COVID ‐19‐Related Financial Hardship and Adherence to Adjuvant Endocrine Therapy Among Women With Early‐Stage Breast Cancer
研究分析了217名早期乳腺癌女性在新冠疫情中遭遇的经济困难（如收入损失、保险中断）与一年内辅助内分泌治疗依从性的关联，发现经历困难的患者依从性显著更低，尤其低收入和曾接受放化疗者受影响更大。
OBJECTIVE: To examine the association between COVID-19-related hardship and 1-year adjuvant endocrine therapy (AET) adherence among women with early-stage hormone-receptor-positive breast cancer. STUDY SETTING AND DESIGN: This post hoc analysis utilized data from the THRIVE trial, which tested a 6-month remote monitoring intervention on 1-year AET adherence, measured using an electronic pillbox. The 1-year follow-up survey included questions about pandemic-related hardship, including financial loss, changes/gaps in health insurance, and difficulty accessing basic needs. Participants reporting any of these were categorized as experiencing pandemic-related hardship. Logistic regressions estimated the association between patient characteristics and pandemic-related hardship, and between hardship and AET adherence (≥ 80% proportion of days covered), controlling for patient characteristics and randomization group. DATA SOURCES AND ANALYTIC SAMPLE: We included 217 women diagnosed with early-stage breast cancer prescribed AET at a large cancer center who enrolled in THRIVE between April 2019 and June 2021. PRINCIPAL FINDINGS: Overall, 39.6% of participants reported any pandemic-related hardship: 34.6% reported financial loss, 10.6% reported changes/gaps in insurance, and 11.1% reported difficulty accessing basic needs. In adjusted analyses, having an income ≤ 100% of federal poverty level or prior chemotherapy or radiation was associated with a 41.4 (95% CI: 9.8-73.0) and 13.8 (95% CI: 0.3-27.2) percentage-point higher likelihood, respectively, of having any pandemic-related hardship. Over half (52%) of participants were AET adherent. In adjusted analyses, 40.1% of those with any pandemic-related hardship were AET adherent, compared with 59.5% of those without hardship, a 19.3 percentage-point lower likelihood (95% CI: -33.0 to -5.7). CONCLUSIONS: Pandemic-related hardship was more common among individuals with lower income or prior radiation or chemotherapy, and was associated with lower AET adherence, with possible impacts on cancer progression and survival. These findings highlight the need for routine financial screening and targeted support, particularly among lower-income patients on long-term AET. TRIAL REGISTRATION: NCT03592771.