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在治疗中一直存在种族差异 以及肾细胞癌(RCC)患者的预后。然而，目前还不清楚这些是如何 随着最近口服抗癌药物的引入和广泛采用，差距将会改变 代理(OAA)。与医疗技术的任何进步一样，这些制剂的引入 有可能显著改善患者的预后，但也有可能 如果OAA中的这些进步不是同等可用的或不是 为所有患者提供相同的好处。拟议的研究解决了我们在 通过调查具有全国代表性的不同人群的患者来了解知识 在美国患有肾癌。不幸的是，没有肾脏患者的单一数据集 癌症的存在能够捕获具有全国代表性的所有年龄段和所有人的患者数据 在美国境内的保险地位。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、地域和种族的患者来调查 与患者出现的OAA相关的当前和未来的利用率、结果和成本 患有肾癌。 目的1-调查肾细胞癌患者在使用OAA方面的患者水平差异 目的2-调查肾细胞癌患者中使用OAA的提供者和系统水平的差异。 目标3-调查患者-提供者网络(PPN)对OAA采用和 找出较晚或未采用的供应商。 拟议的研究将(1)评估和描述口服抗癌药物的现状 药物利用、交付和依从性；(2)确定患者、提供者、结构和 坚持的系统性障碍和结果的差异；以及(3)开发模型和 改进安全和有效地提供这些制剂的战略，以便更好地获得 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. .