EMR optimized oral chemotherapy monitoring program: Adherence and ADR outcomes.

Abstract

77 Background: Utilization of oral anticancer agents (OAA) has drastically increased over the past decade, accounting for more than 70% of new oncology agents approved in 2013. There are many challenges associated with OAA, including monitoring of adverse drug reactions (ADR) and adherence. While few studies estimate adherence of OAA, it is known that a multidisciplinary approach with intensive pharmacist counseling may improve outcomes. Currently, the electronic medical record (EMR) at our institution has many limitations on tracking OAA. In 2007, 1,872 OAA prescriptions were written. The 2014 annualized OAA prescriptions will surpass 5,510, demonstrating a growth of 194%. The purpose of this project is to establish an OAA monitoring program to allow consistent documentation, closer monitoring, and timely management of ADR. Methods: American Society of Clinical Oncology’s Quality Oncology Practice Initiative criteria were utilized to develop a unique monitoring tool, specific for OAA, which was employed via EMR. The monitoring tool assesses the current regimen, ADR, labs, adherence, and drug interactions. The initial analysis focused on testing the tools on two of the most commonly prescribed OAA agents within our institution. New start patients were identified through utilization of an OAA pharmacist verification queue. The pharmacist provided education, intensive follow up, and communicated treatment complications to other healthcare team members. Results: Follow-up calls were placed for 24 capecitabine patients and four erlotinib patients. Over half of the patients required an intervention. For capecitabine, there were seven patients with barriers to adherence. There were two patients who were non-adherent and one patient who was lost to follow-up; therefore, overall adherence rate was 91%. For erlotinib, adherence rate was 100% with no barriers to adherence. Symptom management and education were provided to 16 patients with grade 1 toxicities, and four drug interactions were identified. Conclusions: Oral chemotherapy should be treated with the same intensive monitoring as IV chemotherapy. A multidisciplinary pharmacist driven OAA monitoring program may improve adherence and allow more timely management of ADR.