e-Poster Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2021

Patient self-funding of cancer therapeutics - a single centre review of anticancer monoclonal antibody use in solid tumours (#241)

Yang Jian Ong 1 2 , Ashleigh De Marie 2 , Nisha Sikotra 2 , Janelle Prunster 1 2 , Adash Das 2 , Eli Gabbay 2 3 , Timothy Clay 2 4
  1. Bendat Respiratory Research and Development Fund, St John of God Subiaco Hospital, Subiaco, WA, Australia
  2. St John of God Subiaco Hospital, Subiaco, WA, Australia
  3. School of Medicine, University of Notre Dame, Fremantle, WA, Australia
  4. School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia

Background

Most anti-cancer drug therapy in Australia is heavily subsided via the Pharmaceutical Benefits Scheme (PBS).   Patients may require or seek access to non-PBS listed therapies. In the absence of a clinical trial, medication access program or other funding patients may turn to self-funding.  We studied the frequency of self-funding, levels of evidence, financial burden and patient outcomes from self-funded therapy at our centre for anti-cancer monoclonal antibodies (mAbs) used in patients with solid tumours.

 

Methods

We performed a retrospective observational study follow ethics approval.  Patients treated with self-funded mAbs for solid organ malignancy in the years 2016 to 2019 were identified from pharmacy records.  Data collected included patient demographics, type of cancer, intent of treatment, drug(s) received and cost of therapy.  The level of evidence available to support drug use was identified by a review of the literature contemporaneous to the time of first prescription of the therapy.

 

Results

119 patients identified were identified. Treatment intent: palliative, 108 patients (91%); curative 11 patients (9%).  Line of treatment: 1st line 22%; 2nd or later line 78%.  Cancer types for which therapy was given: gynaecological (n=43, 36%), gastrointestinal (n=28, 23%), thoracic (n=11, 9%), CNS (n=10, 8%), cutaneous (n=9, 8%) breast (n=9, 8%) and other (n=9, 8%).  Best level of evidence for therapy: phase 2 data 53%; phase 3 data 25%; molecularly directed 6%; minimal 16%.  Time of treatment for palliative intent patients median 120 days (range 1 – 1149 days).  Median cost of therapy AUD $37641 (range AUD $1390 - $ 395 968).

 

Conclusion

A sizeable patient cohort was identified at our centre.  While there is demand for treatment only 25% of patients received treatment on the basis of phase 3.  Patients self-funding cancer treatment incur significant personal costs.  Self-funding raises issues of equity of access to cancer therapy in Australia.