Patients fail to receive 1 in 8 oral anticancer drug prescriptions
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An increasing number of oral anticancer drugs have been granted FDA approval and introduced into clinical practice.
However, retrospective studies have shown that between 10% and 20% of prescriptions for oral anticancer drugs are never received by patients.
The reasons for this care gap are not fully understood.
“Oral anticancer drugs are increasing in approval rates and availability, but are a relatively understudied aspect of oncology care,” Sahil D. Doshi, MD, a clinical fellow in the division of medical oncology within department of medicine at Memorial Sloan Kettering Cancer Center, told Healio. “Furthermore, these are drugs that are taken at home and don’t involve coming to the clinic, where someone is watching and making sure the patient is getting them. They pose a unique set of challenges compared with traditional chemotherapy.”
To better understand prescribing and uptake patterns of oral anticancer drugs, Doshi and colleagues conducted a prospective cohort study of 1,024 adults with cancer at Columbia University Irving Medical Center. Eligible patients had received a new prescription for an oral anticancer drug between 2018 and 2019.
Doshi spoke with Healio about the rationale for the study, the study’s findings and how clinicians can work to ensure that eligible patients receive these important medications.
Healio: How did you conduct this study?
Doshi: We prospectively collected data for a 2-year period at Columbia University Medical Center for all adult oncology patients. We tracked when a new oral anticancer drug prescription was written, if the drug was received and when it was received. We then retrospectively looked at clinical and demographic factors within our patient cohort and compiled our data set.
Healio: What did you find?
Doshi: We found that approximately 13% of drugs were not received. There were a few categories we identified when looking at reasons for failure of receipt. The first factor, which applied to the majority of failures, pertained to clinician-directed or patient-directed decision making. Of 158 cases of failure to receive oral anticancer drugs, 73 were placed into this category. We were able to determine this categorization from nursing/pharmacy records at the time of failure of receipt. If this was not clear, we went back to the electronic health record and looked through the clinician and pharmacist notes to get a better sense of what happened.
Clinician-directed decision-making included reasons such as changes in the treatment plan, identifying more effective alternative options or enrolling a patient into a clinical trial. Patient-directed decision-making included concerns about side effects or choosing a different medication with a different efficacy or side-effect profile. Some patients also opted for observation rather than active medical treatment.
It is important to note that cost considerations could have also affected these decisions. We identified 20 cases directly related to financial access issues. There were other cases in which financial issues were not specifically cited but may have been financially motivated.
Healio: Do these findings give you confidence that oral anticancer drugs are being adequately prescribed and received?
Doshi: This study shows a 13% failure rate and that about 13% of the cases were directly related to financial factors. Although neither is very high, it is still a considerable amount.
The study highlights the complexities in oral anticancer drug access. It’s important for clinicians and oncology practices to recognize financial and logistical complexities that they may not have previously considered. With traditional chemotherapy, patients have to come into the clinic to receive the drug and are monitored. It’s a paradigm shift where we now have to think more about whether the patient has received the drug, whether they are able to afford it and whether they are actually taking it. In our study, some of the patients did not take the drugs because they were worried about side effects or costs. So, certain financial and educational interventions may address some of these access issues and patient-related decisions that were known to lead to failure of receipt.
For more information :
Sahil D. Doshi, MD, can be reached at dsahil320@gmail.com.
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