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Association between cognitive impairment and oral anticancer agent use in older patients with metastatic renal cell carcinoma
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8 2022
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Source: J Am Geriatr Soc. 70(8):2330-2343
[PDF-1.16 MB]
Details:
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Alternative Title:J Am Geriatr Soc
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Personal Author:
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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.
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Pubmed ID:35499667
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Pubmed Central ID:PMC9378524
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