COVID-19-Related Financial Hardship and Adherence to Adjuvant Endocrine Therapy Among Women With Early-Stage Breast Cancer

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.