Background With the ever growing arsenal of oral chemotherapy agents now available, cancer treatment is being increasingly managed in the outpatient setting. However, oral chemotherapy use is often associated with several potential obstacles and complications. In order to provide optimal patient safety and oral chemotherapy monitoring, our institution implemented an oral chemotherapy program managed by clinical pharmacists electronically through Epic Beacon. Objective To describe implementation of a novel pharmacist-managed oral chemotherapy program and evaluate pharmacist interventions before and after implementation of an oral chemotherapy program. Methods This was a single-center retrospective chart review of documented pharmacy interventions for oral chemotherapy prescriptions during three months prior to as well as three months following Epic Beacon implementation. Time periods for data inclusion were October-December 2013 (pre-Beacon) and October-December 2014 (post-Beacon). Patients included in the study had one or more oral chemotherapy orders during the pre-Beacon period, the post-Beacon period, or both pre- and post-Beacon. Our analysis did not include oral chemotherapy orders that were placed outside of a treatment plan in the post-Beacon period. Results A total of 240 patients with 450 total oral chemotherapy orders were assessed over the duration of the study. Beacon implementation allowed a greater number of oral chemotherapy orders to be reviewed, with 134 oral chemotherapy orders reviewed in the study period prior to Beacon implementation and 316 orders reviewed in the post-Beacon period. Additionally, there were 660% more pharmacist interventions (89 interventions pre-Beacon versus 681 interventions post-Beacon), with an increased focus on coordination of care, chemotherapy calendar coordination, and assistance with treatment plans. Furthermore, implementation of Epic Beacon allowed identification of over 500% more chemotherapy order errors (41 total errors identified pre-Beacon versus 250 total errors identified post-Beacon). Pharmacists were also able to identify more significant, serious, or potentially lethal errors following implementation. The time associated with oral chemotherapy review and intervention also increased accordingly with number of orders reviewed. Conclusion Implementation of an electronic workflow for oral chemotherapy dramatically increased pharmacist review of orders, resulting in improved documentation of interventions and errors, decreased need for clarification of orders, as well as increased volume of prescriptions at our on-site pharmacy. This study demonstrates a comprehensive approach to maximize safety when oral chemotherapy is utilized as a component of the treatment regimen.

Background Collaborative drug therapy management is a formal partnership between a pharmacist and physician to allow the pharmacist to manage a patient's drug therapy. Literature supports collaborative disease therapy management can improve patient outcomes, improve medication adherence, enhance medication safety, and positively influence healthcare expenditures. Chemotherapy induced nausea or vomiting is considered one of the most distressing and feared adverse events among patients receiving chemotherapy. Chemotherapy induced nausea or vomiting can impact a patient's quality of life and may affect compliance with the treatment plan. Purpose The objective of this pilot study was to determine the pharmacy impact of implementing a chemotherapy induced nausea or vomiting collaborative disease therapy management protocol in the outpatient oncology clinics at a National Cancer Institute (NCI)-designated cancer center associated with an academic medical center. The primary endpoint was to determine the number and type of chemotherapy induced nausea or vomiting clinical interventions made by the oncology pharmacists. Secondary endpoints included comparing patient's Multinational Association for Supportive Care in Cancer scores and revenue of pharmacists' services. Methods The credentialed oncology pharmacists were consulted by an oncologist to manage chemotherapy induced nausea or vomiting. Patients were included in the chemotherapy induced nausea or vomiting collaborative disease therapy management if they were seen in an outpatient oncology clinic from October 2016 to January 2017 and had a referral from a qualified provider to help manage chemotherapy induced nausea or vomiting. Patients admitted to the hospital at the time of consult were excluded from the study. The pharmacists interviewed patients and provided recommendations. The pharmacists followed up with the patient via a telephone call or during the next scheduled clinic visit to assess their symptoms. Results The chemotherapy induced nausea or vomiting collaborative disease therapy management pilot study was implemented in October 2016. From October 2016 to January 2017, there were 45 consults for the management of chemotherapy induced nausea or vomiting. The pharmacists made 188 clinical interventions, which included addition of new medications (37%), patient education (34%), deletion of medications (10%), changing a dose/duration/frequency (8%), and other interventions (11%). Multinational Association for Supportive Care in Cancer symptom scores were available for 5 patients, in which all showed improvements from baseline with the pharmacists' clinical interventions. Conclusions The implementation of our chemotherapy induced nausea or vomiting collaborative disease therapy management pilot study has shown favorable results after a 4-month evaluation period. The pharmacists have made a substantial number of clinical interventions and provided patient education to patients undergoing chemotherapy.

PURPOSE Oral chemotherapy challenges providers' abilities to safely monitor patients' symptoms, adherence, and financial toxicity. COVID-19 has increased the urgency of caring for patients remotely. Collection of electronic patient-reported outcomes (ePROs) has demonstrated efficacy for patients on intravenous chemotherapy, but limited data support their use in oral chemotherapy. We undertook a pilot project to assess the feasibility of implementing an ePRO system for patients starting oral chemotherapy at our cancer center, which includes both an academic site and a community site. METHODS Patients initiating oral chemotherapy were asked to participate. A five-question tool was built in REDCap. Concerning responses triggered outreach within one business day. The primary outcome was time to first symptom assessment. For comparison, we used a historical cohort of patients who had been prescribed oral chemotherapies by providers in the same disease groups at the cancer center. RESULTS Twenty-five of 62 (40%) patients completed ePRO assessments. Fifty historical charts were reviewed. Time to first symptom assessment was 7 days (IQR, 4-14 days) in the historical group compared with 3 days (IQR, 2-4 days) in the ePRO group. Time to clinical action was 14 days (7-35 days) in the historical group compared with 8 days (4-19 days) in the ePRO group. No statistically significant differences were detected in 30-day emergency department visit or hospitalization (12% for both groups) or 90-day emergency department visit or hospitalization rates (historical 28% and ePRO 20%). CONCLUSION An ePRO tool monitoring patient concerns about adherence, cost, and toxicities for patients with new oral chemotherapy regimens is feasible and improves time to symptom assessment. Further investigation is needed to improve patient engagement with ePROs and evaluate the long-term impacts for patients on oral chemotherapy.

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e18007 Background: Patients on oral chemotherapy (OC) often lack consistent education and monitoring, risking toxicity and poor adherence. We developed an OC management program including education and an online tool for active outreach. Methods: In November 2017, we initiated pharmacist-led education for patients newly prescribed OC at a community practice and in the gastrointestinal oncology group at an academic medical center (AMC). An online tool assessing adherence, symptoms, and financial toxicity was emailed to patients three days after starting OC. Non-responders were contacted for phone interviews. A random sample of 28 patients newly started on OC at both sites before the intervention in 2017 was analyzed at baseline. A retrospective chart analysis was done to collect time to symptom assessment, identification and action. A report generated date of first emergency department (ED) visit or hospitalization within the AMC. We conducted a Mann Whitney U-Test, using a one-sided p value of 0.025 with Bonferroni correction. Results: Sixty-nine of 106 eligible patients (66%) received education, of whom 36 (52.1%) received the online tool, and 13 (36.1%) responded. There was a significant difference between the intervention and baseline median times to first new/worsening symptoms (p = 0.0105) but otherwise there were no outcome improvements. Eight of 23 patients who did not respond to the electronic tool were interviewed and indicated that their illness impeded their ability to check email (n = 2), and that they never check email (n = 2). Conclusions: This OC management program improved time to detect new/worsening symptoms and could potentially improve outcomes after further patient accrual. Future investigation should examine ways to improve patient responsiveness to electronic patient-reported symptom tools. [Table: see text]