Potential Obstacles in the Acquisition of Oral Anticancer Medications

Niccolai, Jennifer L; Roman, Danielle; Julius, Justin; Nadour, Rachelle W

doi:10.1200/jop.2016.012302

Cited by 25 publications

(27 citation statements)

References 18 publications

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“…Prior authorizations of diagnostic and therapeutic modalities are increasingly being mandated [18, 19], but we did not have access to direct or surrogate markers of this process to determine if such processes impacted on TTI. The benefits, if any, of such mandates have not been fully studied and our findings suggest the potential of harm to patients [16]. Notably, in our analysis, uninsured patients who do not have to go through a prior authorization process had a faster TTI.…”

Section: Discussionmentioning

confidence: 77%

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Time to initial cancer treatment in the United States and association with survival over time: An observational study

et al. 2019

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Background Delays in time to treatment initiation (TTI) for new cancer diagnoses cause patient distress and may adversely affect outcomes. We investigated trends in TTI for common solid tumors treated with curative intent, determinants of increased TTI and association with overall survival. Methods and findings We utilized prospective data from the National Cancer Database for newly diagnosed United States patients with early-stage breast, prostate, lung, colorectal, renal and pancreas cancers from 2004–13. TTI was defined as days from diagnosis to first treatment (surgery, systemic or radiation therapy). Negative binomial regression and Cox proportional hazard models were used for analysis. The study population of 3,672,561 patients included breast (N = 1,368,024), prostate (N = 944,246), colorectal (N = 662,094), non-small cell lung (N = 363,863), renal (N = 262,915) and pancreas (N = 71,419) cancers. Median TTI increased from 21 to 29 days (P<0.001). Aside from year of diagnosis, determinants of increased TTI included care at academic center, race, education, prior history of cancer, transfer of facility, comorbidities and age. Increased TTI was associated with worsened survival for stages I and II breast, lung, renal and pancreas cancers, and stage I colorectal cancers, with hazard ratios ranging from 1.005 (95% confidence intervals [CI] 1.002–1.008) to 1.030 (95% CI 1.025–1.035) per week of increased TTI. Conclusions TTI has lengthened significantly and is associated with absolute increased risk of mortality ranging from 1.2–3.2% per week in curative settings such as early-stage breast, lung, renal and pancreas cancers. Studies of interventions to ease navigation and reduce barriers are warranted to diminish potential harm to patients.

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Section: Discussionmentioning

confidence: 77%

“…United States (US) health care providers perceive that TTI is worsening with increasing complexity of health-systems and requirements for prior authorizations by insurers [15, 16, 17, 18, 19]. Median wait times for surgery increased in the decade prior to 2005 [20].…”

Section: Introductionmentioning

confidence: 99%

Time to initial cancer treatment in the United States and association with survival over time: An observational study

et al. 2019

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“…Two patients reported this as a cause for missed doses. This is in line with another study that reported patients may encounter process barriers such as pharmacy processing time [20]. A few patients identified initiation of their MM treatment as a time when they struggled with adherence because they felt confused and overwhelmed with all of the medications.…”

Section: Discussionsupporting

confidence: 67%

Barriers and Facilitators of Using Sensored Medication Adherence Devices in a Diverse Sample of Patients With Multiple Myeloma: Qualitative Study (Preprint)

Asfaw¹,

Yan²,

Sweiss³

et al. 2018

Preprint

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“…Financial barriers to expensive anticancer medications were not an issue for any patient because the institution pursued avenues available to low-income individuals to access medications. As a result, financial barriers to adherence were limited to insurance co-payments, and this is uncommon in most settings [30]. Although 70% (14/20) of the patients admitted to missing doses of their cancer medications, the exact level of adherence was not captured or relevant to this study.…”

Section: Discussionmentioning

confidence: 99%

Barriers and Facilitators of Using Sensored Medication Adherence Devices in a Diverse Sample of Patients With Multiple Myeloma: Qualitative Study

Asfaw¹,

Yan²,

Sweiss³

et al. 2018

JMIR Cancer

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BackgroundMany recently approved medications to manage multiple myeloma (MM) are oral, require supportive medications to prevent adverse effects, and are taken under complex schedules. Medication adherence is a concern; however, little attention has been directed toward understanding adherence in MM or associated barriers and facilitators. Advanced sensored medication devices (SMDs) offer opportunities to intervene; however, acceptability among patients with MM, particularly African American patients, is untested.ObjectiveThis study aimed to explore patients’ (1) perceptions of their health before MM including experiences with chronic medications, (2) perceptions of adherence barriers and facilitators, and (3) attitudes toward using SMDs.MethodsAn in-person, semistructured, qualitative interview was conducted with a convenience sample of patients being treated for MM. Patients were recruited from within an urban, minority-serving, academic medical center that had an established cancer center. A standardized interview guide included questions targeting medication use, attitudes, adherence, barriers, and facilitators. Demographics included the use of cell phone technology. Patients were shown 2 different pill bottles with sensor technology—Medication Event Monitoring System and the SMRxT bottle. After receiving information on the transmission ability of the bottles, patients were asked to discuss their reactions and concerns with the idea of using such a device. Medical records were reviewed to capture information on medication and diagnoses. The interviews were audio-recorded and transcribed. Interviews were independently coded by 2 members of the team with a third member providing guidance.ResultsA total of 20 patients with a mean age of 56 years (median=59 years; range=29-71 years) participated in this study and 80% (16/20) were African American. In addition, 18 (90%, 18/20) owned a smartphone and 85% (17/20) were comfortable using the internet, text messaging, and cell phone apps. The average number of medications reported per patient was 13 medications (median=10; range=3-24). Moreover, 14 (70%, 14/20) patients reported missed doses for a range of reasons such as fatigue, feeling ill, a busy schedule, forgetting, or side effects. Interest in using an SMD ranged from great interest to complete lack of interest. Examples of concerns related to the SMDs included privacy issues, potential added cost, and the size of the bottle (ie, too large). Despite the concerns, 60% (12/20) of the patients expressed interest in trying a bottle in the future.ConclusionsResults identified numerous patient-reported barriers and facilitators to missed doses of oral anticancer therapy. Many appear to be potentially mutable if uncovered and addressed. SMDs may allow for capture of these data. Although patients expressed concerns with SMDs, most remained willing to use one. A feasibility trial with SMDs is planned.

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Potential Obstacles in the Acquisition of Oral Anticancer Medications

Cited by 25 publications

References 18 publications

Time to initial cancer treatment in the United States and association with survival over time: An observational study

Time to initial cancer treatment in the United States and association with survival over time: An observational study

Barriers and Facilitators of Using Sensored Medication Adherence Devices in a Diverse Sample of Patients With Multiple Myeloma: Qualitative Study (Preprint)

Barriers and Facilitators of Using Sensored Medication Adherence Devices in a Diverse Sample of Patients With Multiple Myeloma: Qualitative Study

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