Impact of a formal pharmacist-run oral antineoplastic monitoring program: A pilot study in an adult genitourinary oncology clinic

Abstract

Background In recent years, there has been a changing paradigm in the management of oncologic disease states from the use of intravenous therapies, requiring a visit to the infusion center or hospitalization, to new therapies that can be administered orally. Several publications have evaluated the role pharmacists may play in the initial prescribing of oral chemotherapy, however the impact of a formalized pharmacist follow-up program has not been well defined. This study evaluates the impact of a pilot pharmacist-run oral antineoplastic monitoring program. Methods This retrospective cohort analysis evaluated patients prescribed an oral antineoplastic in the genitourinary oncology clinic at an academic medical center between 1 July 2014 and 15 March 2017. Patients enrolled in the program were compared to a historical control group. The primary objective was adherence to pre-defined standards for monitoring. Secondary objectives include persistence on therapy, need to seek medical care, analysis of pharmacist interventions, patient satisfaction, and financial impact for the on-site retail pharmacy. Results In total, 33 patients were evaluated (11 cases, 22 controls). Average adherence to monitoring recommendations was significantly higher in the case group compared to controls (89% vs. 61%; p = 0.008). In total, 67 interventions were made by the clinical pharmacist with an average of 6 per patient. Conclusions This study shows that formalized pharmacist follow-up programs can improve patients' adherence with antineoplastic monitoring standards. Additionally, pharmacists made clinically significant interventions and had high patient satisfaction, providing justification for expansion into other disease states.

Pharmacist-led olaparib follow-up service for ambulatory ovarian cancer patients: A prospective study in a tertiary specialized cancer hospital in China

“…For example, Conliffe and colleagues reported a pharmacist-run oral antineoplastic monitoring program and its impact on improving therapy adherence. In this program, pharmacists made clinically significant interventions and received high patient satisfaction, providing justification for service expansion into other disease states ( Conliffe et al, 2019 ). Khrystolubova and colleagues reported a pharmacist-led, multi-center, collaborative patient education and proactive ADR management program in a community-based oncology setting.…”

Adherence to and effectiveness of lenalidomide after 1 year of treatment in a real world setting

“…Many experiences have informed improvement in adherence in the oncological field, through the use of different strategies put in place by pharmacists, such as the use of therapy diaries that include counseling and reminders, 42 text messaging, 43 direct calls on a periodic basis, [44][45][46][47] as well as specific patient support programs implemented by pharmacists in order to support the patient in understanding the correct modes of drug administration. 20 Such evidence underlines how important it is to measure adherence so as to put in place specific activities to support patients on the basis of the therapy at hand. The datum on the median PFS described in the literature varies from a minimum of 9 to a maximum of 21 months.…”

“…[14][15][16][17] Unlike intravenous therapy, whose administration is under the control of doctors and nurses, oral therapy involves patients' commitment for the entire duration of treatment to complying with the instructions provided by physicians. [18][19][20] Regarding oral cancer therapy, it has been estimated that about 39% of patients take the wrong dose, 10% forget one or more doses, 13.6% take the wrong drug and 11% does not comply with the duration of therapy. 21,22 These data underscore how medication adherence is a matter of great importance for public health.…”

Interpersonal communication-, education- and counselling-based interventions to support adherence to oral anticancer therapy: a systematic review

“…Among those,127 were selected for full text review, with 24 meeting the study inclusion criteria (Figure 1). Among the 24 included studies, 13 were based in North America (all in the United States), 6,[23][24][25][26][27][28][29][30][31][32][33][34] 6 in Europe, [35][36][37][38][39][40] 4 in Asia, [41][42][43][44] and one in Africa 45 (Table 1). Among the 22 studies that reported the type of malignancies studied, nine included patients with solid tumours only, 24,26,36,37,39,40,[43][44][45] five included patients with hematological malignancies only (all chronic myeloid leukemia [CML]), 27,32,35,41,42 and eight included patients with either a solid or hematological malignancy.…”

“…6,23,[28][29][30][31]34,38 While the sample size of these studies ranged from 33 to 928, the majority (n = 15) included less than 100 people. 23,25,[27][28][29][30]33,35,37,39,41,[43][44][45]…”