Justin Trogdon
Department of Health Policy and Management
University of North Carolina, Chapel Hill

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Abstract

Chronic condition medication adherence changes after a cancer diagnosis. We conduct a mediation analysis of the provider team’s role in changes to chronic condition medication adherence among cancer survivors.  Using a linear regression analysis of Surveillance, Epidemiology, and End Results-Medicare data, 2008-2014, we study each cancer site, chronic condition, and follow-up period separately among Medicare beneficiaries aged ≥66 years newly diagnosed with breast, colorectal, lung or prostate cancer and using medication for at least one chronic condition and similar individuals without cancer. We report the natural direct effect of cancer on adherence, the natural indirect effect (NIE) of cancer on adherence through changes to the provider team, and the total effect (TE) of cancer on chronic condition medication adherence. The number of providers and patient sharing among providers increased after cancer diagnosis relative to the non-cancer control group. Changes in provider team complexity explained only small changes in medication adherence. NIE’s were statistically insignificant in 13 of 17 analytic samples with significant TE. Statistically significant NIEs were small in magnitude (