Presenting Authors: Colton Zwart, PharmD, BCOP, and Mark Wagner, PharmD, BCOP, Cowell Family Cancer Center, Munson Healthcare, Traverse City, MI
Co-Authors: Karen Farris, PhD, University of Michigan College of Pharmacy, Ann Arbor, MI; David Reyes-Gastelum, and Katie Young, Michigan Institute for Care Management and Transformation, Ann Arbor, MI; Emily Mackler, PharmD, BCOP, Michigan Oncology Quality Consortium, Michigan Institute for Care Management and Transformation, YesRx, and University of Michigan, Ann Arbor, MI
BACKGROUND: Multiple publications have highlighted the pharmacist’s role in managing immune-related adverse events (AEs) from immune checkpoint inhibitor (ICI) therapy for patients with cancer.
OBJECTIVE: The purpose of this study was to compare outcomes in patients initiating ICI therapy for cancer before and after the integration of 2 clinically embedded clinical pharmacists in a large community oncology practice via the Pharmacists Optimizing Oncology Care Excellence in Michigan program.
METHODS: This single-center, retrospective analysis was conducted with data from March 2018 to March 2024. The intervention was clinically embedded pharmacist care, which was identified by a pharmacist education visit. Up to 134 patients in each of the pre- and postintervention groups were identified. Charts were eligible for abstraction if the patients were newly prescribed an ICI for cancer. The following data were abstracted: patient demographics, ICI medication, therapy intent (curative vs palliative), cancer diagnosis, start date, education date, corticosteroid use, follow-up visits, emergency department and hospitalizations, reason for emergency department/hospitalization, and reasons for ICI discontinuation. Chi-square analysis compared the pre- and postintervention time periods.
RESULTS: Abstraction was completed for 133 patients in the preintervention group and 134 patients in the postintervention group. The demographics in the preintervention group versus the postintervention group included a mean age of 67 years (standard deviation [SD], 12.3) versus 69 years (SD, 11.5), respectively; 64% female versus 70% female, respectively; 96% White versus 97% White, respectively; and 17% curative versus 34% curative, respectively. The most common cancer diagnoses were lung, endometrial, melanoma, kidney, breast, and bladder. Pembrolizumab was utilized most frequently in 43% of the preintervention patients and 52% of the postintervention patients. More patients in the postintervention group received education before starting ICI therapy (99% vs 86%; P=.002). The postintervention group had a 41% discontinuation rate due to AEs, progression, or hospice/death compared with 51% in the preintervention group (P=.098). Steroid use was similar between groups, with 27% of patients in the preintervention group requiring steroids and 25% in the postintervention group. There were no differences between the groups in the time to steroid initiation or the time receiving a steroid. The postintervention group had less hospitalizations (24% vs 41%; P=.009) and less emergency department visits (28% vs 46%; P=.005) within the first 6 months of therapy for cancer or treatment-related AEs compared with the preintervention group.
CONCLUSION: Embedded clinical pharmacist care improved the outcomes of patients receiving ICIs for the treatment of cancer, including improved rates of education and decreased incidence of unplanned healthcare utilization.
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- POEM program. Accessed October 4, 2024. www.moqc.org/poem