Department of Population Health Sciences, Duke University, Durham, North Carolina, USA.
National Clinician Scholars Program, Yale University, New Haven, Connecticut, USA.
J Am Geriatr Soc. 2022 Aug;70(8):2330-2343. doi: 10.1111/jgs.17826. Epub 2022 May 2.
Kidney cancer is the fastest-growing cancer diagnosis in the developed world. About 16% of new cases are stage IV, which has a low five-year survival rate. Many patients with metastatic renal cell carcinoma (mRCC) are older and may have mild cognitive impairment or dementia (MCI/D). Given prior reports of patients with dementia initiating less cancer therapy and the importance of oral anticancer agents (OAAs) in mRCC treatment, we investigated the prevalence of preexisting MCI/D in patients with mRCC and their OAA use.
SEER-Medicare patients were analyzed who were ≥65 years, diagnosed with mRCC between 2007 and 2015, and had Medicare part D coverage. Patterns and predictors of (a) OAA utilization within the 12 months following mRCC diagnosis and (b) adherence (percent of days covered [PDC] ≥ 80%) during the first 90 days following treatment initiation were assessed.
Of the 2792 eligible patients, 268 had preexisting MCI/D, and 907 initiated OAA treatment within 12 months of mRCC diagnosis. Patients with preexisting MCI/D were less likely to begin an OAA than those without MCI/D (fully-adjusted HR 0.53, 95% CI 0.38-0.76). Among OAA initiators, a preexisting MCI/D diagnosis did not alter the likelihood that a person would be adherent (adjusted RR 0.84, 95% CI 0.55-1.28).
Patients with preexisting MCI/D were half as likely to start an OAA during the year following mRCC diagnosis than patients without comorbid MCI/D. The 90-day adherence of OAA initiators was not significantly different between those with and without preexisting MCI/D. In light of this, clinicians should assess mRCC patients for cognitive impairment and take steps to optimize OAA utilization by those with MCI/D.
在发达国家，肾癌是诊断率增长最快的癌症。约 16%的新病例为 IV 期，五年生存率较低。许多转移性肾细胞癌 (mRCC) 患者年龄较大，可能有轻度认知障碍或痴呆 (MCI/D)。鉴于先前有报道称痴呆症患者开始接受的癌症治疗较少，以及口服抗癌药物 (OAA) 在 mRCC 治疗中的重要性，我们调查了 mRCC 患者中是否存在预先存在的 MCI/D 及其对 OAA 的使用情况。
分析了 2007 年至 2015 年间年龄≥65 岁、被诊断为 mRCC 且有 Medicare 部分 D 覆盖的 SEER-Medicare 患者。评估了 (a) 在 mRCC 诊断后 12 个月内 OAA 的使用模式和预测因素，以及 (b) 在治疗开始后 90 天内的依从性（覆盖天数百分比 [PDC]≥80%）。
在 2792 名符合条件的患者中，有 268 名患有预先存在的 MCI/D，907 名在 mRCC 诊断后 12 个月内开始接受 OAA 治疗。与无 MCI/D 的患者相比，患有预先存在的 MCI/D 的患者开始使用 OAA 的可能性较小（完全调整后的 HR 0.53，95%CI 0.38-0.76）。在 OAA 使用者中，预先存在的 MCI/D 诊断并未改变一个人依从的可能性（调整后的 RR 0.84，95%CI 0.55-1.28）。
在 mRCC 诊断后一年内，患有预先存在的 MCI/D 的患者开始使用 OAA 的可能性是无合并 MCI/D 的患者的一半。在 OAA 使用者中，有和没有预先存在的 MCI/D 的患者的 90 天依从率没有显著差异。鉴于此，临床医生应该评估 mRCC 患者的认知障碍，并采取措施优化 MCI/D 患者对 OAA 的使用。
