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Objective Poor adherence to oral chemotherapy adversely impacts clinical outcomes and escalates overall healthcare costs. Despite barriers to medication adherence, a significant gap remains in assessing adherence to oral chemotherapy among multiple myeloma (MM) patients with lower socioeconomic status. Hence, our study aims to evaluate immunomodulator adherence in MM patients at a county hospital, primarily serving underrepresented and indigent individuals with low socioeconomic status across the greater Houston area. Methods Inclusion criteria composed of patients diagnosed with MM, aged at least 18 years, and treated with lenalidomide or pomalidomide—two widely used immunomodulators—for a minimum of 2 months or having two or more records of dispensation between May 2019 and May 2021. Adherence was gauged using an adjusted version of the medication possession ratio (MPR). Results Sixty-two patients were enrolled, yielding a mean MPR value of 88% (SD, ± 18.9). Of these, 43 patients (69.3%) demonstrated adherence with an MPR of ≥ 0.90. A significant difference was found in treatment duration between the adherent (mean 8.8 months; SD, ± 7.2) and non-adherent (mean 13.4 months; SD, ± 7.9) groups ( p  = 0.027). Notably, race/ethnicity demonstrated a significant difference ( p  = 0.048), driven by disparities in African American and Hispanic representation across adherence levels. Conclusion In summary, our findings highlight race and treatment duration to be predictors of immunomodulator adherence among MM patients with lower socioeconomic status. Further research is imperative to devise and test innovative interventions aimed at enhancing medication adherence, thereby contributing to improved survival and healthcare quality in this population.

BackgroundAdherence to oral endocrine therapy (OET) is crucial in ensuring its maximum benefit in the prevention and treatment of hormone receptor-positive (HR +) breast cancer (BC). Medication use behavior is suboptimal especially in racial/ethnic minorities with lower socioeconomic status (SES).AimWe aimed to assess the impact of the coronavirus disease 2019 (COVID-19) pandemic on OET adherence and identify demographic and/or clinical characteristics associated with nonadherence in racial/ethnic minorities with lower SES.MethodA retrospective study was conducted at the Harris Health System in Houston, Texas. Data were collected during the 6 months before and 6 months after the start of the pandemic. The adherence was assessed using the prescription refill data using the proportion of days covered. A multivariable logistic regression model was used to identify demographic/clinical characteristics associated with nonadherence. Eighteen years or older patients on appropriate doses of OET for prevention or treatment of BC were included.ResultsIn 258 patients, adherence was significantly lower during the pandemic (44%) compared to before the pandemic (57%). The demographic/clinical characteristics associated with OET nonadherence before the pandemic were Black/African American, obesity/extreme obesity, prevention setting, tamoxifen therapy, and 4 or more years on OET. During the pandemic, prevention setting and those not using home delivery were more likely to be nonadherent.ConclusionOET adherence was significantly reduced during the COVID-19 pandemic in racial/ethnic minority patients with low SES. Patient-centered interventions are necessary to improve OET adherence in these patients.

Poor adherence to oral endocrine therapy (OET) is a significant problem among patients with hormone receptor-positive breast cancer as it results in higher risk of recurrence and mortality. Non-adherence to OET is prevalent among underserved patients, often attributable to socioeconomic factors and limited healthcare access. We evaluated OET adherence patterns over time using group-based trajectory modeling (GBTM) and identified predictors of suboptimal adherence trajectory among patients seen at Harris Health System, serving underserved patients in Houston, Texas. A single-center, retrospective study was conducted from October 2019 through December 2020. OET adherence was measured using proportion of days covered (PDC). A logistic GBTM was conducted using 2-5 adherence groups considering the Bayesian information criteria, clinical relevance, and a 5% minimum membership requirement. Multinomial logistic regression was used to assess the predictors of non-adherence trajectories. Among 496 patients, majority were Hispanic (62.50%) or African American (15.12%) and <65 years of age (82.66%). Four distinct adherence trajectories were identified: consistent high adherence (41.4%); constant PDC at ~0.6 (32.6%); rapid decline (14.6%); low adherence with gradual decline (11.5%). African Americans had higher likelihood of having low adherence with gradual decline [odds ratio (OR): 2.462 (confidence interval (CI): 1.1149-5.276), p=0.0205]. Patients with diabetes were more likely to have constant PDC at ~0.6 [OR: 1.714 (CI: 1.042-2.820), p=0.0338]. Longer time (4 or greater years) on therapy predicted low adherence with gradual decline [OR: 2.463 (CI: 1.266-4.793), p=0.008) and constant PDC at ~0.6 (OR: 1.966 (CI: 1.141-3.388), p=0.0149] trajectories. The identified predictors, including comorbidities like diabetes, African American descent, and longer OET treatment are crucial considerations when developing patient-centered interventions to enhance OET adherence among underserved populations. These insights can guide the implementation of initiatives such as mobile health applications, community-based educational programs, and financial aid efforts.