Gender and Cost-related Medication Non-adherence

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Less than 8% of men and more than 12% of women reported CRN.
Less than 8% of men and more than 12% of women reported CRN.

Significant gender differences exist in cost-related medication non-adherence among survivors of cancer, even after controlling for differences in socioeconomic demographics, health status, and insurance coverage, according to a study published in the Journal of Cancer Survivorship.1

Cost-related non-adherence (CRN) is widely associated with treatment failure and increased health care costs. Spending on cancer treatments has grown significantly, and patients and their families are experiencing unprecedented out-of-pocket expenses related to diagnosis, treatment, and follow-up care.

Estimates of CRN range from 30% to 60% of patients. A growing number of studies are showing that CRN causes a range of health problems for chronically ill patients, including myocardial infarction, stroke, and death.

One study found that of 174 patients with cancer who responded to a cross-sectional survey, 89% reported employing a lifestyle-altering strategy, and 39% reported a care-altering strategy to cope with financial distress caused by the high cost of cancer treatment.2 Some patients resorted to CRN, while lifestyle-altering strategies included spending less on basic necessities (57% of patients), borrowing money (54%), or spending savings (50%).

While previous studies examined gender differences in diagnosis, treatment, and mortality among patients with cancer, gender differences in CRN remain poorly understood. The 2016 study  examined National Health Interview Survey (NHIS) self-reported CRN data from survivors of cancer. Significantly higher rates of CRN were noted among female survivors than males.

The researchers used NHIS data from 2006 through 2013 to produce a nationally representative sample that included 15,159 survivors (5713 men and 9446 women). Less than 8% of men and more than 12% of women reported CRN; the analysis found that CRN prevalence was highest for uninsured survivors and lowest for Medicare recipients. Gender differences persisted for all insurance types, including Medicare.

After controlling for relevant covariates including socioeconomic demographics, marital status, region, education level, health care coverage, and comorbidities, the researchers found that female cancer survivors were 27% more likely than male survivors to report CRN.

Inability to afford medication was reported by 40.8% of uninsured male cancer survivors and 48.9% of uninsured female cancer survivors. The number of reported comorbidities was strongly indicative of CRN: male and female cancer survivors with 4 or more comorbidities reported CRN nearly twice as often as those with 0 or 1 comorbidities.

Male survivors were more likely than female survivors to have higher insurance coverage, and the authors said it appeared that “the generosity of private insurance plans differs significantly” between male and female survivors.

RELATED: Determining the Role of Gender in Oncology Trial and Treatment Outcomes

The findings were consistent with those of 2 previous studies of gender-related CRN. One found that male patients with cancer were 46% less likely to report CRN than female patients, and the other that among Medicare recipients, females were 20% more likely to report CRN than males.3,4

One of the study's authors wrote that lack of access to medication among cancer survivors is “a critical public health problem,” especially given that the population of survivors is growing. They recommended close monitoring of CRN in high-risk groups, such as female cancer survivors and uninsured patients, and extending financial support and counseling to improve medication adherence among disadvantaged population groups.

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