Grant Number:	7R01CA225647-06 Interpret this number
Primary Investigator:	Shih, Ya-Chen
Organization:	University Of California Los Angeles
Project Title:	Targeted Oral Anticancer Agents: Patterns of Indicated and Off-Label Use, the Associated Factors and Economic Implications
Fiscal Year:	2023

PROJECT SUMMARY Targeted oral anticancer medications (TOAMs) have been the focus of oncology drug development in the past two decades. Although these novel agents contribute to survival improvement in several cancers and are convenient to administer, high drug prices have raised concerns on their affordability and possibly low treatment adherence driven by high out-of-pocket expenses. Current knowledge on the utilization and adherence of TOAMs is largely built upon studies of patients with chronic myelogenous leukemia. It remains unclear whether such knowledge is directly transferrable to other cancers, especially those with both oral and intravenous anticancer medications as viable treatment options. The specific aims of the study are: (1) to examine the utilization patterns of TOAMs as indicated vs. off-label use; (2) to estimate the impact of TOAM use on the overall costs of cancer care, costs of non-hormonal systemic therapies, as well as out-of-pocket payment; (3) to investigate the factors associated with the initiation of a TOAM and time to treatment initiation; and (4) to explore patterns of treatment switches and discontinuation and the associated factors among patients who started their systemic therapy with a TOAM. We will address our research questions using various cohorts of cancer patients extracted from three large claims databases: the SEER-Medicare, MarketScan, and Health Care Cost Institution data. We will conduct a series of studies to better understand the role of TOAMs in modern cancer care delivery by systematically studying the utilization pattern and economic impact of TOAMs as well as factors affecting the initiation and discontinuation of these novel therapies, paying special attention to financial factors for patients and providers. The findings from our study will inform patients, clinicians, and policy makers of the extent to which off-label prescription of TOAM is practiced in the real-world and the long-term economic impact of TOAM use, and provide critical information to guide reform or re-design of insurance policies to avoid creating financial disincentive to prescribe or use TOAM. Ultimately, the goal of our research is to improve the accessibility, affordability, effectiveness, and safety of TOAMs.




The utility of value frameworks in cost communications: making them real for patients.
Authors: Shih Y.T. , Yabroff K.R. , Bradley C. .
Source: Journal Of The National Cancer Institute, 2024-07-14 00:00:00.0; , .
EPub date: 2024-07-14 00:00:00.0.
PMID: 39003520
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Financial Outcomes of "Bagging" Oncology Drugs Among Privately Insured Patients With Cancer.
Authors: Shih Y.T. , Xu Y. , Yao J.C. .
Source: Jama Network Open, 2023-09-05 00:00:00.0; 6(9), p. e2332643.
EPub date: 2023-09-05 00:00:00.0.
PMID: 37676663
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Discarded Targeted Oral Anticancer Medication-A Hard Pill to Swallow?
Authors: Bradley C.J. , Yabroff K.R. , Shih Y.T. .
Source: Jama Oncology, 2023-09-01 00:00:00.0; 9(9), p. 1202-1204.
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Olanzapine With or Without Fosaprepitant for Preventing Chemotherapy Induced Nausea and Vomiting in Patients Receiving Highly Emetogenic Chemotherapy: A Phase III Randomized, Double-Blind, Placebo-Controlled Trial (ALLIANCE A221602).
Authors: Navari R.M. , Le-Rademacher J. , Smieliauskas F. , Ruddy K.J. , James Saphner T. , Liu H. , Harlos E. , Onitilo A.A. , Giridhar K. , Paul Singh P. , et al. .
Source: The Oncologist, 2023-08-03 00:00:00.0; 28(8), p. 722-729.
PMID: 37284847
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Vertical Integration in Oncology: What Does It Mean for Patients with Cancer?
Authors: Tak H.J. , Shih Y.T. .
Source: Journal Of The National Cancer Institute, 2022-12-30 00:00:00.0; , .
EPub date: 2022-12-30 00:00:00.0.
PMID: 36583541
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Prescription Drug Provisions in the Inflation Reduction Act: Any Relief of Financial Hardship for Patients With Cancer?
Authors: Shih Y.T. , Yabroff K.R. , Bradley C.J. .
Source: Jama Oncology, 2022-12-08 00:00:00.0; , .
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Disparity in checkpoint inhibitor utilization among commercially insured adult patients with metastatic lung cancer.
Authors: Li M. , Liao K. , Chen A.J. , Cascone T. , Shen Y. , Lu Q. , Shih Y.T. .
Source: Journal Of The National Cancer Institute, 2022-11-08 00:00:00.0; , .
EPub date: 2022-11-08 00:00:00.0.
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Growing Financial Burden From High-Cost Targeted Oral Anticancer Medicines Among Medicare Beneficiaries With Cancer.
Authors: Li M. , Liao K. , Pan I.W. , Shih Y.T. .
Source: Jco Oncology Practice, 2022 Nov; 18(11), p. e1739-e1749.
EPub date: 2022-09-13 00:00:00.0.
PMID: 36099549
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Costs Around the First Year of Diagnosis for 4 Common Cancers Among the Privately Insured.
Authors: Shih Y.T. , Xu Y. , Bradley C. , Giordano S.H. , Yao J. , Yabroff K.R. .
Source: Journal Of The National Cancer Institute, 2022-09-13 00:00:00.0; , .
EPub date: 2022-09-13 00:00:00.0.
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Costs Around the First Year of Diagnosis for 4 Common Cancers Among the Privately Insured.
Authors: Shih Y.T. , Xu Y. , Bradley C. , Giordano S.H. , Yao J. , Yabroff K.R. .
Source: Journal Of The National Cancer Institute, 2022-09-13 00:00:00.0; , .
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Health Care Resource Utilization for Esophageal Cancer Using Proton versus Photon Radiation Therapy.
Authors: Lin S.H. , Liao K. , Lei X. , Verma V. , Shaaban S. , Lee P. , Chen A.B. , Koong A.C. , Hoftstetter W.L. , Frank S.J. , et al. .
Source: International Journal Of Particle Therapy, 2022 Summer; 9(1), p. 18-27.
EPub date: 2022-06-23 00:00:00.0.
PMID: 35774487
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Financial toxicity impact on younger versus older adults with cancer in the setting of care delivery.
Authors: Corrigan K.L. , Fu S. , Chen Y.S. , Kaiser K. , Roth M. , Peterson S.K. , Shih Y.T. , Jagsi R. , Giordano S.H. , Volk R.J. , et al. .
Source: Cancer, 2022-04-13 00:00:00.0; , .
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Cancer's Lasting Financial Burden: Evidence from a Longitudinal Assessment.
Authors: Shih Y.T. , Owsley K.M. , Nicholas L.H. , Yabroff K.R. , Bradley C. .
Source: Journal Of The National Cancer Institute, 2022-03-24 00:00:00.0; , .
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Treating the Whole Patient With Cancer: The Critical Importance of Understanding and Addressing the Trajectory of Medical Financial Hardship.
Authors: Yabroff K.R. , Shih Y.T. , Bradley C.J. .
Source: Journal Of The National Cancer Institute, 2022-01-04 00:00:00.0; , .
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Sensitivity of Psychosocial Distress Screening to Identify Cancer Patients at Risk for Financial Hardship During Care Delivery.
Authors: Maldonado J.A. , Fu S. , Chen Y.S. , Acquati C. , Yabroff K.R. , Banegas M.P. , Chang S. , Conti R.M. , Checka C.M. , Peterson S.K. , et al. .
Source: Jco Oncology Practice, 2021 Dec; 17(12), p. e1856-e1865.
EPub date: 2021-05-27 00:00:00.0.
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A Coordinated Policy Approach to Address Medical Financial Toxicity.
Authors: Bradley C.J. , Yabroff K.R. , Shih Y.T. .
Source: Jama Oncology, 2021-12-01 00:00:00.0; 7(12), p. 1761-1762.
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A look at the gynecologic oncologist workforce - Are we meeting patient demand?
Authors: Ackroyd S.A. , Shih Y.T. , Kim B. , Lee N.K. , Halpern M.T. .
Source: Gynecologic Oncology, 2021 Nov; 163(2), p. 229-236.
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A Systematic Review of Economic and Quality-of-Life Research in Carcinoid Syndrome.
Authors: Pan I.W. , Halperin D.M. , Kim B. , Yao J.C. , Shih Y.T. .
Source: Pharmacoeconomics, 2021-08-11 00:00:00.0; , .
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Financial Burden of Discarded Weight-based Antineoplastic Drugs to Payers and Patients in the Private Insurance Market.
Authors: Shih Y.T. , Xu Y. , Zhao H. , Schrag D. , Yao J. .
Source: Jnci Cancer Spectrum, 2021 Aug; 5(4), p. pkab045.
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Patient-Reported Out-of-Pocket Costs and Financial Toxicity During Early-Phase Oncology Clinical Trials.
Authors: Huey R.W. , George G.C. , Phillips P. , White R. , Fu S. , Janku F. , Karp D.D. , Naing A. , Piha-Paul S. , Subbiah V. , et al. .
Source: The Oncologist, 2021 07; 26(7), p. 588-596.
EPub date: 2021-04-21 00:00:00.0.
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State of Physician and Pharmacist Oncology Workforce in the United States in 2019.
Authors: Shih Y.T. , Kim B. , Halpern M.T. .
Source: Jco Oncology Practice, 2021 01; 17(1), p. e1-e10.
EPub date: 2020-12-03 00:00:00.0.
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Time to add screening for financial hardship as a quality measure?
Authors: Bradley C.J. , Yabroff K.R. , Zafar S.Y. , Shih Y.T. .
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Understanding Financial Hardship Among Cancer Survivors in the United States: Strategies for Prevention and Mitigation.
Authors: Yabroff K.R. , Bradley C. , Shih Y.T. .
Source: Journal Of Clinical Oncology : Official Journal Of The American Society Of Clinical Oncology, 2020-02-01 00:00:00.0; 38(4), p. 292-301.
EPub date: 2019-12-05 00:00:00.0.
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Treatment value of second-generation BCR-ABL1 tyrosine kinase inhibitors compared with imatinib to achieve treatment-free remission in patients with chronic myeloid leukaemia: a modelling study.
Authors: Shih Y.T. , Cortes J.E. , Kantarjian H.M. .
Source: The Lancet. Haematology, 2019 Aug; 6(8), p. e398-e408.
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Rising Economic Burden of Renal Cell Carcinoma among Elderly Patients in the USA: Part II-An Updated Analysis of SEER-Medicare Data.
Authors: Shih Y.T. , Xu Y. , Chien C.R. , Kim B. , Shen Y. , Li L. , Geynisman D.M. .
Source: Pharmacoeconomics, 2019-07-08 00:00:00.0; , .
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