All ETDs from UAB

Advisory Committee Chair

S Robert Hernandez

Advisory Committee Members

Amy Yarbrough Landry

Stephen J O'Connor

Jeff M Szychowski

Document Type

Dissertation

Date of Award

2022

Degree Name by School

Executive Doctor of Science (DSc) School of Health Professions

Abstract

Advancements in medical knowledge are producing significant improvements in medical technology, developing breakthrough drug therapies, advancing the practice of medicine, and improving outcomes for cancer patients. However, there are delays in getting new and improved therapies incorporated into routine clinical use, depriving cancer patients of valuable and potentially lifesaving treatments. The purpose of this study was to examine the rate of adoption of new cancer drug discoveries into routine clinical practice in non-academic cancer centers. The process of adoption takes a period of time to embrace new therapies, due in part to a prescriber’s need to gain greater comfort with efficacy, performance, toxicity, and safety profiles of new drug therapies. We also explored the effect of patient age, patient race, patient ECOG performance scale status, and region of the country, on the adoption of new cancer therapies. This study found that non-academic cancer centers took 15 calendar months, on average, following a Category 1 Level of Evidence recommendation in the NCCN Guidelines®, to reach 50% adoption using a rolling 6-month average to measure sustainable guideline concordance. For calendar year 2021, the average monthly percent of guideline concordant prescriptions equaled 52.71%. Guideline concordance never reached the industry target level of 80%. This study found that a patient presenting to a non-academic cancer center with a newly diagnosed, most common metastatic (Stage IV) iv breast cancer, had odds of only slightly over a 50/50 chance of being prescribed the therapy with the highest level of scientific evidence and expert clinical consensus. This study also found that race and ECOG (Eastern Cooperative Oncology Group) Performance Scale Status were significant predictors of adoption. The odd of patients identifying as Black or African American receiving concordant therapy were 19% lower versus White patients (P = 0.005). As a patient’s ECOG Performance Scale Status increased by each level on the scale, the odds of receiving concordant therapy were 16% lower (P < 0.001). This research provides a better understanding of the adoption of breakthrough cancer drugs and yields valuable insight into ways that may help accelerate their appropriate incorporation into regular clinical use in all cancer centers.

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