Implementation of a model integrating primary and oncology pharmacists' care for patients taking oral anticancer agents (OAA)

Farris, Karen B.; Cadwallader, Tiffany; Farley, Joel F.; Gatwood, Katie S.; Mackler, Emily; Gatwood, Justin

doi:10.1016/j.rcsop.2022.100163

Cited by 5 publications

(3 citation statements)

References 37 publications

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“…Although both studies analyzed the implementation of an interprofessional care program for patients treated with OAT, the studies are difficult to compare with our AMBORA Center because they focused on other healthcare professional groups and lack effectiveness outcomes. A recent single-arm pilot study [49] recruiting 40 hemato-oncological patients treated with OAT assessed the implementation of a model integrating primary and oncology pharmacists by performing interviews, but neither applied systematic frameworks nor included effectiveness outcomes.…”

Section: Discussionmentioning

confidence: 99%

Optimizing Medication Safety with Oral Antitumor Therapy: A Methodological Approach for the Real-World Implementation of the AMBORA Competence and Consultation Center

et al. 2023

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Generating evidence for the efficacy of an intervention is not sufficient to guarantee its implementation in real-world settings. The randomized AMBORA trial (Medication Safety with Oral Antitumor Therapy) demonstrated that an intensified clinical pharmacological/pharmaceutical care program has substantial benefits for patients, treatment teams, and the healthcare system. Thus, we are now investigating its implementation into routine care within the AMBORA Competence and Consultation Center (AMBORA Center). We perform a multicenter type III hybrid trial following the RE-AIM framework to assess the clinical effectiveness of this care program under real-world conditions, while evaluating the implementation outcomes. Semi-structured stakeholder interviews based on the Consolidated Framework for Implementation Research (CFIR) have been conducted to identify barriers and facilitators. So far, 332 patients treated with oral antitumor drugs have been referred to the AMBORA Center by 66 physicians from 13 independent clinical units. In 20 stakeholder interviews (e.g., with clinic directors), 30% (6/20) of the interviewees anticipated possible barriers which may partly hinder sustainable implementation (e.g., unavailable consultation rooms). Furthermore, important facilitators (e.g., operational processes) were identified. This methodological description adds knowledge on how to structure a hybrid effectiveness–implementation trial and proposes multilevel implementation strategies to improve the medication safety of oral antitumor therapy.

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Section: Discussionmentioning

confidence: 99%

Optimizing Medication Safety with Oral Antitumor Therapy: A Methodological Approach for the Real-World Implementation of the AMBORA Competence and Consultation Center

et al. 2023

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“…7 Bei verschiedenen Krebserkrankungen wird eine Adhärenz von ≥90 % mit verbesserten klinischen Therapieergebnissen in Verbindung gebracht. 8 Allerdings geht aus Schätzungen hervor, dass die Adhärenz zu oralen onkologischen Therapien stark variiert: Außerhalb klinischer Studien wird sie mit zwischen 50 % und 70 % beziffert. 6 , 8…”

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“…8 Allerdings geht aus Schätzungen hervor, dass die Adhärenz zu oralen onkologischen Therapien stark variiert: Außerhalb klinischer Studien wird sie mit zwischen 50 % und 70 % beziffert. 6 , 8…”

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BTKi-Therapie bei CLL: Die MFA als Förder:innen der Adhärenz

2022

CNE Pflegemanagement

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Inhibitoren (BTKi) ist bei chronischer lymphatischer Leukämie (CLL) etabliert und steht für eine langfristige Krankheitskontrolle. 1-5 Sie ist als orale Dauertherapie angelegt, die bis zum Fortschreiten der Krankheit fortgesetzt werden soll. Die Möglichkeit zur eigenständigen oralen Einnahme wird von der Mehrheit der Patient:innen gegenüber der parenteralen Gabe des Medikaments im ambulanten Setting bevorzugt. 6 MFA können Patient:innen darin unterstützen, adhärent zur BTKi-Therapie zu sein, und so eine wirksame Dauertherapie sichern. Weniger Kontakte unter oraler Dauertherapie sind eine Erleichterung sowohl für Patient:innen als auch für das Praxisteam. Allerdings verlagert sich die Verantwortung in Richtung der Patient:innen -der Stellenwert der Adhärenz steigt. Sie ist definiert als das Ausmaß, in dem das Medikamenteneinnahmeverhalten der Patient:innen mit den Empfehlungen der Ärzt:innen übereinstimmt. 7 Bei verschiedenen Krebserkran-kungen wird eine Adhärenz von ≥90 % mit verbesserten klinischen Therapieergebnissen in Verbindung gebracht. 8 Allerdings geht aus Schätzungen hervor, dass die Adhärenz zu oralen onkologischen Therapien stark variiert: Außerhalb klinischer Studien wird sie mit zwischen 50 % und 70 % beziffert. 6,8 Unterschiede der BTKi beachtenDie zugelassenen BTKi unterscheiden sich in ihrem spezifischen Nebenwirkungs-

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Optimal hyperglycemia thresholds in patients undergoing chemotherapy: a cross sectional study of oncologists’ practices

Salgado,

Birari,

Alshahawey

et al. 2024

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Purpose Neither the United States nor the European oncology guidelines include details for appropriate management of hyperglycemia in cancer patients. The aim was to identify fasting and random blood glucose thresholds, and hemoglobin A1c (HbA1c) targets used by oncologists in clinical practice when managing hyperglycemia in patients with cancer undergoing chemotherapy. Methods This national, cross sectional study utilized a questionnaire to collect oncologists’ perceptions about optimal blood glucose thresholds and HbA1c targets in patients with cancer undergoing chemotherapy. Descriptive statistics were calculated to summarize glucose thresholds, HbA1c targets, and sample characteristics. Responses to an open-ended question about oncologists’ approach to hyperglycemia management were analyzed via thematic analysis using an inductive approach. Results Respondents (n = 229) were on average 52.1 years of age, 67.7% men, and 91.3% White. For patients without diabetes but experiencing hyperglycemia, oncologists targeted lower and upper fasting blood glucose levels between 75-121 mg/dL and 105-135 mg/dL, respectively. For patients with diabetes, the targets for lower and upper fasting blood glucose levels ranged between 100-130 mg/dL and 128-150 mg/dL, respectively. Fasting blood glucose (95.6%) and HbA1c (78.6%) were the most commonly used clinical indicators to consider chemotherapy dose reduction, delay, or discontinuation due to hyperglycemia in patients receiving chemotherapy with curative intent. Among those receiving palliative intent chemotherapy, the preferred clinical parameters were random blood glucose (90.0%), patient-reported blood glucose readings (70.7%), continuous glucose monitoring readings (65.1%), and patient-reported symptoms of hyperglycemia (65.1%). Three main themes emerged about oncologists’ approach to hyperglycemia management: 1) identification of high-risk patients; 2) need for early identification, screening, and diagnosis of hyperglycemia; and 3) multiple hyperglycemia management strategies. Conclusion Oncologists reported a wide variation of target blood glucose ranges considered appropriate in patients undergoing chemotherapy. Lack of clear guidance for hyperglycemia management during chemotherapy in the United States may be contributing to a lack of consistency in clinical practice.

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Implementation of a model integrating primary and oncology pharmacists' care for patients taking oral anticancer agents (OAA)

Cited by 5 publications

References 37 publications

Optimizing Medication Safety with Oral Antitumor Therapy: A Methodological Approach for the Real-World Implementation of the AMBORA Competence and Consultation Center

Optimizing Medication Safety with Oral Antitumor Therapy: A Methodological Approach for the Real-World Implementation of the AMBORA Competence and Consultation Center

BTKi-Therapie bei CLL: Die MFA als Förder:innen der Adhärenz

Optimal hyperglycemia thresholds in patients undergoing chemotherapy: a cross sectional study of oncologists’ practices

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