Pharmacist-Led 14-Day Oncolytic Drug Check-In Protocol

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).

1. Dürr P, Schlichtig K, Kelz C, et al. The randomized AMBORA trial: impact of pharmacological/pharmaceutical care on medication safety and patient-reported outcomes during treatment with new oral anticancer agents. J Clin Oncol. 2021;39:1983-1994.
2. Hershman DL, Shao T, Kushi LH, et al. Early discontinuation and non-adherence to adjuvant hormonal therapy are associated with increased mortality in women with breast cancer. Breast Cancer Res Treat. 2011;126:529-537.
3. Simons S, Ringsdorf S, Braun M, et al. Enhancing adherence to capecitabine chemotherapy by means of multidisciplinary pharmaceutical care. Support Care Cancer. 2011;19:1009-1018.
4. Arthurs G, Simpson J, Brown A, et al. The effectiveness of therapeutic patient education on adherence to oral anti-cancer medicines in adult cancer patients in ambulatory care settings: a systematic review. JBI Database System Rev Implement Rep. 2015;13:244-292.
5. Stokes M, Reyes C, Xia Y, et al. Impact of pharmacy channel on adherence to oral oncolytics. BMC Health Serv Res. 2017;17:414.
6. McCabe CC, Barbee MS, Watson ML, et al. Comparison of rates of adherence to oral chemotherapy medications filled through an internal health-system specialty pharmacy vs external specialty pharmacies. Am J Health Syst Pharm. 2020;77:1118-1127.
7. Khandelwal N, Duncan I, Ahmed T, et al. Impact of clinical oral chemotherapy program on wastage and hospitalizations. J Oncol Pract. 2011;7(3 suppl):e25s-e29s.
8. Rosenberg SM, Petrie KJ, Stanton AL, et al. Interventions to enhance adherence to oral antineoplastic agents: a scoping review. J Natl Cancer Inst. 2020;112:443-465.
9. Lam MS, Cheung N. Impact of oncology pharmacist-managed oral anticancer therapy in patients with chronic myelogenous leukemia. J Oncol Pharm Pract. 2016;22:741-748.
10. Jacobs JM, Pensak NA, Sporn NJ, et al. Treatment satisfaction and adherence to oral chemotherapy in patients with cancer. J Oncol Pract. 2017;13:e474-e485. Epub 2017 Apr 11.
11. Dürr P, Schlichtig K, Krebs S, et al. Ökonomische Aspekte bei der Versorgung von Patient*innen mit neuen oralen Tumortherapeutika: Erkenntnisse aus der AMBORA-Studie [Economic aspects in the care of patients with new oral anticancer drugs: findings from the AMBORA trial]. Z Evid Fortbild Qual Gesundhwes. 2022;169:84-93.
12. Staskon FC, Kirkham HS, Pfeifer A, Miller RT. Estimated cost and savings in a patient management program for oral oncology medications: impact of a split-fill component. J Oncol Pract. 2019;15:e856-e862. Epub 2019 Aug 29.