Perceptions of Health-Care Workers of the Cost and Safety of Oral Oncolytic Agents for Patients: A Survey

PURPOSE: The number of newly approved cancer medications continues to grow; many of these newly approved medications are oral agents. Oral oncolytic agents have advantages including patient convenience, prolonged drug exposure, and noninvasive administration. However, these advantages come at a cost premium that many patients cannot afford, which can lead to change in therapy or abandonment. This study evaluates the perceptions of health-care workers regarding the cost and safety of oral oncolytic agents. METHODS: This is a descriptive, nonexperimental, cross-sectional study of health-care professionals in hematology/oncology patient care settings across the United States. Data were collected using a 35-item online questionnaire to measure quality improvement areas when using oral oncolytic agents. RESULTS: Results are based on 503 survey respondents comprising mainly pharmacists (54%), pharmacy administrators (15%), and nurses (10%). Adherence to oral oncolytics was not included in outcome measurements at 31.5% of respondents’ facilities. Treatment abandonment due to cost was reported by 46.6% of respondents. The most common agents abandoned due to cost included capecitabine, abiraterone, and palbociclib. To reduce cost, some respondents (6.1%) have utilized drug interactions to increase drug half-life. Prior authorization delays were perceived to occur in 1 to 2 patients weekly, creating a 4- to 6-day wait to initiate therapy; 24.0% of respondents spend more than 30 hours weekly resolving these issues. CONCLUSIONS: Health-care workers underscore their concerns about the prevalence of issues related to oral oncolytic therapy, by reporting on the incidence of abandonment of therapy, delay in therapy initiation, resources needed to assure patient access to oral oncolytic agents, and impact on patient care. Patients diagnosed with cancer require prompt access to appropriate treatments to produce favorable outcomes. In many instances, patients are unable to understand the extensive process involved in determining an appropriate course of treatment. Many factors aid in deciding on a particular course of therapy, including efficacy, safety, access to medication, adherence, and out-of-pocket cost of medication. Until recently, cancer therapy consisted primarily of IV infusion therapy, but oral oncolytic agents have been added to the therapy options over the past several years.