Dinan and her colleagues assembled multiple data sets to analyze kidney cancer patients across all ages, insurance levels, ethnicities, and geographies. In 13 peer-reviewed papers on treatment barriers and disparities in access to essential medications, Dinan documented substantial differences in access to the drugs across race and gender. Black patients were significantly less likely than white patients to receive oral anticancer treatments. The same was true for women compared to men. Also less likely to receive the drugs were those residing in impoverished neighborhoods, older patients, patients who had chronic conditions, and unmarried, divorced, and widowed individuals.
The work also showed that female health care providers and those based in urban areas were more likely to prescribe oral therapies.
Cancer patient outcomes also are influenced by how closely patients follow a treatment regimen. Patients receiving chemotherapy do so at a qualified health center, where they can be monitored for symptoms and reminded about dosing schedules. Oral drug therapy removes this kind of oversight, Dinan noted. Her studies of kidney cancer patients found that even for patients who were able to get access to the oral drugs, some did not follow their treatment schedule, and those patients were more likely to die from their disease. Dinan studied whether the cost of the drugs played a role in patients deviating from the course of treatment – Medicare payments for kidney cancer treatments ballooned 41 percent from 2015 to 2019. Some of the increase came as oral therapies were more widely used, but the drugs also increased in price. Interestingly, the out-of-pocket costs remained relatively stable over the study period.
Dinan’s data showed that patients in lower-income neighborhoods and patients who paid higher out-of-pocket costs for the treatment were less likely to follow their course of treatment. “If costs are impacting patients’ abilities to be adherent, and we know adherence is related to better survival, then costs become a pretty important part of the story,” she said.
However, when Dinan consulted with patient advocates across her studies, she found that patients reported costs as their least important issue. This disconnect makes sense, she said.
“If I had a life-threatening diagnosis, probably the last thing that I would want to have to think about is the cost of treatment,” she said. “But the unfortunate reality of the world that we live in is that cost does have an impact on whether or not patients stay adherent.”
She said this knowledge opens a new line of conversation for providers to have with their patients. The American Society of Clinical Oncology (ASCO) cited her findings on treatment cost and patient adherence in its new treatment guidelines for kidney cancer. Released in 2022, the updated guidelines recommend physicians discuss with patients both oral therapies and less expensive alternatives, such as hospital-based chemotherapy, other anti-cancer agents, or new drugs. Efforts should also be made to encourage insurance companies to cover more costs, Dinan said. She said health care providers must target costs and also target communities that have lower rates of access to these drugs. “It’s really about making these drugs more accessible from a cost perspective and taking the burden off of patients.”