Patient, provider, and hospital factors associated with oral anti-neoplastic agent initiation and adherence in older patients with metastatic renal cell carcinoma.
Patient, provider, and hospital factors associated with oral anti-neoplastic agent initiation and adherence in older patients with metastatic renal cell carcinoma.
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DOI：
10.1016/j.jgo.2022.01.008
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发表时间：
2022-06
影响因子：
3
通讯作者：
Dinan, Michaela A.
中科院分区：
文献类型：
--
作者：
Kaye, Deborah R.;Wilson, Lauren E.;Greiner, Melissa A.;Spees, Lisa P.;Pritchard, Jessica E.;Zhang, Tian;Pollack, Craig E.;George, Daniel;Scales, Charles D., Jr.;Baggett, Chris D.;Gross, Cary P.;Leapman, Michael S.;Wheeler, Stephanie B.;Dinan, Michaela A.
关键词：
治疗转移性肾细胞癌 (mRCC) 的口服抗肿瘤药 (OAA) 与癌症特异性生存率的增加有关。然而，生存方面的种族差异仍然存在，老年人的癌症特异性生存率最低。对其他癌症的研究表明，获得专业服务与高质量的癌症护理有关，但老年人接受癌症治疗的频率低于年轻人。因此，我们研究了患者、提供者和医院特征是否与 OAA 启动、依从性和启动后癌症特异性生存相关，以及种族、民族和/或年龄是否与去看肿瘤科医生诊断 mRCC 的可能性增加相关。我们使用监测、流行病学和最终结果 (SEER) 医疗保险数据来识别 2007 年至 2015 年诊断为 mRCC 并参加医疗保险 D 部分的 ≥ 65 岁患者。保险索赔用于确定转移诊断后 12 个月内是否收到 OAA，计算承保天数比例，并确定主要癌症提供者和医院。我们检查了与 OAA 启动、依从性以及 OAA 启动后的全因死亡率相关的提供者和医院特征。我们确定了 2,792 名符合纳入标准的患者。增加 OAA 起始时间与接触肿瘤内科医生有关。如果患者的主要肿瘤医生是泌尿科医生，则患者开始 OAA 治疗的可能性较小（风险比 [HR] 0.62；95% 置信区间 [CI] 0.49–0.77）。提供者/医院特征与 OAA 依从性或死亡率的差异无关。开始索拉非尼治疗的患者（比值比 [OR] 0.50；95% CI 0.29–0.86）、年龄较大（年龄 >81 OR 0.56；95% CI 0.34–0.92）和生活在高度贫困邮政编码区的患者（OR 0.48；95% CI 0.29–0.80）不太可能坚持 OAA 治疗。此外，一旦 OAA 启动，提供者的特征并不能解释死亡率的差异。最后，只有年龄 > 81 岁在统计学和临床上与就诊肿瘤科医生的相对风险降低相关（风险比 [RR] 0.87；CI 0.82-0.92）。提供者/医院因素，特别是由医学肿瘤科医生进行 mRCC 诊断，与 OAA 启动相关。老年患者不太可能去看肿瘤内科医生；然而，种族和/或族裔与就诊肿瘤科医生的差异无关。与提供者/医院因素相比，患者因素对 OAA 依从性和 OAA 开始后的死亡率更为重要。
Oral anti-neoplastic agents (OAAs) for metastatic renal cell carcinoma (mRCC) are associated with increased cancer-specific survival. However, racial disparities in survival persist and older adults have the lowest rates of cancer-specific survival. Research from other cancers demonstrates specialty access is associated with high-quality cancer care, but older adults receive cancer treatment less often than younger adults. We therefore examined whether patient, provider, and hospital characteristics were associated with OAA initiation, adherence, and cancer-specific survival after initiation and whether race, ethnicity, and/or age was associated with an increased likelihood of seeing a medical oncologist for diagnosis of mRCC. We used Surveillance, Epidemiology, and End Results (SEER)Medicare data to identify patients ≥ 65 years of age who were diagnosed with mRCC from 2007–2015 and enrolled in Medicare Part D. Insurance claims were used to identify receipt of OAAs within twelve months of metastatic diagnosis, calculate proportion of days covered, and to identify the primary cancer provider and hospital. We examined provider and hospital characteristics associated with OAA initiation, adherence, and all-cause mortality after OAA initiation. We identified 2,792 patients who met inclusion criteria. Increased OAA initiation was associated with access to a medical oncologist. Patients were less likely to begin OAA treatment if their primary oncologic provider was a urologist (hazard ratio [HR] 0.62; 95% confidence interval [CI] 0.49–0.77). Provider/hospital characteristics were not associated with differences in OAA adherence or mortality. Patients who started sorafenib (odds ratio [OR] 0.50; 95% CI 0.29–0.86), were older (aged >81 OR 0.56; 95% CI 0.34–0.92), and those living in high poverty ZIP codes (OR 0.48; 95% CI 0.29–0.80) were less likely to adhere to OAA treatment. Furthermore, provider characteristics did not account for differences in mortality once an OAA was initiated. Last, only age > 81 years was statistically and clinically associated with a decreased relative risk of seeing a medical oncologist (risk ratio [RR] 0.87; CI 0.82–0.92). Provider/hospital factors, specifically, being seen by a medical oncologist for mRCC diagnosis, are associated with OAA initiation. Older patients were less likely to see a medical oncologist; however, race and/or ethnicity was not associated with differences in seeing a medical oncologist. Patient factors are more critical to OAA adherence and mortality after OAA initiation than provider/hospital factors.
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作者：
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DOI：
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发表时间：
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期刊：
Cancer causes & control : CCC
影响因子：
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