Oral chemotherapy safety practices at US cancer centres: questionnaire survey

Weingart, Saul N.; Flug, Jonathan A.; Brouillard, Daniela; Morway, Laurinda; Partridge, Ann H.; Bartel, Sylvia; Shulman, Lawrence N.; Connor, Maureen

doi:10.1136/bmj.39069.489757.55

Cited by 104 publications

(75 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Unfortunately, many oncology practices have not established standard protocols and documentation procedures for prescribing oral antineoplastic agents, educating patients about how to take these medications appropriately, monitoring for symptoms and adverse effects, or tracking adherence over time [19,20]. A study in our institution revealed significantly lower rates of clinician documentation of discussions regarding treatment plans for oral chemotherapy relative to intravenous chemotherapy, per measures outlined in the American Society of Clinical Oncology (ASCO) Quality Oncology Practice Initiative [21].…”

Section: Introductionmentioning

confidence: 91%

A Systematic Review of Adherence to Oral Antineoplastic Therapies

et al. 2016

View full text Add to dashboard Cite

Background. Oral antineoplastic therapies not only improve survival but also reduce the burden of care for patients. Yet patients and clinicians face new challenges in managing adherence to these oral therapies. We conducted a systematic literature review to assess rates and correlates of adherence to oral antineoplastic therapies and interventions aimed at improving adherence. Methods. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we conducted a comprehensive literature search of the Ovid MEDLINE database from January 1, 2003 to June 30, 2015, using relevant terminology for oral antineoplastic agents. We included observational, database, and intervention studies. At least two researchers evaluated each paper to ensure accuracy of results and determine risk of bias. Results. We identified 927 records from the search and screened 214 abstracts. After conducting a full-text review of 167

show abstract

Section: Introductionmentioning

confidence: 91%

A Systematic Review of Adherence to Oral Antineoplastic Therapies

et al. 2016

View full text Add to dashboard Cite

show abstract

“…6,7 Updated ASCO/ONS guidelines and ASCO's QOPI test measures provided mechanisms for self-assessment and a framework that our center could use to design improved systems. 9,10 The UWCCC implemented a variety of clinical processes designed to improve the management of oral chemotherapy.…”

Section: Discussionmentioning

confidence: 99%

“…Delivering oral chemotherapies in an established and recurring fashion with episodic visits to cancer clinics frequently bypasses components of safety systems designed for intravenous chemotherapy and necessitates a different approach and new skills for safe delivery of therapy. 6,7 Early in the process, prescription accuracy and completeness, patient education, consenting processes, and clarity regarding goals of therapy all pose challenges. Once prescriptions are actually being filled, lack of consistency and expertise may exist in the pharmacy independent of the double-checking processes.…”

Section: Introductionmentioning

confidence: 99%

Multidisciplinary Optimization of Oral Chemotherapy Delivery at the University of Wisconsin Carbone Cancer Center

Mulkerin

Bergsbaken

Fischer

et al. 2016

JOP

View full text Add to dashboard Cite

PROBLEM FACED: Broad use of oral chemotherapy poses safety challenges that are not manageable by systems designed for intravenous chemotherapy. Our institution, the University of Wisconsin Carbone Cancer Center, was experiencing challenges in safety and uniformity of processes for delivering oral chemotherapy and associated care.WHAT WE DID: ASCO and the Oncology Nursing Society jointly published safety standards for administering chemotherapy that offered a framework for improving oral chemotherapy practice. We used these standards to define gaps in the safety and uniformity of our oral chemotherapy practice and to develop recommendations for improving processes. Areas for improvement were addressed by multidisciplinary workgroups that focused on education, workflows, and information technology. Key changes included defining chemotherapy, standardizing patient and caregiver education, mandating the use of comprehensive electronic order sets, routing all oral chemotherapy prescriptions for review by an independent pharmacy before dispensing, and standardizing documentation of dose modification. In addition, drug-specific materials were developed to create uniformity in adherence and toxicity monitoring. Collectively, these processes enabled significant safety mechanisms for oral chemotherapy analogous to those in place for intravenous chemotherapy. Revised processes were implemented over a 5-month period.WHAT WE FOUND: Defining oral chemotherapy allowed creation of a list of oral chemotherapies that could be recognized and grouped in our electronic health record (EHR), which enabled EHR-facilitated solutions,includingconsent verification, prospectiveorderreview,education, and monitoring.Thefollowing are key performance indicators: 92.5% of oral chemotherapy orders (n = 1,216) were initiated within comprehensive electronic order sets (N = 1,315), 89.2% compliance with informed consent was achieved, 14.7% of orders (n = 193) required an average of 4.4 minutes review time by the pharmacist, and 100% compliance with first-cycle adherence and toxicity monitoring was achieved. We defined elements needed for complete patient education and provided staff education on this effort but did not build any EHR-based forcing functions. Subsequent assessment showed poor performance in documenting all elements of oral chemotherapy education (36%), which demonstrated the need for continued improvement. CONFOUNDING FACTORS, DRAWBACKS:We achieved demonstrable success in improving oral chemotherapy practice. Our approach relied heavily on the ability to electronically recognize oral chemotherapy prescriptions and apply all of the safety systems designed for intravenous chemotherapy. Our institution uses a well-established EHR and can dispense many oral chemotherapies because we have a specialty pharmacy. Potential limitations of our approach include EHR specificity, as well as ongoing time commitments by pharmacists for prospective order review. The capacity to fill many prescriptions mitigates the risk of pharmacy-related errors an...

show abstract

“…In a survey of 42 US national cancer centers, few had systems established for monitoring and managing risks linked with oral chemotherapy. 70,71 The key issue in oral therapy is drug adherence, formerly known as drug compliance. General rates of medication adherence vary from 20% to 100%.…”

Section: Administrationmentioning

confidence: 99%

Role of pharmacists in optimizing the use of anticancer drugs in the clinical setting

Sj¹

2014

IPRP

View full text Add to dashboard Cite

Oral chemotherapy safety practices at US cancer centres: questionnaire survey

Cited by 104 publications

References 11 publications

A Systematic Review of Adherence to Oral Antineoplastic Therapies

A Systematic Review of Adherence to Oral Antineoplastic Therapies

Multidisciplinary Optimization of Oral Chemotherapy Delivery at the University of Wisconsin Carbone Cancer Center

Role of pharmacists in optimizing the use of anticancer drugs in the clinical setting

Contact Info

Product

Resources

About