{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T19:48:28Z","timestamp":1784576908441,"version":"3.55.0"},"reference-count":39,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2017,10,4]],"date-time":"2017-10-04T00:00:00Z","timestamp":1507075200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100007314","name":"Duncan Family Institute","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100007314","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000133","name":"Agency for Healthcare Research and Quality","doi-asserted-by":"publisher","award":["R01 HS020263"],"award-info":[{"award-number":["R01 HS020263"]}],"id":[{"id":"10.13039\/100000133","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000054","name":"National Cancer Institute","doi-asserted-by":"publisher","award":["R01 CA207216"],"award-info":[{"award-number":["R01 CA207216"]}],"id":[{"id":"10.13039\/100000054","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancer"],"published-print":{"date-parts":[[2018,1,15]]},"abstract":"<jats:sec><jats:title>BACKGROUND<\/jats:title><jats:p>Tyrosine kinase inhibitors (TKIs) improve the survival of patients with chronic myeloid leukemia (CML) dramatically; however, nonadherence to TKI therapy may lead to resistance to the therapy. TKIs are very expensive and are covered under Part D insurance for Medicare patients. To the authors' knowledge, the impact of low\u2010income subsidy status and cost sharing on adherence among this group has not been well studied in the literature.<\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS<\/jats:title><jats:p>Surveillance, Epidemiology, and End Results (SEER) registry data linked with Medicare Part D data from the years 2007 through 2012 were used in the current study. The authors identified 836 patients with CML with Medicare Part D insurance coverage who were new TKI users. Treatment nonadherence was defined as a binary variable indicating the percentage of days covered was &lt;80% during the 180\u2010day period after the initiation of TKI therapy. Logistic regression was used to examine the relationship between out\u2010of\u2010pocket costs per 30\u2010day drug supply, Medicare Part D plan characteristics, and treatment adherence while controlling for other patient characteristics.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p>Overall, 244 of the 836 patients with CML (29%) were nonadherent to targeted oral therapy during the 180 days after the initiation of treatment with TKIs. The multivariable logistic regression demonstrated that patients with heavily subsidized (odds ratio, 6.7; 95% confidence interval, 2.8\u201015.9) and moderately subsidized (odds ratio, 3.0; 95% confidence interval, 1.4\u20106.5) Medicare Part D plans were much more likely to demonstrate nonadherence compared with patients without a subsidy.<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS<\/jats:title><jats:p>The current population\u2010based study found a significantly higher rate of nonadherence among heavily subsidized patients with substantially lower out\u2010of\u2010pocket costs, which suggests that future research is needed to help lower the nonadherence rate among these individuals. <jats:bold><jats:italic>Cancer<\/jats:italic> 2018;124:364\u201073<\/jats:bold>. \u00a9 <jats:italic>2017 American Cancer Society<\/jats:italic>.<\/jats:p><\/jats:sec>","DOI":"10.1002\/cncr.31050","type":"journal-article","created":{"date-parts":[[2017,10,4]],"date-time":"2017-10-04T11:16:44Z","timestamp":1507115804000},"page":"364-373","source":"Crossref","is-referenced-by-count":33,"title":["Adherence to tyrosine kinase inhibitors among Medicare Part D beneficiaries with chronic myeloid leukemia"],"prefix":"10.1002","volume":"124","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5463-3872","authenticated-orcid":false,"given":"Chan","family":"Shen","sequence":"first","affiliation":[{"name":"Department of Health Services Research The University of Texas MD Anderson Cancer Center Houston Texas"},{"name":"Department of Biostatistics The University of Texas MD Anderson Cancer Center Houston Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bo","family":"Zhao","sequence":"additional","affiliation":[{"name":"Department of Health Services Research The University of Texas MD Anderson Cancer Center Houston Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lei","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Preventive Medicine Northwestern University Chicago Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ya\u2010Chen Tina","family":"Shih","sequence":"additional","affiliation":[{"name":"Department of Health Services Research The University of Texas MD Anderson Cancer Center Houston Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2017,10,4]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"crossref","first-page":"294","DOI":"10.1097\/PPO.0000000000000135","article-title":"Targeted therapy for cancer in the genomic era","volume":"21","author":"Afghahi A","year":"2015","journal-title":"Cancer J."},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/djr060"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/PPO.0b013e31823dec8d"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.25656"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2010-10-309807"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2009.26.3087"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2014.58.2320"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.2165\/00019053-200725060-00004"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clml.2015.07.647"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1185\/03007990903396469"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2010.33.3179"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.291.19.2344"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMsa030954"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1001\/archpsyc.62.4.435"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2013.52.9123"},{"key":"e_1_2_8_17_1","volume-title":"SEER Cancer Statistics Review, 1975\u20102012","author":"Howlader N","year":"2015"},{"key":"e_1_2_8_18_1","unstructured":"Medicare Payment Advisory Commission.Report to the Congress: Medicare payment policy.http:\/\/www.medpac.gov\/documents\/reports\/chapter\u201014\u2010status\u2010report\u2010on\u2010part\u2010d\u2010(march\u20102015\u2010report).pdf. Accessed August 10 2017."},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12913-014-0665-3"},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.1002\/phar.1502"},{"key":"e_1_2_8_21_1","first-page":"188","article-title":"Impact of cost sharing on specialty drug utilization and outcomes: a review of the evidence and future directions","volume":"22","author":"Doshi JA","year":"2016","journal-title":"Am J Manag Care."},{"issue":"4","key":"e_1_2_8_22_1","first-page":"s78","article-title":"High cost sharing and specialty drug initiation under Medicare Part D: a case study in patients with newly diagnosed chronic myeloid leukemia","volume":"22","author":"Doshi JA","year":"2016","journal-title":"Am J Manag Care."},{"key":"e_1_2_8_23_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2016.67.4184"},{"key":"e_1_2_8_24_1","unstructured":"National Cancer Institute Surveillance Epidemiology and End Results (SEER) Program.Site Recode ICD\u2010O\u20103\/WHO 2008 Definition.https:\/\/seer.cancer.gov\/siterecode\/icdo3_dwhoheme\/index.html. Accessed August 10 2017."},{"key":"e_1_2_8_25_1","doi-asserted-by":"publisher","DOI":"10.1345\/aph.1H018"},{"key":"e_1_2_8_26_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11899-016-0325-2"},{"key":"e_1_2_8_27_1","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2014.302490"},{"key":"e_1_2_8_28_1","doi-asserted-by":"publisher","DOI":"10.1159\/000345722"},{"key":"e_1_2_8_29_1","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/94.9.652"},{"key":"e_1_2_8_30_1","doi-asserted-by":"publisher","DOI":"10.3322\/caac.20004"},{"key":"e_1_2_8_31_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.leukres.2012.01.021"},{"key":"e_1_2_8_32_1","doi-asserted-by":"publisher","DOI":"10.1038\/bjc.2012.348"},{"key":"e_1_2_8_33_1","doi-asserted-by":"crossref","first-page":"122","DOI":"10.1186\/s12885-017-3110-2","article-title":"Supporting adherence to oral anticancer agents: clinical practice and clues to improve care provided by physicians, nurse practitioners, nurses and pharmacists","volume":"17","author":"Timmers L","year":"2017","journal-title":"BMC Cancer."},{"key":"e_1_2_8_34_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.soncn.2011.02.005"},{"issue":"15","key":"e_1_2_8_35_1","doi-asserted-by":"crossref","first-page":"e11067","DOI":"10.1200\/jco.2012.30.15_suppl.e11067","article-title":"Retrospective study of predictors and consequences of nonadherence with lapatinib (LAP) in women with metastatic breast cancer (MBC) who were previously treated with trastuzumab","volume":"30","author":"Kartashov A","year":"2012","journal-title":"J Clin Oncol."},{"key":"e_1_2_8_36_1","first-page":"231","article-title":"Adherence to targeted oral anticancer medications","volume":"15","author":"Geynisman DM","year":"2013","journal-title":"Discov Med."},{"key":"e_1_2_8_37_1","doi-asserted-by":"publisher","DOI":"10.18553\/jmcp.2016.22.1.63"},{"key":"e_1_2_8_38_1","unstructured":"American Society of Clinical Oncology.Financial considerations.http:\/\/www.cancer.net\/navigating\u2010cancer\u2010care\/financial\u2010considerations\/financial\u2010resources. Accessed August 10 2017."},{"key":"e_1_2_8_39_1","unstructured":"CancerCare.Sources of financial assistance.https:\/\/www.cancercare.org\/publications\/62-sources_of_financial_assistance. Accessed August 10 2017."},{"key":"e_1_2_8_40_1","unstructured":"American Cancer Society.Help paying for prescription drugs.https:\/\/www.cancer.org\/treatment\/finding\u2010and\u2010paying\u2010for\u2010treatment\/understanding\u2010health\u2010insurance\/if\u2010you\u2010have\u2010trouble\u2010paying\u2010a\u2010bill\/prescription\u2010drug\u2010assistance\u2010programs.html. Accessed August 10 2017."}],"container-title":["Cancer"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Fcncr.31050","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/acsjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/cncr.31050","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,12]],"date-time":"2025-10-12T14:54:54Z","timestamp":1760280894000},"score":1,"resource":{"primary":{"URL":"https:\/\/acsjournals.onlinelibrary.wiley.com\/doi\/10.1002\/cncr.31050"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,10,4]]},"references-count":39,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2018,1,15]]}},"alternative-id":["10.1002\/cncr.31050"],"URL":"https:\/\/doi.org\/10.1002\/cncr.31050","archive":["Portico"],"relation":{},"ISSN":["0008-543X","1097-0142"],"issn-type":[{"value":"0008-543X","type":"print"},{"value":"1097-0142","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,10,4]]}}}