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Delays in acquisition of oral antineoplastic agents
Investigator (PI): Hershman, Dawn
Performing Organization (PO): (Current): Columbia University Irving Medical Center, Vagelos College of Physicians & Surgeons, Department of Medicine, Division of Hematology/Oncology / (212) 305-2055
Supporting Agency (SA): National Institutes of Health (NIH), National Cancer Institute (NCI)
Initial Year: 2020
Final Year: 2022
Record Source/Award ID: RePorter/ R21CA242044
Funding: 2020 Award Amount: $189,338
Award Type: Grant
Abstract: Over the past few years there has been an accelerating expansion of oral anticancer drugs. These drugs are expensive and cost up to $10,000/month. To counteract increasing medication costs, pharmacy benefit plans have increased copayment rates, deductibles, and preauthorization. We propose to define barriers to initiation and nonadherence to anticancer medications that are considerably more expensive and the acquisition more complex than other cancer and noncancer therapies. We propose to conduct a prospective cohort study among a diverse population of cancer patients prescribed non-hormonal oral antineoplastic agents, to define barriers to acquisition, initiation, and first prescription renewal; and we will conduct semi-structured interviews on a subset of 30 participants. We hypothesize that the increasing costs and subsequent complexities in acquisition associated with oral medications results in delays and barriers to access due to the administrative burden on the practice. Our specific aims are (1) to determine the rate and factors associated with non-initiation of oral antineoplastic agents in a socioeconomically, racially, and ethnically diverse cohort of 750 patients prescribed oral cancer therapy; (2) to define the time (days) to initiation of antineoplastic treatment and factors contributing to longer initiation time; (3) to examine factors related to early discontinuation of oral antineoplastic agents (<90 days) among those who initiate; and (4) to explore patient perceptions on the medication acquisition process. The goal of this proposal is to define and characterize the extent of use of these new expensive oral therapies, as well as to determine human costs and insurance-related factors associated with delays in initiation and early discontinuation. We will determine the extent to which financial factors contribute to disparities in use. Results will inform policies and assist with the design of interventions to improve the quality and safety of oral medication use in oncology care.
MeSH Terms:
  • Access to Health Care
  • Antineoplastic Agents /*administration & dosage
  • /*economics
  • Drug Costs
  • Health Care Disparities
  • Health Insurance
  • Health Policy
  • Humans
  • Neoplasms /*drug therapy
  • * Oral Administration
  • Perception
  • Prospective Studies
  • Quality of Health Care
  • Socioeconomic Status
  • Treatment Delay
Keywords:
  • United States
  • anticancer
  • antineoplastic agents
  • barrier to care
  • cancer patient
  • cancer therapy
  • cohort
  • comorbidity
  • cost
  • drug prescriptions
  • ethnic diversity
  • financial hardship
  • health insurance
  • insurance
  • interview
  • malignant neoplasms
  • medication compliance
  • perception
  • pharmaceutical preparations
  • prescription insurance
  • prospective
  • prospective cohort study
  • race
  • racial diversity
  • socioeconomics
Country: United States
State: New York
Zip Code: 10032
UI: 20204289
Project Status: Ongoing