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.
Keywords
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Article info
Publication history
Published online: April 23, 2022
Accepted:
April 18,
2022
Received in revised form:
April 14,
2022
Received:
December 2,
2021
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
