Medical and Psychosocial Impact of Oral Therapy on Patients with Metastatic Castration-Resistant Prostate Cancer

The introduction of 2 therapies for the treatment of patients with metastatic castration-resistant prostate cancer (mCRPC)—the orally administered abiraterone acetate (Zytiga) and enzalutamide (Xtandi)—has prompt­­ed Leslie Hazel-Fernandez, PhD, Comprehensive Health Insights, Louisville, KY, and colleagues to conduct a qualitative study to evaluate the personal and other factors that influence the use of oral drugs among patients with mCRPC, as well as to gauge caregivers’ and physicians’ experiences with patients who use these oral medications. The results of this study were presented at the 2015 Academy of Managed Care Pharmacy annual meeting.

All the patients were prescribed either abiraterone acetate or enzalutamide for mCRPC and were randomly selected from Humana’s pharmacy claims database for phone interviews. Overall, the researchers interviewed 31 patients; 26 caregivers; and 30 physicians, including oncologists and urologists.

The interview questions centered on relationships with physicians, patient and physician communication, access to these oral medications, overall support and communication, the role of a patient’s attitude in coping with the diagnosis of mCRPC, and the disruption of patients’ physical and social activities.

Study Findings

The phone-based interviews showed that more than 85% of patients who continued taking oral medications for mCRPC defined the efficacy of the medications in terms of reductions in their prostate-specific antigen (PSA) values. In addition, 19% of the patients who discontinued treatment did so because the medication was not effective in lowering their PSA and/or was negatively affecting the patient’s quality of life.

The study highlighted several interesting findings, including the impor­tant role that physicians play in guiding patients’ decisions to obtain oral treatment: the patients put the physicians’ interpretation and instructions at the forefront of their treatment decision-­making.

In terms of the therapy’s potential for hindering patients’ physical and social activities, 65% of patients reported that the loss of social functioning and quality of life were their primary concerns regarding therapy; conversely, 50% of caregivers listed patients’ longevity and 60% of physicians listed pain as their primary concern with therapy.

Overall, 77% of patients were satisfied with their quality of care and communication with their physicians, and regarded physicians as their primary resource for information about treatments for mCRPC. Caregivers, however, were less trusting of physicians; 50% of caregivers held unfavorable opinions about physicians, and were more likely to doubt physicians’ accuracy and quality of information.

Drug cost and the healthcare navigation system were cited as the greatest barriers to accessing oral medications by patients, caregivers, and physicians; in addition, physicians viewed cost as the biggest obstacle to prescribing oral therapies for mCRPC. Furthermore, all 3 stakeholders agreed that the physicians’ office is a central location for obtaining oral therapies.

Finally, 81% of patients believed that a positive attitude helped them cope and manage their mCRPC. In addition, patients looked to caregivers for psychosocial support, with 85% of caregivers reporting a sense of pride at being a good caregiver.

Dr Hazel-Fernandez and colleagues concluded that “gaps in disease information, financial concerns, and limited caregiver support impact the patient and caregiver.” Surveying a larger sample of patients, caregivers, and physicians is needed to confirm these findings.

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