Presenting Author:
Ann Wang, B.A.
Principal Investigator:
Shikha Jain, M.D.
Department:
Medicine
Keywords:
Adherence, non-adherence, oral anticancer drugs, targeted therapy, associated factors, determinants, oncology, abandonme... [Read full text]
Location:
Ryan Family Atrium, Robert H. Lurie Medical Research Center
C43 - Clinical
Exploring factors delaying initiation of novel oral anticancer drugs
Introduction: In the past decade, oral anticancer agents, once considered an alternative for IV chemotherapy, have become a standard of care and even first-line therapy in many malignancies. However, issues impacting the access to novel oral oncolytics are not well-explored. We created a retrospective database of patients prescribed novel oral oncolytics to identify potential barriers that delay time to treatment. In this study, we aim to determine whether insurance is associated with pharmacy fill times, treatment abandonment, and other delays. Methods: This was a retrospective review of adults with active malignancies who were newly prescribed a novel oral oncolytic for FDA-approved indications in 2016. Patients who previously received the drug or received the drug for off-label indications were excluded. The primary outcome studied was time between initial prescription date and pharmacy dispense date (fill time). Insurance status and record of pharmacy transfer, manufacturer assistance, and delays in treatment were extracted via chart review. Tests of association were performed to identify whether fill time, pharmacy transfer, manufacturer assistance, other delays, and abandonment were associated with insurance category. Results: In our interim analysis of 199 patients who met inclusion criteria, 88 (44.2%) patients received insurance through Medicare, 11 (5.5%) through Medicaid, and 98 (49.3%) through private insurers. 2 (1.0%) patients were uninsured. A total of 29 unique anticancer drugs were prescribed, with palbociclib as the most frequently prescribed drug (n=50, 25.0%). The median time-to-fill was 5 days (range: 0-109 days; Q1-Q3: 2-8 days). Pharmacy transfers, applications for manufacturer assistance, and delays noted in patient records were associated with statistically significant increases in fill times (all p<0.01). While patients with public and private insurance experienced similar average fill times (6.8 and 7.9 days, respectively; p=0.11), the two uninsured patients experienced longer fill times (21-22 days, p=0.02). Insurance status also affected the cause of delays. Privately insured patients were more likely to require pharmacy transfers (p=0.01), while publicly insured patients were more likely to apply for manufacturer assistance. (p=0.005). Both uninsured patients applied for manufacturer assistance. Drug abandonment did not vary significantly across insurance categories. Conclusions: While patients with public and private insurance experienced similar fill times, uninsured patients waited significantly longer to receive their prescription. Interestingly, public and private insurance were associated with different causes of delay. As the landscape of oncology changes, barriers to treatment will emerge as new agents are approved. Our study shows that potential exists to prevent treatment delays and improve access to care. Quality improvement initiatives can then be developed to better streamline the process.
