Oral Anticancer Agent (OAA) Adherence and Survival in Elderly Patients With Metastatic Renal Cell Carcinoma (mRCC)

Michaela A. Dinan; Lauren E. Wilson; Melissa A. Greiner; Lisa P. Spees; Jessica E. Pritchard; Tian Zhang; Deborah Kaye; Daniel George; Charles D. Scales; Chris D. Baggett; Cary P. Gross; Michael S. Leapman; Stephanie B. Wheeler

doi:10.1016/j.urology.2022.07.012

Oral Anticancer Agent (OAA) Adherence and Survival in Elderly Patients With Metastatic Renal Cell Carcinoma (mRCC)

Michaela A. Dinan, Lauren E. Wilson, Melissa A. Greiner, Lisa P. Spees, Jessica E. Pritchard, Tian Zhang, Deborah Kaye, Daniel George, Charles D. Scales, Chris D. Baggett, Cary P. Gross, Michael S. Leapman, Stephanie B. Wheeler

Research output: Contribution to journal › Article › peer-review

1 Scopus citations

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.

Original language	English (US)
Pages (from-to)	129-136
Number of pages	8
Journal	Urology
Volume	168
DOIs	https://doi.org/10.1016/j.urology.2022.07.012
State	Published - Oct 2022
Externally published	Yes

ASJC Scopus subject areas

Urology

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10.1016/j.urology.2022.07.012

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Dinan, M. A., Wilson, L. E., Greiner, M. A., Spees, L. P., Pritchard, J. E., Zhang, T., Kaye, D., George, D., Scales, C. D., Baggett, C. D., Gross, C. P., Leapman, M. S., & Wheeler, S. B. (2022). Oral Anticancer Agent (OAA) Adherence and Survival in Elderly Patients With Metastatic Renal Cell Carcinoma (mRCC). Urology, 168, 129-136. https://doi.org/10.1016/j.urology.2022.07.012

@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 = "Publisher Copyright: {\textcopyright} 2022 Elsevier Inc.",

year = "2022",

month = oct,

doi = "10.1016/j.urology.2022.07.012",

language = "English (US)",

volume = "168",

pages = "129--136",

journal = "Urology",

issn = "0090-4295",

publisher = "Elsevier Inc.",

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TY - JOUR

T1 - Oral Anticancer Agent (OAA) Adherence and Survival in Elderly Patients With Metastatic Renal Cell Carcinoma (mRCC)

AU - Dinan, Michaela A.

AU - Wilson, Lauren E.

AU - Greiner, Melissa A.

AU - Spees, Lisa P.

AU - Pritchard, Jessica E.

AU - Zhang, Tian

AU - Kaye, Deborah

AU - George, Daniel

AU - Scales, Charles D.

AU - Baggett, Chris D.

AU - Gross, Cary P.

AU - Leapman, Michael S.

AU - Wheeler, Stephanie B.

PY - 2022/10

Y1 - 2022/10

N2 - 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.

AB - 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.

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U2 - 10.1016/j.urology.2022.07.012

DO - 10.1016/j.urology.2022.07.012

M3 - Article

C2 - 35878815

AN - SCOPUS:85136247696

SN - 0090-4295

VL - 168

SP - 129

EP - 136

JO - Urology

JF - Urology

ER -

Oral Anticancer Agent (OAA) Adherence and Survival in Elderly Patients With Metastatic Renal Cell Carcinoma (mRCC)

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