Grant Number:	5R01CA226842-05 Interpret this number
Primary Investigator:	Dinan, Michaela
Organization:	Yale University
Project Title:	Disparities in the Use of Oral Anticancer Agents in Kidney Cancer
Fiscal Year:	2023

We have long known that real-world black-white racial disparities have existed in the treatment and outcomes of patients with renal cell carcinoma (RCC). However, it is unclear how these disparities will change with the recent introduction and widespread adoption of oral anticancer agents (OAAs). As with any advance in medical technology, the introduction of these agents has the potential to significantly improve patient outcomes, but also has the potential to exacerbate current disparities if these advances in OAAs are not equally available or do not provide the same benefit to all patients. The proposed study addresses this critical gap in our knowledge by investigating a mix of nationally representative, yet diverse populations of patients with kidney cancer in the United States. Unfortunately, no single dataset of patients with kidney cancer exists that is able to capture nationally-representative data on patients of all ages and all insurance status within the United States. However, by using three complementary data sources we are able to include patients of all ages, insurance, geography, and race to investigate the current and future utilization, outcomes, and costs associated with emerging OAAs in patients with kidney cancer. Aim 1 – Investigate patient-level disparities in OAA use in RCC patients Aim 2 – Investigate provider- and system-level disparities in OAA use in RCC patients.. Aim 3 – Investigate the impact of patient-provider networks (PPNs) on OAA adoption and identify pockets of late or non-adopting providers. The proposed research will (1) assess and describe the current state of oral anticancer medication utilization, delivery, and adherence; (2) identify patient, provider, structural, and systemic barriers to adherence and disparities in outcomes; and (3) develop models and strategies to improve safe and effective delivery of these agents in order to improve access to optimal clinical care and outcomes. .




Cost trends of metastatic renal cell carcinoma therapy: the impact of oral anticancer agents and immunotherapy.
Authors: Forman R. , Long J.B. , Westvold S.J. , Agnish K. , Mcmanus H.D. , Leapman M.S. , Hurwitz M.E. , Spees L.P. , Wheeler S.B. , Gross C.P. , et al. .
Source: Jnci Cancer Spectrum, 2024-09-02 00:00:00.0; 8(5), .
PMID: 39133171
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Disparities in immune and targeted therapy utilization for older US patients with metastatic renal cell carcinoma.
Authors: Chow R.D. , Long J.B. , Hassan S. , Wheeler S.B. , Spees L.P. , Leapman M.S. , Hurwitz M.E. , McManus H.D. , Gross C.P. , Dinan M.A. .
Source: Jnci Cancer Spectrum, 2023-05-02 00:00:00.0; 7(3), .
PMID: 37202354
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End-of-Life Care for Patients With Metastatic Renal Cell Carcinoma in the Era of Oral Anticancer Therapy.
Authors: Dzimitrowicz H.E. , Wilson L.E. , Jackson B.E. , Spees L.P. , Baggett C.D. , Greiner M.A. , Kaye D.R. , Zhang T. , George D. , Scales C.D. , et al. .
Source: Jco Oncology Practice, 2023 Feb; 19(2), p. e213-e227.
EPub date: 2022-11-22 00:00:00.0.
PMID: 36413741
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Patient- And Provider-Level Predictors of Survival Among Patients With Metastatic Renal Cell Carcinoma Initiating Oral Anticancer Agents.
Authors: Spees L.P. , Dinan M.A. , Jackson B.E. , Baggett C.D. , Wilson L.E. , Greiner M.A. , Kaye D.R. , Zhang T. , George D.J. , Scales C.D. , et al. .
Source: Clinical Genitourinary Cancer, 2022 10; 20(5), p. e396-e405.
EPub date: 2022-04-25 00:00:00.0.
PMID: 35595633
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Oral Anticancer Agent (OAA) Adherence and Survival in Elderly Patients With Metastatic Renal Cell Carcinoma (mRCC).
Authors: Dinan M.A. , Wilson L.E. , Greiner M.A. , Spees L.P. , Pritchard J.E. , Zhang T. , Kaye D. , George D. , Scales C.D. , Baggett C.D. , et al. .
Source: Urology, 2022-07-22 00:00:00.0; , .
EPub date: 2022-07-22 00:00:00.0.
PMID: 35878815
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Evaluation of mild cognitive impairment and dementia in patients with metastatic renal cell carcinoma.
Authors: Miller S.M. , Wilson L.E. , Greiner M.A. , Pritchard J.E. , Zhang T. , Kaye D.R. , Cohen H.J. , Becher R.D. , Maerz L.L. , Dinan M.A. .
Source: Journal Of Geriatric Oncology, 2022 Jun; 13(5), p. 635-643.
EPub date: 2022-01-05 00:00:00.0.
PMID: 34996724
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Patient, provider, and hospital factors associated with oral anti-neoplastic agent initiation and adherence in older patients with metastatic renal cell carcinoma.
Authors: Kaye D.R. , Wilson L.E. , Greiner M.A. , Spees L.P. , Pritchard J.E. , Zhang T. , Pollack C.E. , George D. , Scales C.D. , Baggett C.D. , et al. .
Source: Journal Of Geriatric Oncology, 2022 Jun; 13(5), p. 614-623.
EPub date: 2022-02-04 00:00:00.0.
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Association between cognitive impairment and oral anticancer agent use in older patients with metastatic renal cell carcinoma.
Authors: Pritchard J.E. , Wilson L.E. , Miller S.M. , Greiner M.A. , Cohen H.J. , Kaye D.R. , Zhang T. , Dinan M.A. .
Source: Journal Of The American Geriatrics Society, 2022-05-02 00:00:00.0; , .
EPub date: 2022-05-02 00:00:00.0.
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Provider- and patient-level predictors of oral anticancer agent initiation and adherence in patients with metastatic renal cell carcinoma.
Authors: Spees L.P. , Wheeler S.B. , Jackson B.E. , Baggett C.D. , Wilson L.E. , Greiner M.A. , Kaye D.R. , Zhang T. , George D. , Scales C.D. , et al. .
Source: Cancer Medicine, 2021-09-04 00:00:00.0; , .
EPub date: 2021-09-04 00:00:00.0.
PMID: 34480518
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Patterns and Predictors of Oral Anticancer Agent Use in Diverse Patients With Metastatic Renal Cell Carcinoma.
Authors: Wheeler S.B. , Spees L.P. , Jackson B.E. , Baggett C.D. , Wilson L.E. , Greiner M.A. , Kaye D.R. , Zhang T. , George D. , Scales C.D. , et al. .
Source: Jco Oncology Practice, 2021-06-17 00:00:00.0; , p. OP2001082.
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Real-World Utilization of Oral Anticancer Agents and Related Costs in Older Adults with Metastatic Renal Cell Carcinoma in the United States.
Authors: Wilson L.E. , Spees L. , Pritchard J. , Greiner M.A. , Scales C.D. , Baggett C.D. , Kaye D. , George D.J. , Zhang T. , Wheeler S.B. , et al. .
Source: Kidney Cancer (clifton, Va.), 2021; 5(3), p. 115-127.
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