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 increased preauthorization. We propose to define barriers to initiation and non-adherence to anticancer medications that are considerably more expensive and the acquisition is more complex that other cancer and non-cancer therapies. We propose 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. (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.

Public Health Relevance

The goal of cancer research is not only to identify effective treatments, but to make them available for the population in need. Identifying the impact of variations in prescription insurance coverage on drug use patterns, medication compliance and safety can impact public policy and ultimately cancer mortality.

Agency
National Institute of Health (NIH)
Institute
National Cancer Institute (NCI)
Type
Exploratory/Developmental Grants (R21)
Project #
1R21CA242044-01A1
Application #
9975367
Study Section
Health Services Organization and Delivery Study Section (HSOD)
Program Officer
Croswell, Jennifer
Project Start
2020-03-01
Project End
2022-02-28
Budget Start
2020-03-01
Budget End
2021-02-28
Support Year
1
Fiscal Year
2020
Total Cost
Indirect Cost
Name
Columbia University (N.Y.)
Department
Radiation-Diagnostic/Oncology
Type
Schools of Medicine
DUNS #
621889815
City
New York
State
NY
Country
United States
Zip Code
10032