Despite a limited understanding about access to oral anticancer drugs, new research finds challenges in patient and clinician decision-making.
Among patients with cancer, 13% of prescribed oral anticancer drugs (OACDs) were never received; however, patients with nonmetastatic solid cancers were found more likely to receive their prescription. The primary reason (46%) was caused by a change in the decision-making by the patient or clinician, according to the study, published in JAMA Network Open.
“(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,” the study authors wrote.
FDA approvals for OACDs increased in the past century. By 2020, 67% of OACDs were newly approved cancer agents. These novel therapies can be expensive though, and out-of-pocket costs may inhibit patients from ever accessing them.
Looking at previous retrospective studies, the authors noted that “patient beliefs regarding treatment effectiveness and adverse effects… [and] financial burden, including copayments and insurance approval,” have been presented as potential barriers that prevent patients from beginning their treatment regimen.
Additional reasons explaining why patients do not receive an OACD include transfer of care, loss to follow-up, or another reason. Researchers conducted a prospective study to understand why oncology patients do not receive OACDs, and the extent that demographic and clinical factors contribute to this issue.
The cohort had 1024 patients, of whom White patients were 45% of the group, 14% were non-Hispanic Black, and 29% were Hispanic patients. The researchers evaluated the outcomes of 1197 OACD prescriptions.
Patients with a hematologic malignant neoplasm were more likely to not receive an OACD prescription, but “the reasons for the failure to receive a prescribed OACD were multifactorial and may have been appropriate in some cases,” the study authors wrote.
Although the findings suggest that patients with nonmetastatic solid tumors were more likely to receive prescriptions, they were also more likely to receive adjuvant therapy. The authors noted that this may reflect increased changes in patient and clinician decision-making. Although changes in decisions are the main barrier for not receiving an OACD, it appears to exclude these tumor patients, according to the researchers.
The results also showed that 1 in every 8 OACD prescriptions were not delivered to the patient and 13% of prescriptions not received were credited to patient financial access issues.
One limitation of the study identified is the limited data available from pharmacy databases. Additionally, the researchers did not account for every reason a patient did not receive their OACD. Finally, they were unable to see whether cost was associated with a missed OACD prescription delivery.
“Although the failure to receive OACD prescriptions is infrequent and may often be associated with clinician or patient decision-making, financial and educational interventions may be appropriate to ensure treatment access,” the study authors wrote.
Doshi, Sahil, Lichtenstein, Morgan, Beauchemin, Melissa, et al. Factors Associated With Patients Not Receiving Oral Anticancer Drugs. JAMA Netw Open. 2022;5(10):e2236380. doi:10.1001/jamanetworkopen.2022.36380.