Patient- And Provider-Level Predictors of Survival Among Patients With Metastatic Renal Cell Carcinoma Initiating Oral Anticancer Agents.
Patient- And Provider-Level Predictors of Survival Among Patients With Metastatic Renal Cell Carcinoma Initiating Oral Anticancer Agents.
复制标题
DOI：
10.1016/j.clgc.2022.04.010
复制
发表时间：
2022-10
影响因子：
3.2
通讯作者：
中科院分区：
文献类型：
--
作者：
在 FDA 快速扩大口服抗癌药物 (OAA) 审批的时代，了解与现实世界人群生存相关的因素非常重要，其中包括在 OAA 关键临床试验中没有得到充分代表的群体，例如老年人、少数族裔和病情复杂的患者。我们的目标是评估启动 OAA 的转移性肾细胞癌 (mRCC) 患者的多支付者队列中患者和提供者层面的特征与死亡率的关联。这项回顾性队列研究是使用北卡罗来纳州癌症登记处的数据进行的，这些数据与 2004-2015 年多付款人索赔数据相关。提供者数据来自北卡罗来纳州卫生专业数据系统和国家计划和提供者枚举系统。纳入的患者是接受 OAA 并在开始治疗后存活 ≥ 90 天的 mRCC 患者。我们使用 Cox 风险模型估计了风险比 (HR) 和相应的 95% 置信限 (CL)，以了解患者人口统计数据、患者临床特征、提供者层面的因素和两年全因死亡率之间的关联。该队列包括 207 名接受 OAA 的 mRCC 患者。在多变量模型中，虚弱（HR：1.36，95％CL：1.11-1.67）和新转移诊断（HR：2.63，95％CL：1.67-4.16）等临床变量与较高的全因死亡率相关。此外，与任何私人保险的患者相比，仅接受医疗保险的患者调整后全因死亡率更高（HR：2.35，95% CL：1.32-4.18）。没有调查提供者层面的协变量与全因死亡率相关。在现实世界中服用 OAA 的 mRCC 患者群体中，生存率因患者特征而异。在 FDA 对 OAA 的批准迅速扩大的时代，这些现实世界的数据强调了获得高质量护理的持续重要性，特别是对于资源有限的病情复杂的患者。
In an era of rapid expansion of FDA approvals for oral anticancer agents (OAAs), it is important to understand the factors associated with survival among real-world populations, which include groups not well-represented in pivotal clinical trials of OAAs, such as the elderly, racial minorities, and medically complex patients. Our objective was to evaluate patient- and provider-level characteristics’ associations with mortality among a multi-payer cohort of metastatic renal cell carcinoma (mRCC) patients who initiated OAAs. This retrospective cohort study was conducted using data from the North Carolina state cancer registry linked to multi-payer claims data for the years 2004–2015. Provider data were obtained from North Carolina Health Professions Data System and the National Plan & Provider Enumeration System. Included patients were individuals with mRCC who initiated an OAA and survived ≥90 days after beginning treatment. We estimated hazard ratios (HR) and corresponding 95% confidence limits (CL) using Cox hazard models for associations between patient demographics, patient clinical characteristics, provider-level factors, and two-year all-cause mortality. The cohort included 207 patients with mRCC who received OAAs. In multivariable models, clinical variables such as frailty (HR: 1.36, 95% CL: 1.11–1.67) and de novo metastatic diagnosis (HR: 2.63, 95%CL: 1.67–4.16) were associated with higher all-cause mortality. Additionally, patients solely on Medicare had higher adjusted all-cause mortality compared with patients with any private insurance (HR: 2.35, 95% CL: 1.32–4.18). No provider-level covariates investigated were associated with all-cause mortality. Within a real-world population of mRCC patients taking OAAs, survival differed based on patient characteristics. In an era of rapid expansion of FDA approvals for OAAs, these real-world data underscore the continued importance of access to high-quality care, particularly for medically complex patients with limited resources.
登录
查看更多内容
影响因子：
2.1
作者：
Gudbjartsson, T;Thoroddsen, A;Einarsson, GV
通讯作者：
Einarsson, GV
DOI：
10.1016/j.urolonc.2017.05.013
发表时间：
2017-09-01
影响因子：
2.7
作者：
Lindskog, Magnus;Wahlgren, Thomas;Harmenberg, Ulrika
通讯作者：
Harmenberg, Ulrika
影响因子：
2.6
作者：
Mathes, Tim;Pieper, Dawid;Eikermann, Michaela
通讯作者：
Eikermann, Michaela
影响因子：
6.6
作者：
Paul, Koushik;Sathianathen, Niranjan;Konety, Badrinath R.
通讯作者：
Konety, Badrinath R.
影响因子：
2.6
作者：
Faurot, Keturah R.;Funk, Michele Jonsson;Stuermer, Til
通讯作者：
Stuermer, Til