Provider‐ and patient‐level predictors of oral anticancer agent initiation and adherence in patients with metastatic renal cell carcinoma

Abstract

Background Improving oral anticancer agent (OAA) initiation and adherence is the important quality‐of‐care issues, particularly since one fourth of anticancer agents being developed will be administered orally. Our objective was to identify provider‐ and patient‐level characteristics associated with OAA initiation and adherence among individuals with metastatic renal cell carcinoma (mRCC). Methods We used state cancer registry data linked to multi‐payer claims data to identify patients with mRCC diagnosed in 2004–2015. Provider data were obtained from North Carolina Health Professions Data System and the National Plan & Provider Enumeration System. We estimated risk ratios (RRs) and corresponding 95% confidence limits (CLs) using modified Poisson regression to evaluate factors associated with OAA initiation and adherence. Results Among the 207 (out of 687) patients who initiated an OAA following mRCC diagnosis and survived 90 days, median proportion of days covered was 0.91. Patients with a modal provider specializing in hematology/medical oncology were much more likely to initiate OAAs than those seen by other specialties. Additionally, patients with a female provider were more likely to initiate OAAs than those with a male provider. Compared to patients treated by providers practicing in both urban and rural areas, patients with providers practicing solely in urban areas were more likely to initiate OAAs, after controlling for patient‐level factors (RR = 1.37; 95% CL: 1.09–1.73). Medicare patients were less likely to be adherent than those with private insurance (RR = 0.61; 95% CL: 0.42–0.87). Conclusions Our results suggest that provider‐ and patient‐level factors influence OAA initiation in patients with mRCC but only insurance type was associated with adherence.

End-of-Life Care for Patients With Metastatic Renal Cell Carcinoma in the Era of Oral Anticancer Therapy

“…One potential explanation for the increased likelihood of hospice enrollment for patients on OAAs is that these patients may be more likely to see a medical oncologist, 16,17 and in previous studies, patients with advanced cancer cared for by medical oncologists were more likely to enroll in hospice. 18 Alternatively, concurrent increases in OAA use and national increases in hospice enrollment over the past two decades may account for the increased likelihood of hospice enrollment for patients on OAAs.…”

“…In one study using 2012-2013 Massachusetts private insurance claims, OAA use sharply declined during the last 30 days of life and even more so at 14 days before EOL in multiple cancer types, but they did not examine how OAA use may affect other aspects of EOL care. 15 One potential explanation for the increased likelihood of hospice enrollment for patients on OAAs is that these patients may be more likely to see a medical oncologist, 16,17 and in previous studies, patients with advanced cancer cared for by medical oncologists were more likely to enroll in hospice. 18 Alternatively, concurrent increases in OAA use and national increases in hospice enrollment over the past two decades may account for the increased likelihood of hospice enrollment for patients on OAAs.…”