Evolving Best Practice for Take-Home Cancer Drugs

Abstract

PURPOSE: Take-home cancer drugs (THCDs) have become a standard treatment of many cancers. Robust guidelines have been developed for intravenous chemotherapy drugs, but few exist for THCDs with a focus on decentralized models. Hence, Ontario Health (Cancer Care Ontario) established the Oncology Pharmacy Task Force (OPTF) to develop consensus-based recommendations on best practices for THCDs to ensure that patients receive safe, consistent, high-quality care in the community once they leave the cancer center/practice with a prescription. METHODS: The OPTF included 34 members with comprehensive representation. Guidance from leading authorities was extracted through literature review, thematically analyzed, and synthesized to develop 29 recommendations. The consensus process (> 70% agreement) included a three-step modified Delphi method followed by an extensive review process. RESULTS: Sixteen recommendations were developed: training and education for providers (2), drug access (1), prescribing (4), patient and family/caregiver education (3), communication (1), dispensing (3), monitoring for patient adherence and adverse effects (1), and incident reporting (1). CONCLUSION: Through a rigorous methodology, the OPTF derived a robust set of recommendations similar to the ASCO/Oncology Nursing Society and ASCO/National Community Oncology Dispensing Association guidelines, further validating and strengthening the applicability across multiple jurisdictions, including those with decentralized models. Unique aspects in a decentralized model include the need for two pharmacy professionals, with one doing cognitive verification of the script and the other dispensing the medication; moreover, they optimize interprofessional communication between community providers and the cancer center/practice health care team.

Evaluation of Burnout in a National Sample of Hematology-Oncology Pharmacists

“…In addition, 27% of new drug approvals are in hematology-oncology, creating an increased implementation burden to incorporate new regimens in patient care. [23][24][25] Additionally, oncology clinical trials account for 20% of all clinical trials, more than any other specialty, which require pharmacist expertise to manage drug therapy including dispensing, inventory management, and identification of potential drug-drug interactions. [26][27][28] Hematology-oncology pharmacists manage patients across a spectrum of care goals from curative to palliative, including those receiving toxic chemotherapy with a narrow therapeutic window and a high burden of adverse effects.…”

Proposals of guidance values for surface contamination by antineoplastic drugs based on long term monitoring in Czech and Slovak hospitals and pharmacies

“…In conclusion, long-life exposures of health care staff to ADs represent a major issue, and routine monitoring along with implementation of proper measures help to implement the “as low as reasonably achievable” principle (ALARA) ( 12 ) minimizing thus occupational risks. Challenging problems that require research attention are the take-home anticancer therapies ( 48 ), veterinary clinics or research facilities that might contribute to spread of AD contamination to other environments such as patient homes ( 9 ).…”

Levels and risks of antineoplastic drugs in households of oncology patients, hospices and retirement homes

“…The contamination of hospitals and pharmacies by ADs and related occupational exposures and risks have been studied before and indicated potential health hazards during life-long exposures [25,16]. Much less attention has been paid so far to potential contamination in the households of patients treated with AD chemotherapies despite the increasing trends in using take-home anticancer therapies [30]. The present research aids in this underestimated problem where the studies of AD indoor contamination outside of hospitals or pharmacies are very rare.…”

“…In recent years, the administration of chemotherapy is shifting from controlled hospital healthcare that complies with recommended safety regulations [25,16] to much less controlled settings such as outpatient departments (where the patients spent only a few hours) or to households of the patients. Typically, 80% of total ADs are administrated intravenously-mostly in hospitals or other medical facilities, about 20% can be administered orally [23], and various types of take-home anti-cancer therapies have become a standard for many patients because of the reduced costs and higher patient satisfaction [30].…”