Deborah Kaye

Positions:

Assistant Professor of Surgery

Surgery, Urology
School of Medicine

Core Faculty Member, Duke-Margolis Center for Health Policy

Duke - Margolis Center For Health Policy
Institutes and Provost's Academic Units

Member in the Duke Clinical Research Institute

Duke Clinical Research Institute
School of Medicine

Member of the Duke Cancer Institute

Duke Cancer Institute
School of Medicine

Education:

B.A. 2002

Washington University in St. Louis

M.D. 2010

Medical College of Wisconsin

M.S. 2017

University of Michigan, Ann Arbor

Fellow, Clinical Research Training Program

National Institutes of Health

General Surgery Intern, Surgery

Johns Hopkins Medicine

Urology Resident

Johns Hopkins Medicine

Fellow, Society of Urologic Oncology, Urology

University of Michigan, Ann Arbor

Grants:

Disparities in the Use of Oral Anticancer Agents in Kidney Cancer

Administered By
Population Health Sciences
Awarded By
National Institutes of Health
Role
Collaborator
Start Date
End Date

Publications:

Medication Payments by Insurers and Patients for the Treatment of Metastatic Castrate-Resistant Prostate Cancer.

PURPOSE: The implications of high prices for cancer drugs on health care costs and patients' financial burdens are a growing concern. Patients with metastatic castrate-resistant prostate cancer (mCRPC) are often candidates for multiple first-line systemic therapies with similar impacts on life expectancy. However, little is known about the gross and out-of-pocket (OOP) payments associated with each of these drugs for patients with employer-sponsored health insurance. We therefore aimed to determine the gross and OOP payments of first-line drugs for mCRPC and how the payments vary across drugs. METHODS: This retrospective cohort study included 4,298 patients with prostate cancer who initiated therapy with one of six drugs approved for first-line treatment of mCRPC between July 1, 2013, and June 30, 2019. We compared gross and OOP payments during the 6 months after initiation of treatment for mCRPC using private payer claims data across patients using different first-line drugs. RESULTS: Gross payments varied across drugs. Over the 6 months after the index prescription, mean unadjusted gross drug payments were highest for patients receiving sipuleucel-T ($115,525 USD) and lowest for patients using docetaxel ($12,804 USD). OOP payments were lower than gross drug payments; mean 6-month OOP payments were highest for cabazitaxel ($1,044 USD) and lowest for docetaxel ($296 USD). There was a wide distribution of OOP payments within drug types. CONCLUSION: Drugs for mCRPC are expensive with large differences in payments by drug type. OOP payments among patients with employer-sponsored health insurance are much lower than gross drug payments, and they vary both across and within first-line drug types, with some patients making very high OOP payments. Although lowering drug prices would reduce pharmaceutical spending for patients with mCRPC, decreasing patient financial burden requires understanding an individual patient's benefit design.
Authors
Kaye, DR; Lee, H-J; Gordee, A; George, DJ; Ubel, PA; Scales, CD; Bundorf, MK
MLA Citation
Kaye, Deborah R., et al. “Medication Payments by Insurers and Patients for the Treatment of Metastatic Castrate-Resistant Prostate Cancer.Jco Oncol Pract, vol. 19, no. 4, Apr. 2023, pp. e600–17. Pubmed, doi:10.1200/OP.22.00645.
URI
https://scholars.duke.edu/individual/pub1563310
PMID
36689695
Source
pubmed
Published In
Jco Oncol Pract
Volume
19
Published Date
Start Page
e600
End Page
e617
DOI
10.1200/OP.22.00645

End-of-Life Care for Patients With Metastatic Renal Cell Carcinoma in the Era of Oral Anticancer Therapy.

PURPOSE: New therapies including oral anticancer agents (OAAs) have improved outcomes for patients with metastatic renal cell carcinoma (mRCC). However, little is known about the quality of end-of-life (EOL) care and systemic therapy use at EOL in patients receiving OAAs or with mRCC. METHODS: We retrospectively analyzed EOL care for decedents with mRCC in two parallel cohorts: (1) patients (RCC diagnosed 2004-2015) from the University of North Carolina's Cancer Information and Population Health Resource (CIPHR) and (2) patients (diagnosed 2007-2015) from SEER-Medicare. We assessed hospice use in the last 30 days of life and existing measures of poor-quality EOL care: systemic therapy, hospital admission, intensive care unit admission, and > 1 ED visit in the last 30 days of life; hospice initiation in the last 3 days of life; and in-hospital death. Associations between OAA use, patient and provider characteristics, and EOL care were examined using multivariable logistic regression. RESULTS: We identified 410 decedents in the CIPHR cohort (53.4% received OAA) and 1,508 in SEER-Medicare (43.5% received OAA). Prior OAA use was associated with increased systemic therapy in the last 30 days of life in both cohorts (CIPHR: 26.5% v 11.0%; P < .001; SEER-Medicare: 23.4% v 11.7%; P < .001), increased in-hospital death in CIPHR, and increased hospice in the last 30 days in SEER-Medicare. Older patients were less likely to receive systemic therapy or be admitted in the last 30 days or die in hospital. CONCLUSION: Patients with mRCC who received OAAs and younger patients experienced more aggressive EOL care, suggesting opportunities to optimize high-quality EOL care in these groups.
Authors
Dzimitrowicz, HE; Wilson, LE; Jackson, BE; Spees, LP; Baggett, CD; Greiner, MA; Kaye, DR; Zhang, T; George, D; Scales, CD; Pritchard, JE; Leapman, MS; Gross, CP; Dinan, MA; Wheeler, SB
MLA Citation
Dzimitrowicz, Hannah E., et al. “End-of-Life Care for Patients With Metastatic Renal Cell Carcinoma in the Era of Oral Anticancer Therapy.Jco Oncol Pract, vol. 19, no. 2, Feb. 2023, pp. e213–27. Pubmed, doi:10.1200/OP.22.00401.
URI
https://scholars.duke.edu/individual/pub1556754
PMID
36413741
Source
pubmed
Published In
Jco Oncol Pract
Volume
19
Published Date
Start Page
e213
End Page
e227
DOI
10.1200/OP.22.00401

Oral Anticancer Agent (OAA) Adherence and Survival in Elderly Patients With Metastatic Renal Cell Carcinoma (mRCC).

OBJECTIVE: To examine real-world adherence to oral anticancer agents (OAAs) and its association with outcomes among Medicare beneficiaries with metastatic renal cell carcinoma (mRCC). METHODS: SEER-Medicare retrospective cohort study of patients with metastatic renal cell carcinoma (mRCC) who received an OAA between 2007 and 2015. We examined A) adherence and B) overall and disease-specific 2-year survival landmarked at 3 months after OAA initiation. Adherence was assessed by calculating the proportion of days covered (PDC) within 3 months of OAA initiation, with adherent use being defined as PDC > 80%. RESULTS: A total of 905 patients met study criteria, of whom 445 patients (49.2%) were categorized as adherent to initial OAA treatment. Adjusting for clinical and demographic factors revealed decreased odds of adherence associated with living within an impoverished neighborhood (OR 0.49, CI 0.0.33 - 0.74) and out-of-pocket costs > $200 (OR 0.68, CI 0.47-.98). Adherence was associated with improved 2-year survival in univariate analysis (logrank test, P = .01) and a non-significant trend toward an association with decreased all-cause (HR 0.87, CI 0.72 - 1.05) and RCC-specific survival (HR 0.84, CI 0.69 - 1.03) in multivariable analysis. CONCLUSION: Local poverty levels and high out-of-pocket costs are associated with poor initial adherence to OAA therapy in Medicare beneficiaries with mRCC, which in turn, suggests a trend toward poor overall and disease-specific survival. Efforts to improve outcomes in the broader mRCC population should incorporate OAA adherence and economic factors.
Authors
Dinan, MA; Wilson, LE; Greiner, MA; Spees, LP; Pritchard, JE; Zhang, T; Kaye, D; George, D; Scales, CD; Baggett, CD; Gross, CP; Leapman, MS; Wheeler, SB
MLA Citation
Dinan, Michaela A., et al. “Oral Anticancer Agent (OAA) Adherence and Survival in Elderly Patients With Metastatic Renal Cell Carcinoma (mRCC).Urology, vol. 168, Oct. 2022, pp. 129–36. Pubmed, doi:10.1016/j.urology.2022.07.012.
URI
https://scholars.duke.edu/individual/pub1529018
PMID
35878815
Source
pubmed
Published In
Urology
Volume
168
Published Date
Start Page
129
End Page
136
DOI
10.1016/j.urology.2022.07.012

Association between cognitive impairment and oral anticancer agent use in older patients with metastatic renal cell carcinoma.

BACKGROUND: Kidney cancer is the fastest-growing cancer diagnosis in the developed world. About 16% of new cases are stage IV, which has a low five-year survival rate. Many patients with metastatic renal cell carcinoma (mRCC) are older and may have mild cognitive impairment or dementia (MCI/D). Given prior reports of patients with dementia initiating less cancer therapy and the importance of oral anticancer agents (OAAs) in mRCC treatment, we investigated the prevalence of preexisting MCI/D in patients with mRCC and their OAA use. METHODS: SEER-Medicare patients were analyzed who were ≥65 years, diagnosed with mRCC between 2007 and 2015, and had Medicare part D coverage. Patterns and predictors of (a) OAA utilization within the 12 months following mRCC diagnosis and (b) adherence (percent of days covered [PDC] ≥ 80%) during the first 90 days following treatment initiation were assessed. RESULTS: Of the 2792 eligible patients, 268 had preexisting MCI/D, and 907 initiated OAA treatment within 12 months of mRCC diagnosis. Patients with preexisting MCI/D were less likely to begin an OAA than those without MCI/D (fully-adjusted HR 0.53, 95% CI 0.38-0.76). Among OAA initiators, a preexisting MCI/D diagnosis did not alter the likelihood that a person would be adherent (adjusted RR 0.84, 95% CI 0.55-1.28). CONCLUSIONS: Patients with preexisting MCI/D were half as likely to start an OAA during the year following mRCC diagnosis than patients without comorbid MCI/D. The 90-day adherence of OAA initiators was not significantly different between those with and without preexisting MCI/D. In light of this, clinicians should assess mRCC patients for cognitive impairment and take steps to optimize OAA utilization by those with MCI/D.
Authors
Pritchard, JE; Wilson, LE; Miller, SM; Greiner, MA; Cohen, HJ; Kaye, DR; Zhang, T; Dinan, MA
MLA Citation
Pritchard, Jessica E., et al. “Association between cognitive impairment and oral anticancer agent use in older patients with metastatic renal cell carcinoma.J Am Geriatr Soc, vol. 70, no. 8, Aug. 2022, pp. 2330–43. Pubmed, doi:10.1111/jgs.17826.
URI
https://scholars.duke.edu/individual/pub1520329
PMID
35499667
Source
pubmed
Published In
Journal of the American Geriatrics Society
Volume
70
Published Date
Start Page
2330
End Page
2343
DOI
10.1111/jgs.17826

Evaluation of mild cognitive impairment and dementia in patients with metastatic renal cell carcinoma.

BACKGROUND: Dementia and cancer are both more common in adults as they age. As new cancer treatments become more popular, it is important to consider how these treatments might affect older patients. This study evaluates metastatic renal cell carcinoma (mRCC) as a risk factor for older adults developing mild cognitive impairment or dementia (MCI/D) and the impact of mRCC-directed therapies on the development of MCI/D. METHODS: We identified patients diagnosed with mRCC in a Surveillance, Epidemiology, and End Results (SEER)-Medicare dataset from 2007 to 2015 and matched them to non-cancer controls. Exclusion criteria included age < 65 years at mRCC diagnosis and diagnosis of MCI/D within the year preceding mRCC diagnosis. The main outcome was time to incident MCI/D within one year of mRCC diagnosis for cases or cohort entry for non-cancer controls. Cox proportional hazards models were used to measure associations between mRCC and incident MCI/D as well as associations of oral anticancer agent (OAA) use with MCI/D development within the mRCC group. RESULTS: Patients with mRCC (n = 2533) were matched to non-cancer controls (n = 7027). mRCC (hazard ratio [HR] 8.52, p < .001), being older (HR 1.05 per 1-year age increase, p < .001), and identifying as Black (HR 1.92, p = .047) were predictive of developing MCI/D. In addition, neither those initiating treatment with OAAs nor those who underwent nephrectomy were more likely to develop MCI/D. CONCLUSIONS: Patients with mRCC were more likely to develop MCI/D than those without mRCC. The medical and surgical therapies evaluated were not associated with increased incidence of MCI/D. The increased incidence of MCI/D in older adults with mRCC may be the result of the pathology itself or risk factors common to the two disease processes.
Authors
Miller, SM; Wilson, LE; Greiner, MA; Pritchard, JE; Zhang, T; Kaye, DR; Cohen, HJ; Becher, RD; Maerz, LL; Dinan, MA
MLA Citation
Miller, Samuel M., et al. “Evaluation of mild cognitive impairment and dementia in patients with metastatic renal cell carcinoma.J Geriatr Oncol, vol. 13, no. 5, June 2022, pp. 635–43. Pubmed, doi:10.1016/j.jgo.2021.12.012.
URI
https://scholars.duke.edu/individual/pub1505524
PMID
34996724
Source
pubmed
Published In
J Geriatr Oncol
Volume
13
Published Date
Start Page
635
End Page
643
DOI
10.1016/j.jgo.2021.12.012