Physician dispensing of oral specialty drugs for advanced prostate cancer and its implications for patients

项目摘要 每年有近35，000人死于晚期前列腺癌，使其成为第二大癌症原因 男人之间的死亡针对特定分子的口服特种药物的发展导致了一种范式 男性可以在家中接受前列腺癌治疗的转变。口服特殊药物，如 阿比特龙和恩杂鲁胺与医生给予的化疗具有相似的疗效，毒性更低 并且是截至2015年晚期前列腺癌最常见的一线治疗。这种新疗法 模式的变化伴随着交付系统的变化。越来越多的处方 对于口服特殊药物，由泌尿科医生或肿瘤科医生在其办公室直接分发（参见 称为“医师配药”）。患者可以从这种交付模式中受益，因为它将授权的责任置于 以及对处方医生的经济援助的识别。结合集成和 通过在护理点分配所暗示的协调，这种交付模式可以改善访问，及时性和 坚持使用这些特殊药物。然而，与医生配药相关的经济激励， 通过由每次处方填充产生的余量，可以促进促进利用的处方行为， 削弱了这种输送系统变化的价值，例如在预先存在的患者中使用这些疗法 使他们易受药物不良反应影响的条件。为了理解这种交付模式的含义， 对于患者，我们提出以下建议：（1）测量医生配药对使用专业的影响 前列腺癌的药物;（2）确定医生分配前列腺专用药物的影响 癌症对财务结果和应对行为的影响;（3）测量医生之间的关系 为前列腺癌和患者安全分配特殊药物。这项研究的结果将具有现实世界的 对晚期前列腺癌患者的影响，他们自然对获得最高质量的前列腺癌感兴趣。 癌症护理，同时避免与口服专科药物通常相关的财务后果。

PROJECT SUMMARY Nearly 35,000 succumb to advanced prostate cancer each year, making it the second leading cause of cancer death among men. The development of oral specialty drugs targeting specific molecules has led to a paradigm shift in which men can receive treatment for their prostate cancer at home. Oral specialty drugs, such as abiraterone and enzalutamide, have similar efficacy as physician administered chemotherapy with less toxicity and are the most common first-line treatment for advanced prostate cancer as of 2015. This new treatment paradigm has been accompanied by concurrent changes in in the delivery system. Increasingly, prescriptions for oral specialty drugs are dispensed directly by the urologist or medical oncologist in their office (referred to as “physician dispensing”). Patients may benefit from this delivery model as it places the onus for authorization and identification of financial assistance on the prescribing physician. Combined with the integration and coordination implied by dispensing at the point of care, this delivery model may improve access, timeliness and adherence to these specialty drugs. However, financial incentives associated with physician dispensing, through a margin generated by each prescription fill, may foster prescribing behaviors promoting utilization that undermine the value of this delivery system change, such as use of these therapies in patients with preexisting conditions that predispose them to adverse drug effects. To understand the implications of this delivery model for patients, we propose the following: (1) To measure the effects of physician dispensing on use of specialty drugs for prostate cancer; (2) To determine the impact of physician dispensing of specialty drugs for prostate cancer on financial outcomes and coping behaviors; and (3) To measure the relationship between physician dispensing of specialty drugs for prostate cancer and patient safety. Results from this study will have real-world implications for men with advanced prostate cancer, who are naturally interested in getting the highest quality cancer care while avoiding the financial consequences commonly associated with oral specialty drugs.