1. UNDERSTANDING BARRIERS TO OBTAINING ORAL CANCER TREATMENT AND THEIR
IMPACT ON PATIENTS’ CANCER EXPERIENCE
Breton Roussel1, Rafa Ifthikhar3, Elizabeth Hansen2, Taylor McEachon2, Tatyana Lemelman2, Allison Magnuson2, Elizabeth Guancial2, Supriya G Mohile2
1Rutgers-Robert Wood Johnson Medical School 2University of Rochester 3Northwestern University
! Oral cancer treatments are beneficial in that they offer patients
increased convenience of drug administration, unique
mechanism of action, and a different side effect profile than
traditional intravenous chemotherapy.
! Cost sharing has been shown to be extremely high for patients
prescribed these medications.
! Currently there is little data describing the psychosocial impact
of the financial burden associated with oral cancer medication
and its influence on patient satisfaction and medication
adherence.
! Assess the financial burden of obtaining oral cancer medication.
! Measure the psychosocial impact of out of pocket costs and
prescription wait time.
! Document total time and resources used by healthcare
professionals in assisting patients obtain oral cancer therapy.
! Identify patient characteristics or other factors associated with
patterns of medication adherence.
! Patients experience significant costs associated with taking oral
oncolytic medications.
! Increased cost sharing and wait time for delivery of medication
may be associated with higher psychosocial stress
! Assisting patients procure oral cancer medication is burdensome
and time consuming for health care professionals.
! Future work should further evaluate factors associated with poor
medication adherence in patients taking oral cancer medications.
! The study population includes patients 18 years and older with
solid tumor malignancy, excluding breast, who are prescribed an
oral oncolytic at the University of Rochester Medical Center.
! Patients are followed from time oral cancer medication is
prescribed until approximately 3 months after receipt of
medication.
! Validated patient reported outcomes tools and interviews are
used to quantify financial burden, document side effect profile,
and describe patient experience while taking medication.
Methods
Objectives
Background Methods cont.
! Evaluate medication adherence for patients with genitourinary
malignancy utilizing pill counts and comprehensive review of
medication regiment at monthly intervals.
! Health care professional workload assisting patients to receive
oral cancer treatment is quantified using a questionnaire.
! Bivariate and multivariable analyses will be incorporated to
evaluate potential associations among clinical factors, patient
reports, financial burdens, psychosocial impacts of out of pocket
costs, medication adherence, and certain patterns for
prescription wait times or certain treatment recommendations.
Study Workflow
Patient identified by specialty pharmacy or nursing staff
Weekly telephone survey
Healthcare Professional Survey
BLESSED, baseline survey
Post-medication receipt survey
Follow-up survey #1
Insurance information pulled
from chart
Pill Count #1
*Medication received*
*Medication prescribed*
Time= 8-12 weeks
Time= 2-4 weeks
Time= 4-8 weeks
GU Tumors Other Tumors
Follow-up survey #1
Pill Count #2
Follow-up survey #2
Pill Count #3
Collect paperwork
Time= 4-8 weeks
Assessment Tools
Anticipated Results
Preliminary Data
Characteristics Frequency
Baseline Survey Demographics, Finances, Geriatric Depression Scale, Distress Scale, OARS
Medial Social Support, Comorbidity, Instrumental Activities of Daily Living
Telephone Survey 10-point worry scale regarding wait for oral cancer medication
Post Medication
Receipt Survey
Medication Adherence Questionnaire, finances, healthcare related
resources, NCNN Distress Management Survey, Press Gainey
Questionnaire, PRO-CTCAE
Follow-up Survey Medication Adherence Questionnaire, finances, healthcare related
resources, NCNN Distress Management Survey, Press Ganey
Questionnaire, PRO-CTCAE, CTSQ
Patient Reported Outcomes Tool
BLESSED Screening tool for cognitive impairment: Score >10
consistent with impairment
PRO-CTCAE Patient self reporting medication side effect tool
Press-Ganey Patient satisfaction survey on entire healthcare experience
CTSQ Cancer Therapy Satisfaction Questionnaire: Evaluates
patient’s perspective on cancer specific therapy
Characteristics Frequency
Urologic Malignancy N=4
Non-urologic Malignancy N=9
Age 56.5 (46-70)
Race
Caucasian N=9
Non-Caucasian N=4
Health Care Provider Subjects N=20
Baseline Worry Scale, 10=extremely
worried
5.2 (0-10)
Time to receiving oral oncolytic (days) 13.3 (0-37)
Baseline Monthly Healthcare Expenses (Dollars)
0-199 (N=5)
200-499 (N=2)
500-999 (N=1)
1000-4999 (N=2)
5000-9999 (N=1)