Disparities in the Use of Oral Anticancer Agents in Kidney Cancer

我们早就知道，现实世界中的黑人和白人的种族差异已经存在的待遇， 肾细胞癌（RCC）患者的预后。然而，目前尚不清楚这些 随着最近口服抗癌药的引入和广泛采用， 代理（OAA）。随着医疗技术的进步，这些药物的引入 具有显著改善患者结局的潜力，但也具有 如果在开放式账户方面的这些进展不能平等地提供或 为所有患者提供相同的益处。拟议的研究解决了我们的这一关键差距， 通过调查具有全国代表性但不同的患者人群， 患肾癌的人不幸的是，没有一个肾脏疾病患者的数据集， 癌症存在，能够捕获所有年龄段和所有患者的全国代表性数据， 美国境内的保险。然而，通过使用三个互补的数据源， 我们能够包括所有年龄、保险、地理和种族的患者， 与患者中新兴OAA相关的当前和未来利用率、结局和成本 患了肾癌 目的1 -研究肾细胞癌患者使用OAA的患者水平差异 目的2 -调查RCC患者使用OAA的提供者和系统水平的差异。 目的3 -调查患者-提供者网络（PPN）对OAA采用的影响， 识别迟采用或未采用的供应商。 这项研究将（1）评估和描述口服抗癌药物的现状， 药物利用、递送和依从性;（2）识别患者、提供者、结构和 坚持的系统性障碍和结果的差异;（3）制定模型， 改进安全和有效提供这些制剂的战略， 最佳的临床护理和结果。 .

We have long known that real-world black-white racial disparities have existed in the treatment and outcomes of patients with renal cell carcinoma (RCC). However, it is unclear how these disparities will change with the recent introduction and widespread adoption of oral anticancer agents (OAAs). As with any advance in medical technology, the introduction of these agents has the potential to significantly improve patient outcomes, but also has the potential to exacerbate current disparities if these advances in OAAs are not equally available or do not provide the same benefit to all patients. The proposed study addresses this critical gap in our knowledge by investigating a mix of nationally representative, yet diverse populations of patients with kidney cancer in the United States. Unfortunately, no single dataset of patients with kidney cancer exists that is able to capture nationally-representative data on patients of all ages and all insurance status within the United States. However, by using three complementary data sources we are able to include patients of all ages, insurance, geography, and race to investigate the current and future utilization, outcomes, and costs associated with emerging OAAs in patients with kidney cancer. Aim 1 – Investigate patient-level disparities in OAA use in RCC patients Aim 2 – Investigate provider- and system-level disparities in OAA use in RCC patients.. Aim 3 – Investigate the impact of patient-provider networks (PPNs) on OAA adoption and identify pockets of late or non-adopting providers. The proposed research will (1) assess and describe the current state of oral anticancer medication utilization, delivery, and adherence; (2) identify patient, provider, structural, and systemic barriers to adherence and disparities in outcomes; and (3) develop models and strategies to improve safe and effective delivery of these agents in order to improve access to optimal clinical care and outcomes. .