Real-world evidence on the uptake, barriers and associated factors with targeted therapy among metastatic colorectal cancer patients in China: A multi-center, cross-sectional survey (Preprint)

BACKGROUND Targeted therapy represents an effective modality for metastatic colorectal cancer (mCRC) with substantial health benefits. Targeted agents for mCRC have been approved for over a decade. However, little is known about their application in real-world clinical practice. OBJECTIVE We aimed to explore the uptake of targeted therapy and determine barriers and factors associated with initiating targeted therapy among Chinese mCRC patients. METHODS A cross-sectional, multi-center, hospital-based survey was conducted in China, from March 2020 to March 2021. mCRC patients who had finished at least one cycle of chemotherapy were enrolled from nineteen hospitals in fourteen cities through stratified, multistage cluster sampling. Descriptive analyses were used to report patients' characteristics, distribution on the timing and kinds of targeted agents first time used, and barriers against targeted therapy. Logistic regressions were conducted to assess the factors associated with initiating targeted therapy. RESULTS A total of 1,688 mCRC patients were included. Slightly over half the patients (51.6%, 871/1,688) have initiated the targeted therapy, of whom, 44.5% (388/871), 20.2% (176/871), and 35.2% (307/871) first initiated as the first-line, second-line, and third-line therapy, respectively. Bevacizumab was most frequently used (68.4%, 596/871). Unaffordable medical costs (41.6%, 340/817), not convinced that targeted therapy works (30.8%, 252/817) and fear of side effects (17.3%, 141/817) were the most reported barriers against targeted therapy. Patients treated in the general hospital, and with lower level of education, less annual family income, no medical insurance, poor health-related quality of life prior to the first treatment of mCRC, metastasis outside liver/lung or systemic metastasis, a duration of mCRC<10 months were unlikely to initiate targeted therapy, while patients located in North China and having both liver and lung metastasis were likely to. CONCLUSIONS This study highlights the limited uptake of targeted therapy, and frequent delayed treatment and misuse of targeted agents among mCRC patients in China. Reducing the costs, and interventional education on improving public awareness were recommended to facilitate the application of targeted therapy.