We have long known that real-world black-white racial disparities have existed in the treatment and outcomes of patients with renal cell carcinoma (RCC). However, it is unclear how these disparities will change with the recent introduction and widespread adoption of oral anticancer agents (OAAs). As with any advance in medical technology, the introduction of these agents has the potential to significantly improve patient outcomes, but also has the potential to exacerbate current disparities if these advances in OAAs are not equally available or do not provide the same benefit to all patients. The proposed study addresses this critical gap in our knowledge by investigating a mix of nationally representative, yet diverse populations of patients with kidney cancer in the United States. Unfortunately, no single dataset of patients with kidney cancer exists that is able to capture nationally-representative data on patients of all ages and all insurance status within the United States. However, by using three complementary data sources we are able to include patients of all ages, insurance, geography, and race to investigate the current and future utilization, outcomes, and costs associated with emerging OAAs in patients with kidney cancer.
Aim 1 ? Investigate patient-level disparities in OAA use in RCC patients Aim 2 ? Investigate provider- and system-level disparities in OAA use in RCC patients..
Aim 3 ? Investigate the impact of patient-provider networks (PPNs) on OAA adoption and identify pockets of late or non-adopting providers. The proposed research will (1) assess and describe the current state of oral anticancer medication utilization, delivery, and adherence; (2) identify patient, provider, structural, and systemic barriers to adherence and disparities in outcomes; and (3) develop models and strategies to improve safe and effective delivery of these agents in order to improve access to optimal clinical care and outcomes. .

Public Health Relevance

We have long known that real-world black-white racial disparities have existed in the treatment and outcomes of patients with renal cell carcinoma. However, it is unclear how these disparities will change with the recent introduction and widespread adoption of oral anticancer agents (OAAs), which have the potential to either widen or narrow current disparities. The proposed study addresses this critical gap in our knowledge by using three complementary data sources to capture both nationally representative, yet diverse populations to include patients of all ages, insurance, geography, and race to study modifiable barriers to optimal OAA utilization and adherence a the level of patients, providers, facilities, and region.

Agency
National Institute of Health (NIH)
Institute
National Cancer Institute (NCI)
Type
Research Project (R01)
Project #
1R01CA226842-01A1
Application #
9662207
Study Section
Health Disparities and Equity Promotion Study Section (HDEP)
Program Officer
Castro, Kathleen M
Project Start
2019-01-01
Project End
2023-12-31
Budget Start
2019-01-01
Budget End
2019-12-31
Support Year
1
Fiscal Year
2019
Total Cost
Indirect Cost
Name
Duke University
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
044387793
City
Durham
State
NC
Country
United States
Zip Code
27705