Abstract P6-08-13: Statins and breast cancer recurrence: A population-based case-control study

Background: Breast cancer is the most common cancer among women and a significant number of women experience recurrence. Statins, drugs for lowering cholesterol, were introduced in 1987, and by 2011-12, 27.9% of U.S. adults over the age of 40 reported using cholesterol-lowering medication. Statins may impact other diseases, beyond cardiovascular disease, including cancer. Statin use and breast cancer recurrence or disease-free survival has previously been explored in 8 cohort studies and 1 case-control study with mixed results.

Methods: We designed a nested case-control study with Kaiser Permanente members in NW Oregon and SW Washington to examine the association between statins and breast cancer recurrence.

All subjects were women diagnosed with invasive breast cancer from 1980-2010. Subjects were KPNW health plan members at diagnosis, had local or regional stage cancer, were ER and/or PR positive, and were treated with tamoxifen for 180 days or more. Cases had breast cancer recurrence validated by medical record review. Controls were matched on race, SEER stage, age at diagnosis, year of diagnosis and pattern of health plan membership, and were recurrence-free for at least 12 months longer than their matched case (up to 3:1 match). The index date was the recurrence date for the case and the date for an equivalent period after diagnosis for the matched control. We collected data from medical records and from pharmacy, laboratory, tumor registry, and membership health plan databases.

We performed bivariate analysis to look at characteristics associated with recurrence. A priori, we identified potential confounding variables based on literature review and clinical knowledge. Using multivariable logistic regression analysis, we assessed statin use in relation to breast cancer recurrence, accounting for factors that may alter the association.

Results: We identified 306 cases with breast cancer recurrence and 679 matched controls. Thirty-five cases (11.4%) and 67 controls (9.9%) were prescribed statins at any time between their breast cancer diagnosis and index date. Nearly everyone on statins was prescribed lipophilic statins (99%). We calculated dose equivalents for all statins, using 20 mg of simvastatin as one dose. Among those who took statins, the average number of equivalent doses per day after diagnosis was 1.20 (1.19 for cases; 1.21 for controls) and the average duration of taking statins between diagnosis and recurrence was 2.65 years (2.75 for cases; 2.59 for controls). In our preliminary conditional analysis, we found that post-diagnostic statin use was not associated with a decreased odds of breast cancer recurrence (OR 1.37, 95% CI: 0.79-2.36) after adjusting for age, year of diagnosis, race, BMI, menopause status, tamoxifen use, type of surgery, treatment, smoking history, Charlson score, AJCC summary stage, and Nottingham grade.

Conclusions: While other studies have reported that statins may be associated with decreased odds of breast cancer recurrence, our preliminary multivariable analyses that looked at any statin use between diagnosis and index date do not support those results.

Citation Format: Vandermeer ML, Francisco MC, Richert-Boe KE, Jenkins CL, Weinmann S. Statins and breast cancer recurrence: A population-based case-control study [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P6-08-13.

Patient-centered priorities for improving medication management and adherence

OBJECTIVE

The Centers for Education and Research on Therapeutics convened a workshop to examine the scientific evidence on medication adherence interventions from the patient-centered perspective and to explore the potential of patient-centered medication management to improve chronic disease treatment.

METHODS

Patients, providers, researchers, and other stakeholders (N = 28) identified and prioritized ideas for future research and practice. We analyzed stakeholder voting on priorities and reviewed themes in workshop discussions.

RESULTS

Ten priority areas emerged. Three areas were highly rated by all stakeholder groups: creating tools and systems to facilitate and evaluate patient-centered medication management plans; developing training on patient-centered prescribing for providers; and increasing patients' knowledge about medication management. However, priorities differed across stakeholder groups. Notably, patients prioritized using peer support to improve medication management while researchers did not.

CONCLUSION

Engaging multiple stakeholders in setting a patient-centered research agenda and broadening the scope of adherence interventions to include other aspects of medication management resulted in priorities outside the traditional scope of adherence research.

PRACTICE IMPLICATIONS

Workshop participants recognized the potential benefits of patient-centered medication management but also identified many challenges to implementation that require additional research and innovation.

Patient-centered interventions to improve medication management and adherence: a qualitative review of research findings

OBJECTIVE

Patient-centered approaches to improving medication adherence hold promise, but evidence of their effectiveness is unclear. This review reports the current state of scientific research around interventions to improve medication management through four patient-centered domains: shared decision-making, methods to enhance effective prescribing, systems for eliciting and acting on patient feedback about medication use and treatment goals, and medication-taking behavior.

METHODS

We reviewed literature on interventions that fell into these domains and were published between January 2007 and May 2013. Two reviewers abstracted information and categorized studies by intervention type.

RESULTS

We identified 60 studies, of which 40% focused on patient education. Other intervention types included augmented pharmacy services, decision aids, shared decision-making, and clinical review of patient adherence. Medication adherence was an outcome in most (70%) of the studies, although 50% also examined patient-centered outcomes.

CONCLUSIONS

We identified a large number of medication management interventions that incorporated patient-centered care and improved patient outcomes. We were unable to determine whether these interventions are more effective than traditional medication adherence interventions.

PRACTICE IMPLICATIONS

Additional research is needed to identify effective and feasible approaches to incorporate patient-centeredness into the medication management processes of the current health care system, if appropriate.

Association between use of statins and mortality among patients hospitalized with laboratory-confirmed influenza virus infections: a multistate study

BACKGROUND

Statins may have anti-inflammatory and immunomodulatory effects that could reduce the risk of mortality from influenza virus infections.

METHODS

The Centers for Disease Control and Prevention's Emerging Infections Program conducts active surveillance for persons hospitalized with laboratory-confirmed influenza in 59 counties in 10 states. We analyzed data for hospitalized adults during the 2007-2008 influenza season to evaluate the association between receiving statins and influenza-related death.

RESULTS

We identified 3043 patients hospitalized with laboratory-confirmed influenza, of whom 1013 (33.3%) received statins and 151 (5.0%) died within 30 days of their influenza test. Patients who received statins were more likely to be older, male, and white; to suffer from cardiovascular, metabolic, renal, and chronic lung disease; and to have been vaccinated against influenza that season. In a multivariable logistic regression model, administration of statins prior to or during hospitalization was associated with a protective odds of death (adjusted odds ratio, 0.59 [95% confidence interval, .38-.92]) when adjusting for age; race; cardiovascular, lung, and renal disease; influenza vaccination; and antiviral administration.

CONCLUSIONS

Statin use may be associated with reduced mortality in patients hospitalized with influenza.