Improving Patient Outcomes with Standardization

JHOP - June 2015 Vol 5, No 2
Patrick J. Medina, PharmD, BCOP
Medical Science Liaison
Medical Affairs, GlaxoSmithKline
Collegeville, PA
Adjunct Professor of Pharmacy
University of Oklahoma College of Pharmacy
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The continued increase in oral chemotherapy agents receiving US Food and Drug Administration approval, and their expanded use in the first-line setting or in combination with intravenous agents, continues to impact the oncology practice. Approximately 25% of all cancer drugs approved are oral agents, with the trend expected to continue.1

In the past, issues with intravenous chemotherapy such as co-pays and patient compliance were easily ascertained because patients were seen in the clinic, and medications were administered directly to them. Through the increased use of oral chemotherapy agents, several safeguards regarding safety and patient compliance have been removed.2 Several articles have been published on the need to have appropriate policies in place ensuring that patients are receiving optimum care for their cancer when taking oral chemotherapy.

In this issue of the Journal of Hematology Oncology Pharmacy, Elizabeth Gustafson, PharmD, and Jacob K. Kettle, PharmD, BCOP, examine a variety of drug-related problems associated with oral chemotherapy use in an outpatient setting (see “Analyzing Trends in Oral Anticancer Agents in an Academic Medical Facility”). One of the more striking problems identified in their research was treatment-related toxicity secondary to an oral chemotherapy agent, which was reported by 80% of patients, with 36% classified as severe. In addition, 17% of patients required hospitalization within 90 days of treatment initiation because of toxicity from an oral chemotherapy agent. Finally, a potential drug interaction related to an increase in oral anticancer agent toxicity was identified in 20% of all patients. With these statistics, it is shocking, but not surprising, that pharmacists and other healthcare practitioners have to increase their efforts to provide appropriate patient counseling on these medications that patients are entrusted to take at home.

A recent European cross-sectional study demonstrated the lack of standardization in oral chemotherapy use. Just over half of 157 oncologists in the study reported handing out educational material with the first prescription of oral chemotherapy as a way to limit avoidable side effects, and approximately 23% reported having no systems in place to monitor adherence.3 Only 6% of the 112 centers surveyed in the same study reported that a pharmacist was responsible for developing the educational material, demonstrating a potentially expanded role for the profession. A similar 2007 study of US cancer centers demonstrated an equal lack of consistency regarding oral chemotherapy prescribing practices.4

Despite the many demonstrated clinical benefits of oral chemotherapy agents, inconsistent practice standards regarding their use still exist. Standardization of prescribing procedures and appropriate monitoring of these agents should positively impact patient outcomes. Although a variety of efforts have been made, pharmacists should continue to work with other healthcare practitioners to refine the practice of prescribing oral chemotherapy agents. Continued efforts to maximize their benefit, and, just as importantly, minimize their harm with standard practice procedures are still needed.

1. US Food and Drug Administration. Drug approvals and databases. Updated December 16, 2014. Accessed April 28, 2015.
2. Weingart SN, Brown E, Bach PB, et al. NCCN task force report: oral chemotherapy. J Natl Compr Canc Netw. 2008;6(Suppl 3):S1-S14.
3. Bourmaud A, Pacaut C, Melis A, et al. Is oral chemotherapy prescription safe for patients? A cross-sectional survey. Ann Oncol. 2014;25:500-504.
4. Weingart SN, Flug J, Brouillard D, et al. Oral chemotherapy safety practices at US cancer centres: questionnaire survey. BMJ. 2007;334:407.

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