45 Lenvatinib for endometrial cancer: reducing healthcare disparities and emphasizing equitable medication access through quality improvement

Abstract

Objectives: Combination pembrolizumab with lenvatinib (len/pem) has revolutionized second-line treatment and survival outcomes for patients with mismatch repair-proficient (MMRp) recurrent endometrial cancer (EC). We sought to define existing barriers to medication access and, through quality improvement (QI) techniques, improve access and decrease healthcare disparities in a high risk, medically underserved population. Methods: Following IRB approval, we identified all patients with MMRp EC dispositioned to receive len/pem in our institution. Clinico-demographic data were abstracted from medical records. Lag time was defined as time from decision to treat until specialty medication received or initiation of len/pem. QI interventions included internal process mapping, multidisciplinary roundtable collaboration, and engagement of pharmaceutical access resources. The effect of the interventions on lag time were then assessed after a 10-month follow-up period. Comparative statistics were performed for pre/post-intervention metrics using Chi square, Fisher's exact, and t-tests. Results: From Oct 2019 to Mar 2023, 41 patients were identified and included in analysis. 32 and 9 patients received len/pem in thepre- and post-intervention groups, respectively. Average age was 60 years old, 55% were Hispanic, 29% were non-Hispanic black patients, and 80% had either Medicaid or county/charity healthcare coverage. After interventions, average lag time significantly decreased from 32.5 days (range 10–74) to 15.7 days (range 7–31, p=.005). Utilization of patient access resources (PAP) increased from 40 to 78%. Barriers to medication access were identified to be internal communication breakdowns, uncertainty regarding PAP usage, patient distrust of unverified outside calling numbers, and external specialty pharmacy communication breakdowns. Conclusions: Medication access disparities can be significantly reduced among vulnerable patients with MMRp EC through QI interventions.