ASPO Abstracts
Access not adherence: patient and provider challenges of oral cancer therapies
Category: Survivorship & Health Outcomes/Comparative Effectiveness Research
Conference Year: 2019
Abstract Body:
Background: Oral cancer therapies have emerged as common alternatives to parenteral chemotherapy, comprising nearly one-third of all anticancer agents. Oral therapies may present particular challenges to racial/ethnic minority and under- and uninsured patients because of potential barriers to care and adherence issues. Little is known about how patients and providers address and overcome these challenges. We conducted a qualitative study to assess patient and provider perspectives on oral cancer therapies. Methods: We conducted semi-structured interviews with patients and providers (oncologists, nurses, pharmacists) at a tertiary referral center and county safety-net hospital, each serving distinct groups of patients in North Texas. Interviews probed perspectives on differences between parenteral chemotherapy and oral therapies, adherence, side effects, communication, cost/insurance, and processes of care. Interview transcripts were analyzed thematically using a deductive-inductive coding scheme building from our interview guide.Results: We conduced 22 patient (13 tertiary referral center, 9 safety-net hospital) and 10 provider (7 oncologists, 2 nurses, 1 pharmacist) interviews. Key themes included: (1) structural differences in parenteral chemotherapy vs. oral therapy create challenges that impact communication with patients, documentation, and provider decision-making; (2) patients and providers have divergent attitudes toward adherence; and (3) cost, insurance coverage, and patient-provider communication contribute to different patient experiences of care at the tertiary referral center vs. safety-net hospital. Conclusion: Oral cancer therapies have presented new challenges to delivery of quality cancer care. Many traditional responsibilities of providers, such as adhering to regimens, have moved more directly to patients. Nonetheless, patients reported few challenges adhering to oral therapies. Safety-net patients encountered fewer access barriers and had lower out-of-pocket costs than patients receiving care in the tertiary referral center. Our findings have identified future research opportunities to systematically monitor and support patients prescribed oral therapies.
Keywords: oral cancer therapy; medication adherence; financial toxicity; safety-net healthcare system