Factors associated with duration of care in community direct-to-patient (DTP) pharmacies among Chinese cancer patients taking PD-1/PD-L1 inhibitors: Results from a real-world study.

Abstract

e18654 Background: Several PD-1/PD-L1 inhibitors have been approved in China for multiple cancers. Community DTP pharmacies play an important role in both drug distribution and patient management. Using real-world patient management data, we explored the factors associated with duration of care in community DTP pharmacies among cancer patients using PD-1/PD-L1 in the country. Methods: This is a retrospective cohort study using real-world sales and follow-up data routinely collected from 79 Medbanks community DTP pharmacies between Jan 1, 2019 and Mar 31, 2021. Duration of follow-up (DoFU) was defined as the time interval between first PD-1/PD-L1 purchase and last follow-up contact. Duration of drug purchase (DoDP) was defined as the time interval between the first and the last PD-1/PD-L1 purchase date plus a buffer period which was determined based on the amount of last purchase. Covariates included: gender, age, enrollment in a patient access program (PAP), experience of adverse events (AE) during treatment, patient’s awareness of the disease, and follow-up response rate (FRR; < 30%, 30-70%, > 70%). Uni- and multivariate Cox regression models were conducted to assess the association of DoFU/DoDP with predicting variables among both total population and cancer specific sub-populations. Results: A total of 23,559 patients were evaluated (median age: 61 yrs; male: 73%). The three most common cancer types were lung cancer (51.90%), hepatobiliary cancer (19.69%) and esophageal cancer (9.98%). The median DoFU and DoDP were 6.3 month (95% CI: 6.23̃6.50) and 2.3 months (95% CI: 2.27̃2.33). In multivariate Cox regression model, factors associated with longer DoFU included enrollment in PAP (HR = 0.52, p < 0.001), experience of AE during treatment (HR = 0.71, p < 0.001), FRR 30-70% (HR = 0.66, p < 0.001; ref: < 30%) and FRR > 70% (HR = 0.56, p < 0.001; ref: < 30%); factors associated with longer DoDP included enrollment in PAP (HR = 0.90, p < 0.001), experience of AE during treatment (HR = 0.84, p < 0.001) and FRR > 70% (HR = 0.80, p < 0.001; ref: < 30%). The protective effects of PAP, AE and higher FRR on DoFU and DoDP were also observed in the three main cancer specific sub-populations. Conclusions: High quality patient management service provided in community DTP pharmacies is significantly associated with longer duration of care, which implies the important role of DTP pharmacies in the longitudinal care of cancer patients. A comprehensive service package should be developed and applied in community DTP pharmacies for cancer patients in order to better address their medical needs and financial strain.