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Opportunities for personalizing colorectal cancer care: an analysis of SEER-medicare data

The Pharmacogenomics Journal volume 22, pages 198–209 (2022)Cite this article

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Abstract

United States clinical practice guidelines for metastatic colorectal cancer recommend use of medications impacted by genetic variants but do not recommend testing. We analyzed real-world treatment using a cancer registry and claims dataset to explore pharmacogenomic (PGx) medication treatment patterns and characterize exposure. In a cohort of 6957 patients, most (86.9%) were exposed to at least one chemotherapy medication with PGx guidelines. In a cohort of 2223 patients with retail pharmacy claims available, most (79.2%) were treated with at least one non-chemotherapy (79.2%) medication with PGx guidelines. PGx-associated chemotherapy exposure was associated with age, race/ethnicity, educational attainment, and rurality. PGx-associated non-chemotherapy exposure was associated with medication use and comorbidities. The potential impact of PGx testing is large and policies aimed at increasing PGx testing at diagnosis may impact treatment decisions for patients with metastatic colorectal cancer as most patients are exposed to medications with pharmacogenomics implications during treatment.

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Fig. 1: Study design diagram.
Fig. 2: Cohort identification.
Fig. 3: Combined chemotherapy and non-chemotherapy PGx at-risk exposure.

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Data availability

The data that support the findings of this study are available from The National Cancer Institute Division of Cancer Control and Population Sciences. (https://healthcaredelivery.cancer.gov/seermedicare/obtain/) Restrictions apply to the availability of these data, which were used under license for this study.

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Acknowledgements

We would like to acknowledge the two anonymous reviewers for their thoughtful feedback and constructive criticism.

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Authors and Affiliations

  1. Department of Pharmaceutical Care and Health Systems, University of Minnesota College of Pharmacy, Minneapolis, MN, USA

    Zachary T. Rivers & Joel F. Farley

  2. Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, WA, USA

    Zachary T. Rivers

  3. Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN, USA

    Helen M. Parsons & Karen M. Kuntz

  4. Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA

    Helen M. Parsons, Pamala A. Jacobson, Karen M. Kuntz & David J. Stenehjem

  5. Department of Experimental and Clinical Pharmacology, University of Minnesota College of Pharmacy, Minneapolis, MN, USA

    Pamala A. Jacobson

  6. Department of Pharmacy Practice and Pharmaceutical Sciences, University of Minnesota College of Pharmacy, Duluth, MN, USA

    David J. Stenehjem

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Contributions

ZTR was responsible for designing the research proposal, conducting data analysis, interpreting the results, and drafting and revising this report. DJS contributed to conceiving this work, interpreting the results, and revising this report. JFF, KMK, and PAJ contributed to interpreting the results and revising this report. HMP acquired data for this project, contributed to conceiving this work, interpreting results, and revising this report.

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Correspondence to Zachary T. Rivers.

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Competing interests

ZTR received support through National Institutes of Health’s National Center for Advancing Translational Sciences, grants TL1R002493 and UL1TR002494 for his work on this project. JFF, PAJ, KMK, and DLS report no conflicts or funding for this work. HMP was funded by NIH P30 CA77598 Masonic Cancer Center.

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Rivers, Z.T., Parsons, H.M., Jacobson, P.A. et al. Opportunities for personalizing colorectal cancer care: an analysis of SEER-medicare data. Pharmacogenomics J 22, 198–209 (2022). https://doi.org/10.1038/s41397-022-00276-6

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