Do patients who utilize financial assistance programs to pay for oral anti-cancer medications face delays in treatment initiation and continuity?

197 Background: Oral anticancer medications (OAMs) are increasingly prescribed for patients with cancer but often carry high cost-sharing burdens. Financial assistance (FA) programs by foundations or manufacturers mitigate costs but often require onerous applications and frequent renewals that may lead to delays and gaps in treatment. This study sought to characterize whether patients receiving FA face longer times to treatment initiation and higher rates of treatment gaps compared to unassisted patients. Methods: This retrospective cross-sectional study included 2585 adult patients with cancer who started a new OAM prescription at the University of California, San Francisco specialty pharmacy between 7/1/2021–6/30/2023. Of this cohort, 400 patients were randomly selected for chart abstraction to determine time to treatment initiation (in days) and whether a dose interruption of more than 7 days occurred. To match the overall cohort, the smaller cohort was purposely sampled by whether patients received FA. Associations of FA receipt with having a dose interruption and time to treatment initiation (measured among those who started within thirty days) were determined via logistic and mixed effects linear regression models, respectively. All models were adjusted for age, living status, sex, race, ethnicity, primary language, employment status, insurance provider, and residential setting (urban, suburban, rural). Results: 333 out of 400 patients sampled met eligibility criteria and were included in the analysis; the remaining 67 either never started or were not newly prescribed the OAM. 34% (n = 114) received FA, 25% (n = 84) had at least one dose interruption, and median time to treatment initiation was 11 days (IQR 6-23 days). Most participants were 65 years or older (69%), male (57%), English-speaking (87%), Non-Hispanic White (65%) and Medicare-insured (50%). In a multivariable Poisson regression model, receipt of FA was not significantly associated with a change in likelihood of having at least one dose interruption (IRR = 0.921, 95% CI: 0.680–1.246, p = 0.593). In a linear regression model, receipt of FA was associated with a longer time to treatment initiation among patients who started treatment within thirty days (β = 2.64, 95% CI: 0.56 to 4.73, p = 0.013). Conclusions: Receipt of FA was associated with minor delays in treatment initiation, but did not impact OAM continuity when compared to patients who did not receive FA. System-level drug assistance programs for OAMs can successfully ameliorate financial toxicity without significantly impacting clinical and pharmacologic outcomes. This study took place in an institution with dedicated pharmacy navigation services; in the future, patterns of FA receipt and their impact on clinical outcomes should be evaluated in diverse delivery settings to ensure generalizability of these results.