Factors Associated With Patients Not Receiving Oral Anticancer Drugs

被引:3
|
作者
Doshi, Sahil D. [1 ]
Lichtenstein, Morgan R. L. [2 ,3 ]
Beauchemin, Melissa P. [3 ,4 ]
Raghunathan, Rohit [3 ]
Lee, Shing [3 ]
Law, Cynthia [3 ]
Accordino, Melissa K. [2 ,3 ]
Elkin, Elena B. [5 ]
Wright, Jason D. [3 ,6 ]
Hershman, Dawn L. [2 ,3 ,5 ]
机构
[1] Mem Sloan Kettering Canc Ctr, Dept Med, Div Med Oncol, New York, NY 10065 USA
[2] Columbia Univ, Dept Med, Div Hematol Oncol, Irving Med Ctr, New York, NY USA
[3] Columbia Univ, Herbert Irving Comprehens Canc Ctr, Irving Med Ctr, New York, NY USA
[4] Columbia Univ, Sch Nursing, Irving Med Ctr, New York, NY USA
[5] Columbia Univ, Mailman Sch Publ Hlth, Irving Med Ctr, New York, NY USA
[6] Columbia Univ, Dept Obstet & Gynecol, Div Gynecol Oncol, Irving Med Ctr, New York, NY USA
关键词
ADJUVANT HORMONAL-THERAPY; CANCER; WOMEN;
D O I
10.1001/jamanetworkopen.2022.36380
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
IMPORTANCE Oral anticancer drugs (OACDs) are increasingly prescribed for cancer treatment and require significant coordination of care. Retrospective studies suggest that 10% to 20% of OACD prescriptions are never received by the patients, but the reasons behind this are poorly understood. OBJECTIVES To estimate the rate of failure to receive OACD prescriptions among patients with cancer and to examine the underlying reasons for this failure. DESIGN, SETTING, AND PARTICIPANTS A prospective cohort study was conducted among patients with cancer who were prescribed a new OACD from January 1, 2018, to December 31, 2019, at an urban academic medical center. Data analysis was conducted between 2021 and 2022. MAIN OUTCOMES AND MEASURES Patient demographic, clinical, and insurance data and OACD delivery dates were collected. The reasons for a failure to receive a prescribed OACD within 3 months were confirmed by manual review of medical records and were classified into 7 categories: clinical deterioration, financial access, clinician-directed change in decision-making, patient-directed change in decision-making, transfer of care, loss to follow-up, and unknown or other. A multivariable random-effects model was developed to identify factors associated with failure to receive a prescribed OACD. RESULTS The cohort included 1024 patients (538 men [53%]; mean [SD] age, 66.2 [13.9] years; 463 non-Hispanic White patients [45%], 140 non-Hispanic Black patients [14%], and 300 Hispanic patients [29%]), representing 1197 new OACD prescriptions. Of the 1197 prescriptions, 158 (13%) were categorized as having not been received by the patient. The most common reason for the failure to receive a prescribed OACD was due to patient and clinician decision-making (73 of 158 [46%]), and 20 cases (13%) in which prescriptions were not received were associated with financial access issues. In multivariable analysis, patients with a nonmetastatic solid malignant neoplasm were significantly less likely to not receive their OACDs than those with a hematologic malignant neoplasm (odds ratio, 0.57 [95% CI, 0.33-1.00]; P=.048). CONCLUSIONS AND RELEVANCE This cohort study of patients prescribed a new OACD found that 13% of prescriptions were not received. The failure to receive a prescribed OACD was most frequently due to a change in clinical decision-making or patient choice. Ultimately, the reasons for the failure to receive a prescribed OACD were multifactorial and may have been appropriate in some cases.
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页数:7
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