Association between cognitive impairment and oral anticancer agent use in older patients with metastatic renal cell carcinoma

Details

• Alternative Title:
  J Am Geriatr Soc
• Personal Author:
  Pritchard, Jessica E. ; Wilson, Lauren E. ; Miller, Samuel M. ; Greiner, Melissa A. ; Cohen, Harvey Jay ; Kaye, Deborah R. ; Zhang, Tian ; Dinan, Michaela A.
• Description:
  Background
  
  Kidney cancer is the fastest-growing cancer diagnosis in the developed world. About 16% of new cases are stage IV, which has a low five-year survival rate. Many patients with metastatic renal cell carcinoma (mRCC) are older and may have mild cognitive impairment or dementia (MCI/D). Given prior reports of patients with dementia initiating less cancer therapy and the importance of oral anticancer agents (OAAs) in mRCC treatment, we investigated the prevalence of preexisting MCI/D in patients with mRCC and their OAA use.
  
  Methods
  
  SEER-Medicare patients were analyzed who were ≥65 years, diagnosed with mRCC between 2007 and 2015, and had Medicare part D coverage. Patterns and predictors of a) OAA utilization within the 12 months following mRCC diagnosis and b) adherence (percent of days covered [PDC] ≥ 80%) during the first 90 days following treatment initiation were assessed.
  
  Results
  
  Of the 2,792 eligible patients, 268 had preexisting MCI/D and 907 initiated OAA treatment within 12 months of mRCC diagnosis. Patients with preexisting MCI/D were less likely to begin an OAA than those without MCI/D (fully-adjusted HR 0.53, 95% CI 0.38 – 0.76). Among OAA initiators, a preexisting MCI/D diagnosis did not alter the likelihood that a person would be adherent (adjusted RR 0.84, 95% CI 0.55 – 1.28).
  
  Conclusions
  
  Patients with preexisting MCI/D were half as likely to start an OAA during the year following mRCC diagnosis than patients without comorbid MCI/D. The 90-day adherence of OAA initiators was not significantly different between those with and without preexisting MCI/D. In light of this, clinicians should assess mRCC patients for cognitive impairment and take steps to optimize OAA utilization by those with MCI/D.
  
  
• Subjects:
  Aged Antineoplastic Agents Carcinoma, Renal Cell Cognitive Dysfunction Dementia Humans Kidney Neoplasms Medicare Part D United States
• Keywords:
  Alzheimer's Disease Alzheimer's Disease Sequencing Project Antiviral Agents Cognitive Impairment Dementia Herpes Simplex Human Papillomavirus Metastatic Cancer Renal Cell Carcinoma Targeted Therapy Torque Teno Viruses Whole Exome Sequencing Whole Genome Sequencing

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• Source:
  J Am Geriatr Soc. 70(8):2330-2343
• Pubmed ID:
  35499667
• Pubmed Central ID:
  PMC9378524
• Document Type:
  Journal Article
• Funding:
  HHSN261201000140C/CA/NCI NIH HHSUnited States/ ; HHSN261201000035C/CA/NCI NIH HHSUnited States/ ; UL1 TR001863/TR/NCATS NIH HHSUnited States/ ; R01 CA226842/CA/NCI NIH HHSUnited States/ ; 3R01CA226842-02S1/CA/NCI NIH HHSUnited States/ ; HHSN261201000034C/CA/NCI NIH HHSUnited States/ ; U58 DP003862/DP/NCCDPHP CDC HHSUnited States/ ; TL1 TR001864/TR/NCATS NIH HHSUnited States/ ; HHSN261201000035I/CA/NCI NIH HHSUnited States/
• Volume:
  70
• Issue:
  8
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha-512:5dc1831ad92a6673292407765081946fd1f6c16af72c2be24117e4c9321db355d7235381990be5336393f75096e60a79250e01a3a80307f7834193718d97d3f1
• Download URL:
  https://stacks.cdc.gov/view/cdc/120414/cdc_120414_DS1.pdf
• File Type:
  [PDF - 1.16 MB ]