A Registry-Based Study of Patterns of Use of Targeted Therapies for Metastatic Cancers in Diverse Populations

近代史上最重要的癌症治疗进展之一是靶向治疗的快速传播 治疗方法(分子靶向激酶抑制剂和免疫检查点抑制剂)用于患者的护理 患有转移性癌症。这些新疗法的使用适应症的显著扩大已得到推动。 由于内科肿瘤学家对其对患者生存的潜在影响的热情日益高涨 预后非常差。尽管这些疗法对大多数患者的生存益处不大，但一小部分患者 大多数人经历了长期的缓解，甚至有可能治愈了以前无法治愈的癌症。尽管 这些疗法令人振奋的前景是，它们非常昂贵--有时每月超过1万美元。 由于这些疗法的高成本和高风险，了解它们的使用模式至关重要；然而 人们对靶向治疗在不同人群中的使用知之甚少。此外，对临床医生的影响 影响使用差异的因素尚不清楚。在缺乏这些知识的情况下，很难开发出有效的 干预措施，以支持向日益增长的患者群体公平地提供这些治疗 转移性癌。因此，我们将在不同的样本中调查靶向治疗的使用模式。 在2019年确诊的2240名转移性非小细胞肺癌、泌尿生殖道癌和 黑色素瘤，并由佐治亚州和洛杉矶县SEER登记处确认。我们将首先描述一下 与未接收相关的患者因素，通过创建归档临床和 社会人口登记数据，加上SEER工作人员将直接收集的其他治疗数据 来自临床医生和实践者。我们假设患者对靶向治疗的使用存在显著差异。 跨年龄、种族/民族、社会经济地位和地理位置。然后，我们将确定临床医生的因素 与开出靶向治疗的倾向有关。由我们将通过以下方式收集的定性数据提供信息 采访医学肿瘤学家，我们将调查治疗这些患者的医学肿瘤学家(临床医生)， 包括许多在资源有限的环境中执业的人。我们将评估临床医生的知识和态度 关于靶向治疗，询问他们的实践设置的具体细节，并使用临床片段来衡量 他们倾向于开出靶向治疗。我们将对1025名临床医生进行调查，预计回复率为65% 费率，基于我们之前的工作。我们假设某些临床医生不太可能开出有针对性的处方 治疗，包括那些对靶向治疗了解较少的人和那些在资源方面实践的人 有限的设置。最后，我们将合并临床医生数据和患者数据，以量化和解释 临床医生对患者使用靶向治疗的差异进行了研究。我们假设大多数(&gt；50%)变异 发生在临床医生层面，而临床医生的知识和态度驱动了大部分的变异。调查结果 这项研究将为制定多层次干预措施提供信息，以改善有针对性的公平接受 在不同的患者群体和实践环境中进行治疗。

One of the most important cancer care advances in recent history is the rapid dissemination of targeted therapies (molecularly targeted kinase inhibitors and immune checkpoint inhibitors) into the care of patients with metastatic cancer. The marked expansion of indications for use of these novel therapies has been fueled by growing enthusiasm among medical oncologists regarding their potential impact on survival for patients with very poor prognosis. Although the survival benefit of these therapies is modest for most patients, a small proportion experience long-term remission and potentially even cure of previously incurable cancer. Despite the exciting promise of these therapies, they are very expensive – sometimes exceeding $10,000 per month. Because of the high cost and high stakes of these therapies, it is critical to understand their patterns of use; yet very little is known about targeted therapy use across diverse populations. Moreover, the impact of clinician factors on variations in use is not known. In the absence of such knowledge it is difficult to develop effective interventions to support equitable delivery of these therapies to the growing population of patients living with metastatic cancer. Therefore, we will investigate patterns of use of targeted therapy among a diverse sample of 2,240 patients diagnosed in 2019 with metastatic non-small cell lung cancer, genitourinary cancer, and melanoma, and ascertained by the Georgia and Los Angeles county SEER registries. We will first characterize patient factors associated with non-receipt, by creating a powerful combination of archival clinical and sociodemographic registry data augmented with additional treatment data that SEER staff will collect directly from clinicians and practices. We hypothesize that significant variations exist in patient use of targeted therapy across age, race/ethnicity, socioeconomic status, and geography. We will then identify clinician factors that are associated with tendency to prescribe targeted therapy. Informed by qualitative data that we will collect through interviews with medical oncologists, we will survey the medical oncologists (clinicians) who treat these patients, including many who practice in resource-limited settings. We will assess clinicians’ knowledge & attitudes about targeted therapy, ask specific details about their practice setting, and use clinical vignettes to measure their tendency to prescribe targeted therapy. We will survey 1025 clinicians and anticipate a 65% response rate, based on our prior work. We hypothesize that certain clinicians are less likely to prescribe targeted therapy, including those with less knowledge around targeted therapy and those who practice in resource- limited settings. Finally, we will merge clinician data with patient data to quantify and explain the influence of clinicians on variations in patients’ use of targeted therapy. We hypothesize that most (>50%) of the variation occurs at the clinician level, and that clinician knowledge and attitudes drive most of the variation. The findings from this study will inform the development of multilevel interventions to improve equitable receipt of targeted therapies across diverse patient populations and practice settings.