@article{b5080ca775c24b8a95b5cc30942c4cda,
title = "Oral Anticancer Agent (OAA) Adherence and Survival in Elderly Patients With Metastatic Renal Cell Carcinoma (mRCC)",
abstract = "Objective: To examine real-world adherence to oral anticancer agents (OAAs) and its association with outcomes among Medicare beneficiaries with metastatic renal cell carcinoma (mRCC). Methods: SEER-Medicare retrospective cohort study of patients with metastatic renal cell carcinoma (mRCC) who received an OAA between 2007 and 2015. We examined A) adherence and B) overall and disease-specific 2-year survival landmarked at 3 months after OAA initiation. Adherence was assessed by calculating the proportion of days covered (PDC) within 3 months of OAA initiation, with adherent use being defined as PDC > 80%. Results: A total of 905 patients met study criteria, of whom 445 patients (49.2%) were categorized as adherent to initial OAA treatment. Adjusting for clinical and demographic factors revealed decreased odds of adherence associated with living within an impoverished neighborhood (OR 0.49, CI 0.0.33 – 0.74) and out-of-pocket costs > $200 (OR 0.68, CI 0.47-.98). Adherence was associated with improved 2-year survival in univariate analysis (logrank test, P = .01) and a non-significant trend toward an association with decreased all-cause (HR 0.87, CI 0.72 – 1.05) and RCC-specific survival (HR 0.84, CI 0.69 – 1.03) in multivariable analysis. Conclusion: Local poverty levels and high out-of-pocket costs are associated with poor initial adherence to OAA therapy in Medicare beneficiaries with mRCC, which in turn, suggests a trend toward poor overall and disease-specific survival. Efforts to improve outcomes in the broader mRCC population should incorporate OAA adherence and economic factors.",
author = "Dinan, {Michaela A.} and Wilson, {Lauren E.} and Greiner, {Melissa A.} and Spees, {Lisa P.} and Pritchard, {Jessica E.} and Tian Zhang and Deborah Kaye and Daniel George and Scales, {Charles D.} and Baggett, {Chris D.} and Gross, {Cary P.} and Leapman, {Michael S.} and Wheeler, {Stephanie B.}",
note = "Funding Information: Research reported in this publication was supported by the National Cancer Institute of the National Institutes of Health (NIH) (R01CA226842). Federal money is financing 100% of the cost. This study used the linked SEER-Medicare database. 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 here 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 interpretation and reporting of these data are the sole responsibility of the authors. 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. Financial Disclosure: Dr. Wheeler receives unrelated grant funding paid to her institution from Pfizer Foundation. Dr. Zhang has research funding and consulting relationships with Pfizer, Merck, and consulting relationships with Exelixis and Bayer. Dr. George has a current relationship with Bayer and Pfizer. Dr. Spees receives unrelated funding paid to her institution from AstraZeneca. All other authors have no conflicts of interest to report. Funding Information: Financial Disclosure: Dr. Wheeler receives unrelated grant funding paid to her institution from Pfizer Foundation. Dr. Zhang has research funding and consulting relationships with Pfizer, Merck, and consulting relationships with Exelixis and Bayer. Dr. George has a current relationship with Bayer and Pfizer. Dr. Spees receives unrelated funding paid to her institution from AstraZeneca. All other authors have no conflicts of interest to report. Funding Information: This study used the linked SEER-Medicare database. 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 here 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 interpretation and reporting of these data are the sole responsibility of the authors. 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. Funding Information: Research reported in this publication was supported by the National Cancer Institute of the National Institutes of Health (NIH) (R01CA226842). Federal money is financing 100% of the cost. Publisher Copyright: {\textcopyright} 2022 Elsevier Inc.",
year = "2022",
doi = "10.1016/j.urology.2022.07.012",
language = "English (US)",
journal = "Urology",
issn = "0090-4295",
publisher = "Elsevier Inc.",
}