Disparities in the Use of Oral Anticancer Agents in Kidney Cancer

We have long known that real-world black-white racial disparities have existed in the treatment
and outcomes of patients with renal cell carcinoma (RCC). However, it is unclear how these
disparities will change with the recent introduction and widespread adoption of oral anticancer
agents (OAAs). As with any advance in medical technology, the introduction of these agents
has the potential to significantly improve patient outcomes, but also has the potential to
exacerbate current disparities if these advances in OAAs are not equally available or do not
provide the same benefit to all patients. The proposed study addresses this critical gap in our
knowledge by investigating a mix of nationally representative, yet diverse populations of patients
with kidney cancer in the United States. Unfortunately, no single dataset of patients with kidney
cancer exists that is able to capture nationally-representative data on patients of all ages and all
insurance status within the United States. However, by using three complementary data sources
we are able to include patients of all ages, insurance, geography, and race to investigate the
current and future utilization, outcomes, and costs associated with emerging OAAs in patients
with kidney cancer.
Aim 1 – Investigate patient-level disparities in OAA use in RCC patients
Aim 2 – Investigate provider- and system-level disparities in OAA use in RCC patients..
Aim 3 – Investigate the impact of patient-provider networks (PPNs) on OAA adoption and
identify pockets of late or non-adopting providers.
The proposed research will (1) assess and describe the current state of oral anticancer
medication utilization, delivery, and adherence; (2) identify patient, provider, structural, and
systemic barriers to adherence and disparities in outcomes; and (3) develop models and
strategies to improve safe and effective delivery of these agents in order to improve access to
optimal clinical care and outcomes.
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