Improving Care for Underserved People With Cancer and Evaluating Delays in Receiving Cancer Medications: Research from the 2021 Quality Care Symposium

September 20, 2021
Brielle Gregory Collins, ASCO staff

The 2021 Quality Care Symposium will be held in person and online on September 24 and 25 in Boston, Massachusetts. This meeting from the American Society of Clinical Oncology (ASCO) gathers health care experts to discuss strategies for improving cancer care and reducing disparities in care for all people with cancer.

There will be 2 studies highlighted at this year’s symposium:

  • Community-based program for underserved people with cancer improves quality of life and lowers hospital visits

  • Prior authorization for oral medications is associated with a delay in patients receiving cancer treatment

Learn more about research from this symposium by following the #ASCOQLTY21 hashtag on Twitter.

Community-based program for underserved people with cancer improves quality of life and lowers hospital visits

Providing a community-based, culturally relevant program that engages low-income and minority people newly diagnosed with cancer can improve their quality of life, result in fewer visits to the hospital and emergency room, and increase patients’ activation in their care, according to a new study in Atlantic City, New Jersey. Researchers defined “activation” in cancer care as a person’s willingness and ability to participate in decisions about their care.

Compared with affluent and white populations, low-income and minority populations experience lower quality of life, less activation in their cancer care, and more hospital and emergency care use after a cancer diagnosis. Public health researchers are working to find and implement effective initiatives that address these disparities and improve cancer care for these underserved communities.

In this study, researchers tested a community-based interventional program called LEAPS (Lay health workers Engage educate and Activate Patients to Share). In LEAPS, community health workers with specific training are assigned to newly diagnosed patients to help engage them in their cancer care. The researchers collaborated with an employer-union health fund that represents hospitality workers to include its members as participants in the study. Overall, the study included 160 participants who were newly diagnosed with cancer, half of whom received help through the LEAPS program. The other half received standard care. Most participants in the study were non-white or Latino (74%). The average age of participants was 57 years, and slightly more than half were women (53%). Most of the participants had stage III or stage IV cancer (63%), and the most common diagnoses were breast cancer (31%) and lung cancer (21%). 

In the group receiving the LEAPS intervention, the community health workers provided connections to culturally relevant community resources to help patients cope with challenges from social determinants of health, which are the conditions where a person lives and works that can affect their health, quality of life, care, and survival. These participants were referred to community resources to address needs in housing, food insecurity, transportation, childcare, and financial assistance. The community health workers also helped patients with advanced care planning and screened the patient for symptoms. In addition, they encouraged the patient to discuss these same topics with their cancer care team.

After 4 months of the program, the study found that participants who received the community-based assistance experienced larger improvements in quality of life, were more engaged in their care, and had fewer visits to the hospital or emergency room than participants who did not receive the community-based assistance.

What does this mean? This study shows that providing a community-based program to engage newly diagnosed people with cancer in underserved communities can help empower patients to be more involved with their care and improve their care and quality of life. Tailored programs like this may be a step toward improving equity in cancer care.

“The intervention is an example of how collaborations with communities, employers, and health plans can yield novel approaches to overcome inequities in cancer care delivery. Such interventions can be expanded to other communities in collaboration with community-based cancer clinics and health plans—such as state-based Medicaid organizations and local employers.”

— lead author Manali I. Patel, MD
Stanford University
Palo Alto, California

Prior authorization for oral medications is associated with a delay in patients receiving cancer treatment

A study evaluating U.S. health data from people with cancer prescribed oral cancer therapies found that a large majority of prescriptions (72.3%) required prior authorization from the patient’s health insurance company, and this prior authorization process was associated with a delay in patients receiving their medications by an average of 7 days. Furthermore, whether prior authorization is required may depend on the type of health insurance a person has and the type of drug being prescribed. 

Oral medications are drugs used to treat cancer that can be taken at home, since the medications are taken by mouth as a pill, capsule, or liquid to swallow. They can be used for several types of cancer treatment, including chemotherapy, targeted therapy, and hormone therapy, for different types of cancer. Although the U.S. Food and Drug Administration (FDA) has approved many oral drugs for cancer in the past decade, many people with cancer experience a delay in receiving their prescriptions. Delays in receiving cancer treatment can affect a person’s chances of survival and well-being.

The researchers of this study hypothesized that the prior authorization process required for many cancer medications may contribute to this delay. Prior authorization is a process in which doctors must receive approval from a patient’s health insurance plan before providing certain treatments to their patients.

In this study, researchers wanted to see how prior authorization affected the time it took for a patient to actually receive their cancer medication after it was prescribed, called the “time to receipt.” Researchers collected data for all new cancer medication prescriptions from January 1, 2018, to December 31, 2019, including patient demographics, medical and insurance data, the type of drug being prescribed, and interactions between specialty pharmacies and the patients’ health insurance and financial assistance groups, including any prior authorization information. A specialty pharmacy is a pharmacy that provides medications for people with complex or rare health conditions, including cancer.

The study included 883 patients with 1,014 new prescriptions for cancer medications. The median age of the participants was 66, and the largest racial group identified among the participants was white (44%). Among the study participants, 505 (57.3%) had Medicare, 223 (25.3%) had private insurance, and 140 (15.9%) had Medicaid only. Of the 1,014 new prescriptions, 733 (72.3%) required prior authorization. Overall, the median time to receipt was 1 week. However, 1 of every 4 patients (25%) had to wait more than 14 days for their medication, and 1 of every 20 patients (5%) waited for over 30 days.

Through various analyses, the study found that the type of insurance a person had and the type of prescribed drug were associated with prior authorization being required. Those with Medicaid were nearly 2 times more likely to need prior authorization, compared with those with Medicare. Compared with oral chemotherapy, prescriptions for targeted therapy were 3 times more likely to require prior authorization, and hormone therapy prescriptions were 4 times more likely to need prior authorization. Meanwhile, prior authorization was associated with delayed time to receipt.

Additional analyses showed that having Medicaid only was also associated with a shorter time to receipt. This suggests that factors other than prior authorization may influence how quickly a patient receives their medication and that the prior authorization process may be different based on the type of health insurance.

What does this mean? This study shows that prior authorization, which is required for many oral treatments, can contribute to a delay in people with cancer receiving their necessary treatments. Researchers are hoping this data helps find a more efficient way to get cancer medications into patients’ hands without unnecessary delays.

“It is clear from our work that the current process for obtaining oral oncolytics is complex and multifaceted, and that more research is needed to understand the processes in place so that we can reduce the time it takes for patients to receive prescribed oral anticancer drugs.”

— lead study author Morgan R.L. Lichtenstein, MD
Columbia NewYork-Presbyterian Hospital
New York, New York

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