Evaluation of Treatment Abandonment and Delay with Anticancer Agents at an Outpatient Community Hospital Cancer Center Oral Chemotherapy Clinic: A Retrospective Cohort Analysis

Presenters: Megan May, PharmD, BCOP, Clinical Oncology Pharmacy Specialist, Baptist Health Lexington, Lexington, KY; and Jeannie Patrick, PharmD, BCOP, Clinical Oncology Pharmacy Specialist, Baptist Health Lexington, Lexington, KY

Co-Author: Macy Pike, PharmD, BCPS, Baptist Health Lexington, Lexington, KY

Background: In 2019, the US Census Bureau reported that 27.5 million people (8.5% of the US population) did not have insurance in 2018.¹ The estimated out-of-pocket (OOP) spending on orally administered anticancer agents for Medicare Part D beneficiaries increased from 2010 to 2019, with a mean 12-month OOP spending of $8794 in 2010 versus $10,470 in 2019.² As a result of unmanageable OOP prescription costs, patients may experience delays in initiation of treatment or abandon oral anticancer treatment.³ In 2017, Baptist Health Lexington established an oral chemotherapy clinic, staffed with a full-time oncology-trained pharmacist and a financial navigator to assist with the acquisition and dissemination of oral anticancer drugs.

Objectives: The primary end point was to describe the incidence of treatment abandonment and delay in an oral chemotherapy clinic designed to minimize these problems at an outpatient cancer care center. Secondary end points included an analysis of patients who abandoned their prescription to initiate alternate treatment, patient’s initial OOP prescription cost, and length of days to dispense medications.

Methods: This was a retrospective cohort analysis of all patients (N = 150) enrolled in the oral chemotherapy clinic who had a new prescription for oral anticancer agents that were prescribed between August 1, 2017, and January 31, 2018. Descriptive statistics were used to evaluate the incidence of treatment abandonment and delay, given the pilot nature of this study and its small sample size.

Results: The incidence of treatment abandonment and delay was low, at 8.7% (N = 13) and 2.7% (N = 4), respectively. Of the 13 participants who abandoned treatment, 5 (38.5%) participants opted for hospice care, 4 (30.8%) participants declined further treatment, 3 (23.1%) participants were transitioned to an alternative intravenous option within the same therapeutic class, and 1 participant opted to pursue a holistic approach with an outside provider. Small differences occurred related to treatment abandonment, with greater initial OOP costs (11%, >$2000 OOP; 8%, <$2000 OOP). The average time from submission of the oral anticancer agent prescription to dispense of the medication was 6.7 days.

Conclusion: These findings suggest that the incidence of treatment abandonment and delay with oral anticancer agents is low when patients have readily available access to services that provide financial assistance. Access to a pharmacist and a financial navigator may improve patient outcomes by reducing treatment abandonment and delay.

1. Berchick ER, Barnett JC, Upton RD. Health Insurance Coverage in the United States: 2018. Current Population Reports P60-267 (RV); November 8, 2019. www.census.gov/library/publications/2019/demo/p60-267.html. Accessed September 15, 2020.
2. Dusetzina SB, Huskamp HA, Keating NL. Specialty drug pricing and out-of-pocket spending on orally administered anticancer drugs in Medicare Part D, 2010 to 2019. JAMA. 2019;321:2025-2027. Erratum in: JAMA. 2019;322:174.
3. Doshi JA, Li P, Huo H, et al. Association of patient out-of-pocket costs with prescription abandonment and delay in fills of novel oral anticancer agents. J Clin Oncol. 2018;36:476-482.