Oncologists’ perspectives on challenges using chemotherapy, immune checkpoint inhibitors, and targeted kinase inhibitors for metastatic cancer.

Abstract

1548 Background: Compared to cytotoxic chemotherapies, the standard of care for metastatic cancers for decades, use of immune checkpoint inhibitors (ICI) and targeted kinase inhibitors (TKI) has rapidly expanded with evolving indications for patients with advanced disease. We evaluated oncologists’ report of challenges to using each type of therapy and associations between challenges and oncology practice resources. Methods: From 2023-24 we surveyed 824 medical oncologists, identified using SEER registry data, in Georgia and Los Angeles. We asked oncologists about challenges to using chemotherapy, ICIs and TKIs for the treatment of metastatic cancer. We also asked about resources available at their practice, including administrative and clinical support staff, financial counselors, dedicated pharmacists, social workers, genetic counselors, and interpreters. We generated descriptive statistics of challenges and assessed bivariate associations between challenges and practice resources. Results: We present results for a preliminary sample (N = 370). The Table shows the proportion of oncologists who endorsed each challenge. Compared to cytotoxic chemotherapy, oncologists were more likely to endorse moderate to big challenges using ICIs and TKIs related to insurance approval/prior authorization, co-pay assistance and out-of-pocket costs, as well as keeping up with clinical guidelines and familiarity with dosing and side effects; symptom management was more likely to be a moderate to big problem for chemotherapy and TKIs than for ICIs (all p < 0.01). Challenges with insurance approval/prior authorization, co-pay assistance, and out-of-pocket costs were associated with the availability of administrative and clinical support staff, dedicated pharmacists, and social workers (all p < 0.05). Challenges with symptom management were associated with the availability of clinical support staff and dedicated pharmacists (all p < 0.05). Conclusions: Oncologists endorsed more challenges using ICIs and TKIs compared to cytotoxic chemotherapy in the treatment of metastatic cancer. TKIs were associated with the most challenges, including problems keeping up with clinical guidelines and familiarity with dosing and side effects for nearly 20% of respondents. It is reassuring that many practice resources exist to help address these challenges. Oncologists may benefit from more educational resources—particularly related to TKIs—in their practices. Oncologist-reported challenges. % reporting moderate to big challenge Cytotoxic chemotherapy ICI TKI P Obtaining insurance approval/prior authorization 13 26 35 <0.01 Obtaining co-pay assistance for patients 19 27 43 <0.01 Out-of-pocket costs to patients 25 42 66 <0.01 Symptom management 50 17 43 <0.01 Keeping up with clinical guidelines 7 14 19 <0.01 Familiarity with dosing and side effects 6 7 17 <0.01