Files
Abstract
Optimal medication use is critical for effective disease management, ensuring patient safety, and maximizing treatment benefits. However, numerous challenges hinder optimal use in routine clinical practice, with low adherence levels being a persistent issue. Medication-taking behavior is a complex phenomenon influenced by a range of factors, including patient characteristics (e.g., age, race, and socioeconomic status), treatment-related attributes (e.g., dosage form, regimen complexity, and duration), and healthcare system factors. The relative impact of these factors varies depending on the patient’s medical condition and treatment context. In oncology, consistent adherence to treatment is essential for achieving favorable outcomes, preventing disease progression, and ultimately saving lives. Breast cancer is the most commonly diagnosed malignancy among women worldwide, and endocrine therapy has played a fundamental role in its treatment for decades. However, significant disparities in treatment adherence and outcomes continue to persist. Based on an extensive literature review and analyses of multiple data sources, this dissertation comprises three interrelated projects that evaluate real-world adherence patterns, clinical outcomes, and adverse events associated with oral endocrine therapies, as well as assess the potential of telehealth as an intervention to improve breast cancer care.
The first project synthesizes evidence on endocrine therapy usage rates, effectiveness, side effects, and contributing factors among breast cancer patients in resource-limited settings. The second project examines the safety profile of endocrine therapies by analyzing reported adverse events in the FDA Adverse Event Reporting System (FAERS), highlighting risks that may affect medication adherence, impair quality of life, or pose life-threatening consequences. The third project uses administrative claims data to evaluate the impact of telehealth utilization on adherence to endocrine therapy, clinical outcomes, and healthcare expenditures in a commercially insured cohort of nonelderly women with breast cancer in the United States.
Collectively, these studies provide critical insights into the drivers of endocrine therapy nonadherence, associated patient outcomes, and safety concerns. Findings from this work inform future strategies aimed at improving breast cancer care, enhancing patient safety, and reducing health disparities across populations. Moreover, this dissertation underscores the promise of digital health interventions to strengthen healthcare delivery and promote patient-centered cancer management.