Presenter: Kristin Hutchinson, PharmD, BCOP, CSP, Trellis Rx, Atlanta, GA
Co-Authors: Jasmine King, PharmD Candidate, Mercer University College of Pharmacy, Atlanta, GA; Jessica Mourani, PharmD, Trellis Rx, Atlanta, GA; Angie Wood, PharmD, BCPS, BCOP, CSP, Trellis Rx at North Memorial Health, Robbinsdale, MN
BACKGROUND: Because of their many adverse effects, oral anticancer medications result in high discontinuation rates and low adherence. Although evidence exists that mitigating these adverse effects improves adherence, data demonstrating the impact that health system specialty pharmacy (HSSP) pharmacists have on improving discontinuation rates are lacking.
OBJECTIVE: To compare discontinuation rates in patients receiving oral anticancer medication before and after a pharmacist-led check-in protocol is put in place to contact patients within 14 days of starting therapy.
METHOD: A retrospective, multicenter, observational study compared oral oncolytic drug discontinuation rates and reasons of patients across Trellis Rx’s partner health systems before and after the implementation of a protocol requiring a pharmacist to contact patients within 14 days of therapy initiation. During this follow-up, adverse event management and mitigation strategies, additional counseling, and question assistance were provided. The providers were contacted when additional supportive care medication was required to mitigate the side effects that the patients reported. The patients were stratified into 2 groups (preprotocol, March 2020-December 2020, and postprotocol, March 2021-December 2021) and were evaluated for the discontinuation rates and reasons as reported by the clinical pharmacist in the Arbor specialty pharmacy technology platform.
RESULTS: A total of 9414 therapies were evaluated. The preprotocol group (N = 4060 therapies) had an overall therapy discontinuation rate of 40.4% versus 29% in the postprotocol group (N = 5354 therapies). Overall, there was an approximate 11% decrease in oral oncolytic drug discontinuations after the implementation of a pharmacist-led check-in protocol. A total of 6.8% of the oral oncolytic therapy discontinuations in the preprotocol group resulted from drug intolerance versus 2.8% in the postprotocol group.
CONCLUSION: The high rate of oral anticancer agent discontinuations leads to poor outcomes for patients, including an increased incidence of mortality. HSSP pharmacists play a pivotal role in decreasing oral anticancer drug discontinuation. We have demonstrated this can be done effectively by incorporating a 14-day check-in providing targeted counseling and side-effect mitigation strategies.
Poster previously presented at National Association of Specialty Pharmacy Annual Meeting & Expo: Hutchinson K, Mourani J, Wood A, King J. Comparison of discontinuation rates in patients receiving an oral anticancer agent before and after implementation of a 14-day pharmacist check-in protocol. September 19-22, 2022.
Abstract previously presented at the National Association of Specialty Pharmacy (2022).
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