@article{e1ceb29032da4211905d38034bc61977,
title = "Association between cognitive impairment and oral anticancer agent use in older patients with metastatic renal cell carcinoma",
abstract = "Background: Kidney cancer is the fastest-growing cancer diagnosis in the developed world. About 16% of new cases are stage IV, which has a low five-year survival rate. Many patients with metastatic renal cell carcinoma (mRCC) are older and may have mild cognitive impairment or dementia (MCI/D). Given prior reports of patients with dementia initiating less cancer therapy and the importance of oral anticancer agents (OAAs) in mRCC treatment, we investigated the prevalence of preexisting MCI/D in patients with mRCC and their OAA use. Methods: SEER-Medicare patients were analyzed who were ≥65 years, diagnosed with mRCC between 2007 and 2015, and had Medicare part D coverage. Patterns and predictors of (a) OAA utilization within the 12 months following mRCC diagnosis and (b) adherence (percent of days covered [PDC] ≥ 80%) during the first 90 days following treatment initiation were assessed. Results: Of the 2792 eligible patients, 268 had preexisting MCI/D, and 907 initiated OAA treatment within 12 months of mRCC diagnosis. Patients with preexisting MCI/D were less likely to begin an OAA than those without MCI/D (fully-adjusted HR 0.53, 95% CI 0.38–0.76). Among OAA initiators, a preexisting MCI/D diagnosis did not alter the likelihood that a person would be adherent (adjusted RR 0.84, 95% CI 0.55–1.28). Conclusions: Patients with preexisting MCI/D were half as likely to start an OAA during the year following mRCC diagnosis than patients without comorbid MCI/D. The 90-day adherence of OAA initiators was not significantly different between those with and without preexisting MCI/D. In light of this, clinicians should assess mRCC patients for cognitive impairment and take steps to optimize OAA utilization by those with MCI/D.",
keywords = "cognitive impairment, dementia, metastatic cancer, renal cell carcinoma, targeted therapy",
author = "Pritchard, {Jessica E.} and Wilson, {Lauren E.} and Miller, {Samuel M.} and Greiner, {Melissa A.} and Cohen, {Harvey Jay} and Kaye, {Deborah R.} and Tian Zhang and Dinan, {Michaela A.}",
note = "Funding Information: The collection of cancer incidence data used in this study was supported by the California Department of Public Health as part of the statewide cancer reporting program mandated by California Health and Safety Code Section 103885; the National Cancer Institute's Surveillance, Epidemiology and End Results Program under contract HHSN261201000140C awarded to the Cancer Prevention Institute of California, contract HHSN261201000035C awarded to the University of Southern California and contract HHSN261201000034C awarded to the Public Health Institute; and the Centers for Disease Control and Prevention's National Program of Cancer Registries, under agreement # U58DP003862‐01 awarded to the California Department of Public Health. The ideas and opinions expressed herein are those of the author(s) and endorsement by the State of California Department of Public Health, the National Cancer Institute, and the Centers for Disease Control and Prevention or their Contractors and Subcontractors is not intended nor should be inferred. The authors acknowledge the efforts of the National Cancer Institute; the Office of Research, Development and Information, CMS; Information Management Services (IMS), Inc.; and the Surveillance, Epidemiology, and End Results (SEER) Program tumor registries in the creation of the SEER‐Medicare database. The lead author would also like to thank her colleagues' pets and children for providing levity during many remote work sessions. Funding Information: Research reported in this manuscript was supported by the National Cancer Institute of the National Institutes of Health under award number 3R01CA226842‐02S1. This grant provided $320,000 and about 95% of the costs associated with this research. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Dr. Miller's time was funded by the Yale National Clinician Scholars Program and by Clinical and Translational Science Award number TL1 TR001864 from the National Center for Advancing Translational Science. Funding information Funding Information: The roles of the National Cancer Institute of the National Institutes of Health, Yale National Clinician Scholars Program, and the National Center for Advancing Translational Science were limited to financial support. They did not contribute to the design, methods, data acquisition, analysis, or manuscript preparation. Publisher Copyright: {\textcopyright} 2022 The American Geriatrics Society.",
year = "2022",
doi = "10.1111/jgs.17826",
language = "English (US)",
journal = "Journal of the American Geriatrics Society",
issn = "0002-8614",
publisher = "Wiley-Blackwell",
}