Presenter: Diana Tamer, PharmD, BCOP, Clinical Assistant Professor, University of Missouri-Kansas City
Co-Authors: Jake Wodtke, Pharmacy Student, PharmD Candidate, University of Missouri-Kansas City; Samira Zantout, Pharmacy Student, PharmD Candidate, University of Missouri-Kansas City; Timothy Schieber, Pharmacy Student, PharmD Candidate, University of Missouri-Kansas City
Background: Oral oncolytic agents continue to be on the forefront of cancer treatment advances. Although more convenient to patients, these treatments place significant responsibilities on patients and clinicians alike, to adhere to potentially complex regimens and schedules, and to monitor and manage serious side effects.1-3 Currently, no standardized guidelines exist for the outpatient management of patients receiving oral oncolytic agents. There is a significant need for patient and clinician education, standardized workflow, and further support for monitoring, to improve patients’ quality of life and treatment outcomes. For that reason, a telehealth clinic was launched by a clinical oncology pharmacy faculty and pharmacy student trainees at a community cancer center at the University of Missouri-Kansas City.
Objective: To describe the development of an oral chemotherapy telehealth clinic and its interventions at a community cancer center.
Methods: This study is a retrospective chart review of adult patients with cancer who were enrolled in the oral chemotherapy clinic at the University of Missouri-Kansas City cancer center between July 1, 2020, and October 30, 2020. Inclusion criteria included adult patients (age ≥18 years) with cancer who received treatment from an oncologist and had complete clinical notes from the provided telehealth service.
Results: During the study period, 59 (66% female) patients were included. The patients’ average age was 62.5 years. The race makeup consisted of white (N = 54; 91.5%), Asian (N = 3; 5.1%), and black or African American (N = 2; 3.4%). The average time since initiation of oral oncolytic therapy was 12.8 months. The average of number of comorbid conditions was 3.1. The average of number of interventions per visit was 2.9. The team made 174 interventions: 5% referrals to a primary care provider, 2% referrals to physical therapy, 1% referrals to a pain specialist, 4% referrals to a specialist, 2% referrals to social work or counseling services, 5% initiation of prescription medication, 16% initiating nonpharmacist recommendations, 1% discontinuing medications, 8% managing treatment-related adverse events, 6% adherence education, 9% symptom/disease management, 28% medication-reconciliation error, 5% drug interaction, 5% scheduling laboratory tests per visit, and 3% for scheduling follow-up visit with the provider (oncologist). The average patient-reported adherence was 99.1%. The average time spent to complete the visit was 25.3 minutes.
Conclusion: This study describes the establishment of a new standardized workflow for an oral chemotherapy telehealth clinic, including the clinic and student training, as well as clinic logistics and the type of interventions performed. This initiative to improve and standardize the oral chemotherapy workflow can lead to improved patient care and outcomes, while also providing a no-cost critical training opportunity for pharmacy students. This model can serve as a guidance to community cancer centers wishing to launch a similar initiative with limited resources.
- DeCardenas R, Helfrich JS. Oral therapies and safety issues for oncology practices: patient support is key to delivering safe oral chemotherapy. Oncol Issues. 2010;25:40-42.
- 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.
- Jin J, Sklar GE, Min Sen Oh V, Chuen Li S. Factors affecting therapeutic compliance: a review from the patient’s perspective. Ther Clin Risk Manag. 2008;4:269-286.