- Copyright © 2013 by American Society of Clinical Oncology
Financial Distress, Use of Cost-Coping Strategies, and Adherence to Prescription Medication Among Patients With Cancer
- Leah L. Zullig, PhD, MPH,
- Jeffrey M. Peppercorn, MD,
- Deborah Schrag, MD,
- Donald H. Taylor Jr, PhD,
- Ying Lu,
- Gregory Samsa, PhD,
- Amy P. Abernethy, MD and
- S. Yousuf Zafar, MD, MHS⇑
+ Author Affiliations
- 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
- Corresponding author: S. Yousuf Zafar, MD, MHS, Duke Cancer Institute, DUMC 3505, Durham, NC 27710; e-mail: Yousuf.firstname.lastname@example.org.
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.