Patients with metastatic non-small cell lung cancer may not have access to certain high-cost agents depending on where they live and where they receive treatment, according to a new report.
The study authors ultimately found that patients living in high-poverty areas were less likely to have access to the newest high-cost lung cancer drugs, and patients who are not treated at a National Cancer Institute (NCI)-designated center were even less likely to have access to these treatments.
The findings are significant because treatment access could largely affect mortality risk, according to study author Cathy J. Bradley, PhD.
“Without these drugs, they may not have the same outcome as those who receive treatment. Some of these drugs have the potential to increase the lifespan of cancer patients,” Dr. Bradley, CU Cancer Center deputy director and associate dean for research at the Colorado School of Public Health, said in a press release.
The researchers performed a retrospective review of SEER-Medicare data spanning 2007 through 2015; the data were supplemented with the Area Health Resource File. Patients eligible for inclusion were aged 66 years or older, enrolled in fee-for-service Medicare Part D, and received a first primary diagnosis of metastatic non-small cell lung cancer, and received an antineoplastic agent. The authors defined high-cost agents as those priced at $5,000 or more per month. Factors taken into consideration included race, residency (urban vs. rural), census tract poverty, and treatment facility type (NCI designation vs. not).
The authors observed that patients living in high-poverty areas were 4% less likely to receive high-cost agents, and patients who received treatment at a non-NCI designated center were 10% less likely to receive high-cost agents. As a whole, the odds of receiving a high-cost agent increased by 27% from 2007 to 2015.
Although patients in rural areas were less likely to receive the high-cost agents, urban patients also had decreased odds depending on where they sought treatment.
“If you live in a rural area, it can be challenging to access an NCI-designated cancer center where these drugs are more commonly used,” Dr. Bradley explained. “And even if you are in an urban area and didn’t go to an NCI center, you also were less likely to get these drugs.”
Putting aside the debate of whether these high-cost agents will be sustainable in the long-term, the way they are being distributed now is concerning, according to study author Marcelo Perraillon, PhD.
Our findings suggest that uneven access to specialized care due to poverty or living in remote areas may explain some of the observed disparities,” said Dr. Perraillon.
“The societal cost of these medications doesn’t mean that they are not worth it,” Dr. Perraillon added. “Our study does not say whether prescribing these agents is good or bad. What it means, and what we show, is that location or income should not hinder the use of these agents by some.”