Pharmacist-Led Oral Chemotherapy Monitoring Pilot Study and Assessment of Patient-Reported Outcomes and Adherence

Presenter: Jessie Signorelli, PharmD, BCOP, Clinical Pharmacist–Hematology/Oncology, Massachusetts General Hospital, Boston

Co-Authors: Christopher Bell, PharmD, BCOP, Clinical Pharmacist–Hematology/Oncology, Pharmacy, Massachusetts General Hospital; Stephanie Monaco, PharmD, BCOP, Clinical Pharmacist–Hematology/Oncology, Pharmacy, Memorial Sloan Kettering Cancer Center

BACKGROUND: With the shift from intravenous to oral chemotherapy, patients are more responsible for self-monitoring medication adherence and adverse events (AEs).^1-6 Specialty pharmacies may assess for adherence or AEs; however, no standard model is currently available for patient assessment.^6-12 Oncology pharmacists are in a unique position to focus on the quality and safety of care for patients with cancer using oral chemotherapy, while providing communication between the patient, the physician, and specialty pharmacies. This pilot study aimed to monitor patients with leukemia who started treatment with oral chemotherapy.

OBJECTIVES: To characterize an oral chemotherapy monitoring program for patients with leukemia, and to quantify and describe the types of patient-centered activities performed.

METHOD: Patients with leukemia who started oral chemotherapy between July 2020 and February 2021 were included in this pilot study. Pharmacists performed education, medication reconciliation, and drug interaction screening at the initiation of oral chemotherapy. Pharmacists followed up with patients every 2 weeks, up to 2 months, and monthly thereafter. Follow-up included telephone calls and in-person visits. Adherence was assessed using the Morisky Medication Adherence Scale-8, and patient-reported outcomes were assessed using the revised Edmonton Symptom Assessment Scale (ESAS).^7,8,11,12 AEs specific to each oral chemotherapy were also assessed. After each follow-up, providers were contacted, which was documented with assessment scores and recommendations.

RESULTS: Of the 32 patients who were screened, 19 patients were included in this pilot study. The oral chemotherapy used by patients included imatinib (N = 4), dasatinib (N = 5), ponatinib (N = 1), gilteritinib (N = 2), enasidenib (N = 1), and venetoclax (N = 6). All 19 patients received oral chemotherapy education, with 79% of the education sessions performed inpatient. In addition, 14 medication reconciliations were performed at oral chemotherapy initiation, and 53 reconciliations were performed at follow-up. We identified 14 drug interactions, 11 medications were discontinued, 9 medications were added, and 2 doses were changed. Pharmacists performed 62 follow-up encounters. A total of 26 adherence assessments demonstrated adherence (N = 21), medium adherence (N = 4), and low adherence (N = 1). Furthermore, 62 revised ESAS assessments were performed, with 64% reporting no symptoms, 17% mild, 13% moderate, and 5% severe symptoms. A total of 20 laboratory tests were ordered based on pharmacist recommendation at oral chemotherapy initiation and follow-up. The median follow-up time spent with patients was 10 minutes (IQR 10-15), and the overall median time spent on follow-up was 25 minutes (IQR 15-29).

CONCLUSION: During this pilot study, pharmacists identified drug interactions, recommended monitoring, and provided symptom assessment and recommendations for patients with leukemia who started oral chemotherapy. The results demonstrated that pharmacists have a role in oral chemotherapy monitoring and symptom management.

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