Lisa P Spees1, Michaela A Dinan2, Bradford E Jackson3, Christopher D Baggett4, Lauren E Wilson5, Melissa A Greiner5, Deborah R Kaye6, Tian Zhang7, Daniel J George8, Charles D Scales9, Jessica E Pritchard5, Michael Leapman10, Cary P Gross11, Stephanie B Wheeler12. 1. Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill (UNC-CH), Chapel Hill, NC; Lineberger Comprehensive Cancer Center (LCCC), UNC-CH, Chapel Hill, NC, USA. Electronic address: lspees21@unc.edu. 2. Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale School of Medicine, New Haven, CT, USA; Department of Chronic Disease Epidemiology, Yale School of Medicine, Yale School of Public Health, New Haven, CT, USA. 3. Lineberger Comprehensive Cancer Center (LCCC), UNC-CH, Chapel Hill, NC, USA. 4. Lineberger Comprehensive Cancer Center (LCCC), UNC-CH, Chapel Hill, NC, USA; Department of Epidemiology, Gillings School of Global Public Health, UNC-CH, Chapel Hill, NC, USA. 5. Department of Population Health Sciences, Duke University School of Medicine (DUSM), Durham, NC, USA. 6. Duke Cancer Institute (DCI) Center for Prostate and Urologic Cancers, Durham, NC, USA; Department of Surgery (Urology), DUSM, Durham, NC, USA. 7. Department of Medicine, DUSM, Durham, NC, USA; Department of Surgery (Urology), DUSM, Durham, NC, USA. 8. Duke Cancer Institute (DCI) Center for Prostate and Urologic Cancers, Durham, NC, USA; Department of Medicine, DUSM, Durham, NC, USA. 9. Department of Population Health Sciences, Duke University School of Medicine (DUSM), Durham, NC, USA; Department of Surgery (Urology), DUSM, Durham, NC, USA. 10. Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale School of Medicine, New Haven, CT, USA; Department of Urology, Yale School of Medicine, New Haven, CT, USA. 11. Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale School of Medicine, New Haven, CT, USA; Department of Medicine, Yale School of Medicine, New Haven, CT, USA. 12. Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill (UNC-CH), Chapel Hill, NC; Lineberger Comprehensive Cancer Center (LCCC), UNC-CH, Chapel Hill, NC, USA; Duke Cancer Institute (DCI), DUSM, Durham, NC, USA.
Abstract
PURPOSE: In an era of rapid expansion of FDA approvals for oral anticancer agents (OAAs), it is important to understand the factors associated with survival among real-world populations, which include groups not well-represented in pivotal clinical trials of OAAs, such as the elderly, racial minorities, and medically complex patients. Our objective was to evaluate patient- and provider-level characteristics' associations with mortality among a multi-payer cohort of metastatic renal cell carcinoma (mRCC) patients who initiated OAAs. METHODS: This retrospective cohort study was conducted using data from the North Carolina state cancer registry linked to multi-payer claims data for the years 2004 to 2015. Provider data were obtained from North Carolina Health Professions Data System and the National Plan & Provider Enumeration System. Included patients were individuals with mRCC who initiated an OAA and survived ≥90 days after beginning treatment. We estimated hazard ratios (HR) and corresponding 95% confidence limits (CL) using Cox hazard models for associations between patient demographics, patient clinical characteristics, provider-level factors, and 2-year all-cause mortality. RESULTS: The cohort included 207 patients with mRCC who received OAAs. In multivariable models, clinical variables such as frailty (HR: 1.36, 95% CL: 1.11-1.67) and de novo metastatic diagnosis (HR: 2.63, 95%CL: 1.67-4.16) were associated with higher all-cause mortality. Additionally, patients solely on Medicare had higher adjusted all-cause mortality compared with patients with any private insurance (HR: 2.35, 95% CL: 1.32-4.18). No provider-level covariates investigated were associated with all-cause mortality. CONCLUSIONS: Within a real-world population of mRCC patients taking OAAs, survival differed based on patient characteristics. In an era of rapid expansion of FDA approvals for OAAs, these real-world data underscore the continued importance of access to high-quality care, particularly for medically complex patients with limited resources.
PURPOSE: In an era of rapid expansion of FDA approvals for oral anticancer agents (OAAs), it is important to understand the factors associated with survival among real-world populations, which include groups not well-represented in pivotal clinical trials of OAAs, such as the elderly, racial minorities, and medically complex patients. Our objective was to evaluate patient- and provider-level characteristics' associations with mortality among a multi-payer cohort of metastatic renal cell carcinoma (mRCC) patients who initiated OAAs. METHODS: This retrospective cohort study was conducted using data from the North Carolina state cancer registry linked to multi-payer claims data for the years 2004 to 2015. Provider data were obtained from North Carolina Health Professions Data System and the National Plan & Provider Enumeration System. Included patients were individuals with mRCC who initiated an OAA and survived ≥90 days after beginning treatment. We estimated hazard ratios (HR) and corresponding 95% confidence limits (CL) using Cox hazard models for associations between patient demographics, patient clinical characteristics, provider-level factors, and 2-year all-cause mortality. RESULTS: The cohort included 207 patients with mRCC who received OAAs. In multivariable models, clinical variables such as frailty (HR: 1.36, 95% CL: 1.11-1.67) and de novo metastatic diagnosis (HR: 2.63, 95%CL: 1.67-4.16) were associated with higher all-cause mortality. Additionally, patients solely on Medicare had higher adjusted all-cause mortality compared with patients with any private insurance (HR: 2.35, 95% CL: 1.32-4.18). No provider-level covariates investigated were associated with all-cause mortality. CONCLUSIONS: Within a real-world population of mRCC patients taking OAAs, survival differed based on patient characteristics. In an era of rapid expansion of FDA approvals for OAAs, these real-world data underscore the continued importance of access to high-quality care, particularly for medically complex patients with limited resources.
Authors: Scott D Ramsey; Aasthaa Bansal; Catherine R Fedorenko; David K Blough; Karen A Overstreet; Veena Shankaran; Polly Newcomb Journal: J Clin Oncol Date: 2016-01-25 Impact factor: 44.544
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Authors: Abiodun Mafolasire; Xiaopan Yao; Cayce Nawaf; Alfredo Suarez-Sarmiento; Wong-Ho Chow; Wei Zhao; Douglas Corley; Jonathan N Hofmann; Mark Purdue; Adebowale J Adeniran; Brian Shuch Journal: Cancer Med Date: 2016-05-26 Impact factor: 4.452