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Principal Investigator: BRENT K. HOLLENBECK
Organization: MASSACHUSETTS GENERAL HOSPITAL
Fiscal Year: 2024
Award: $94,664
Funding agency: National Cancer Institute
PROJECT SUMMARY
Nearly 35,000 succumb to advanced prostate cancer each year, making it the second leading cause of cancer
death among men. The development of oral specialty drugs targeting specific molecules has led to a paradigm
shift in which men can receive treatment for their prostate cancer at home. Oral specialty drugs, such as
abiraterone and enzalutamide, have similar efficacy as physician administered chemotherapy with less toxicity
and are the most common first-line treatment for advanced prostate cancer as of 2015. This new treatment
paradigm has been accompanied by concurrent changes in in the delivery system. Increasingly, prescriptions
for oral specialty drugs are dispensed directly by the urologist or medical oncologist in their office (referred to
as “physician dispensing”). Patients may benefit from this delivery model as it places the onus for authorization
and identification of financial assistance on the prescribing physician. Combined with the integration and
coordination implied by dispensing at the point of care, this delivery model may improve access, timeliness and
adherence to these specialty drugs. However, financial incentives associated with physician dispensing,
through a margin generated by each prescription fill, may foster prescribing behaviors promoting utilization that
undermine the value of this delivery system change, such as use of these therapies in patients with preexisting
conditions that predispose them to adverse drug effects. To understand the implications of this delivery model
for patients, we propose the following: (1) To measure the effects of physician dispensing on use of specialty
drugs for prostate cancer; (2) To determine the impact of physician dispensing of specialty drugs for prostate
cancer on financial outcomes and coping behaviors; and (3) To measure the relationship between physician
dispensing of specialty drugs for prostate cancer and patient safety. Results from this study will have real-world
implications for men with advanced prostate cancer, who are naturally interested in getting the highest quality
cancer care while avoiding the financial consequences commonly associated with oral specialty drugs.
Terms: <1, 2-Dehydrocortisone><Adherence><Adoption><Adverse Experience><Adverse drug effect><Adverse event><Authorization><Authorization documentation><Behavior><Cancer Cause><Cancer Etiology><Cessation of life><Classification><Coping Behavior><Data><Death><Death Rate><Dehydrocortisone><Delta(1)-Cortisone><Deltacortisone><Deltadehydrocortisone><Development><Disease><Disorder><Drug Costs><Drug Targeting><Drugs><Eligibility><Eligibility Determination><Familiarity><Financial Hardship><Financial Support><Fostering><Health Insurance for Aged and Disabled, Title 18><Health Insurance for Disabled Title 18><Heterogeneity><Home><Improve Access><Incentives><Malignant Tumor of the Prostate><Malignant neoplasm of prostate><Malignant prostatic tumor><Measures><Medical><Medical Oncologist><Medical Oncology><Medicare><Medication><Metacortandracin><Modeling><Oral><Out-of-Pocket Expense><Outcome><Patients><Permission><Pharmaceutical Preparations><Pharmacies><Pharmacy facility><Phase><Physicians><Population><Prednisone><Prednisonum><Price><Prostate CA><Prostate Cancer><Prostate malignancy><Prostatic Cancer><Protocol Screening><Recommendation><Risk><Safety><Secure><Specialty><System><Systematics><Time><Title 18><Toxic effect><Toxicities><Uncovered Medical Expenses><Uncovered Uninsured Medical Expense><Underrepresented Groups><Underrepresented Populations><Uninsured Medical Expense><Urologist><Urology><Work><Xtandi><abiraterone><advanced prostate cancer><black male><black men><cancer care><chemotherapy><delta-Cortisone><developmental><drug adherence><drug compliance><drug-related adverse effects><drug/agent><enzalutamide><financial adversity><financial assistance><financial burden><financial distress><financial incentive><financial insecurity><financial reward><financial strain><financial stress><health insurance for disabled><homes><improved><interest><medical expenses not covered by insurance><medical specialties><medication adherence><medication compliance><men><monetary incentive><mortality rate><mortality ratio><out-of-pocket costs><out-of-pocket health care costs><patient safety><point of care><pricing><targeted drug therapy><targeted drug treatments><targeted therapeutic><targeted therapeutic agents><targeted therapy><targeted treatment><therapy duration><total medical expenditure><trend><under representation of groups><under represented groups><under represented people><under represented populations><underrepresentation of groups><underrepresented people>