence and financial distress. Eligible patients were adults receiving treatment for solid malignancies enrolled between June 2010 and May 2011 from the HealthWell Foundation, a national copay assistance program. Nonadherence was defined as taking less medication than prescribed because of cost, not filling or partially filling a prescription because of cost, or taking medications prescribed for others. Logistic regression assessed associations between medication nonadherence and patient-reported, subjective financial distress.

Results: Among 164 participants, 45% reported cost-related medication nonadherence. Four percent took medications prescribed for another person, 22% took less medication than prescribed, 25% filled a partial prescription, and 27% did not fill a prescription, all as a result of cost. Nonadherent participants were more likely than adherent participants to reduce spending on basics like food and clothing to pay for medication (P = .01), and borrow and/or use credit to pay for medications (P < .01). In adjusted analyses, financial distress did not change odds of nonadherence (odds ratio [OR] = 1.60; 95% CI, 0.71 to 3.60). Having a prescription drug plan (OR = 0.27; 95% CI, 0.09 to 0.83) and older age (OR = 0.48; 95% CI, 0.27 to 0.85) decreased odds of nonadherence. Being unemployed increased odds of nonadherence (OR = 6.28; 95% CI, 1.60 to 24.64).

Conclusions: Cost-related medication nonadherence was prevalent among cancer patients who sought financial assistance. Further investigation is needed to understand predictors of prescription medication adherence, a key component of quality care.