Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill (UNC-CH), Chapel Hill, NC.
Lineberger Comprehensive Cancer Center, UNC-CH, Chapel Hill, NC.
JCO Oncol Pract. 2021 Dec;17(12):e1895-e1904. doi: 10.1200/OP.20.01082. Epub 2021 Jun 17.
Availability of targeted oral anticancer agents (OAAs) has transformed care for patients with metastatic renal cell carcinoma (mRCC). Our objective was to identify patterns and predictors of OAA use within 12 months after mRCC was detected to understand real-world adoption of OAAs.
We used a novel, North Carolina cancer registry-linked multipayer claims data resource to examine patterns of use of five oral therapies among patients with mRCC diagnosed in 2006-2015, with claims through 2016. Patients were required to have 12 months of continuous enrollment before metastatic index date. Log-Poisson models estimated unadjusted and adjusted risk ratios (RRs) for associations between patient characteristics and OAA use. In sensitivity analyses, we used a competing risk framework to estimate adjusted risk differences in OAA use.
Our population-based study of 713 patients demonstrated low (37%) OAA use during the first year after metastatic index date among both publicly and privately insured patients, with shifting patterns of use consistent with regulatory approvals over time. Compared with patients age 18-49 years, patients age 70-74 years were half likely to use OAAs (95% confidence limit [CL], 0.34 to 0.78) and patients age 80+ years were 71% less likely to use OAAs (95% CL, 0.17 to 0.50). Patients with two comorbidities (RR, 0.73; 95% CL, 0.55 to 0.98) and those with 3+ comorbidities (RR, 0.68; 95% CL, 0.50 to 0.91) were less likely to receive OAA than those without comorbidities. Patients with higher frailty also had lower OAA utilization (RR, 0.67; 95% CL, 0.52 to 0.85).
These findings suggest a need to better understand the system-level and provider-level drivers of OAA underuse, as well as OAA adherence and associated survival.
靶向口服抗癌药物（OAAs）的可用性改变了转移性肾细胞癌（mRCC）患者的治疗方式。我们的目的是确定在 mRCC 确诊后 12 个月内使用 OAA 的模式和预测因素，以了解 OAAs 的实际应用情况。
我们使用了一种新颖的、北卡罗来纳州癌症登记处链接的多付款人索赔数据资源，来检查 2006-2015 年间诊断为 mRCC 的患者在 2016 年之前使用五种口服治疗方法的模式。患者需要在转移性指数日期前有 12 个月的连续参保。使用对数泊松模型估计患者特征与 OAA 使用之间的关联的未经调整和调整后的风险比（RR）。在敏感性分析中，我们使用竞争风险框架来估计 OAA 使用的调整风险差异。
在这项基于人群的研究中，我们对 713 名患者进行了研究，结果显示，在转移性指数日期后的第一年中，公共保险和私人保险患者的 OAA 使用率均较低（37%），随着时间的推移，使用模式与监管批准一致。与 18-49 岁的患者相比，70-74 岁的患者使用 OAA 的可能性低一半（95%置信区间[CL]，0.34 至 0.78），80 岁及以上的患者使用 OAA 的可能性低 71%（95%CL，0.17 至 0.50）。患有两种合并症的患者（RR，0.73；95%CL，0.55 至 0.98）和患有三种及以上合并症的患者（RR，0.68；95%CL，0.50 至 0.91）使用 OAA 的可能性低于没有合并症的患者。脆弱程度较高的患者 OAA 利用率也较低（RR，0.67；95%CL，0.52 至 0.85）。
这些发现表明，需要更好地了解系统和提供者层面导致 OAA 使用率低的因素，以及 OAA 依从性和相关的生存情况。
