The following select abstracts were presented during the poster presentation at the 16th Annual Conference of the Hematology/Oncology Pharmacy Association (HOPA) in Tampa, FL, in April 2020. Some abstracts were published in the June issue of the journal and the balance of the 2020 abstracts will be published in October and December.
- Healthcare Utilization and Costs Associated with CPX-351 and 7+3 Treatments in Patients with Newly Diagnosed Therapy-Related Acute Myeloid Leukemia and Acute Myeloid Leukemia with Myelodysplasia-Related Changes
- Quality of Life, Medication Adherence, and Actigraphy in Community Patients with Multiple Myeloma Undergoing an In-Class Transition from a Parenteral to an Oral Proteasome Inhibitor in the US MM-6 Study
- Real-World Patients with Multiple Myeloma Are Under-Represented in Clinical Trials Based on Standard Laboratory Parameters and Baseline Characteristics: Analysis of More Than 3000 Patients in the INSIGHT MM Global Study
- Comparison of Direct Oral Anticoagulants versus Warfarin for the Treatment of Venous Thromboembolism in Morbidly Obese Patients: A Retrospective Analysis
- Decreasing Inpatient Cancer-Directed Medication Expenditures Using a Novel Interdisciplinary Formulary Pathway
- The Impact of Pharmacist-Based Patient Education Program on Patients’ Satisfaction and Medication Beliefs in an Ambulatory Care Oncology Setting
- Innovative Active Learning Increases Confidence and Knowledge of Pharmacists Managing CDK4/CDK6 Inhibitors in HR-Positive, HER2-Negative Advanced Breast Cancer
CLINICAL/TRANSACTIONAL TRACK: COMPLETED RESEARCH
Abstract #CT05
Healthcare Utilization and Costs Associated with CPX-351 and 7+3 Treatments in Patients with Newly Diagnosed Therapy-Related Acute Myeloid Leukemia and Acute Myeloid Leukemia with Myelodysplasia-Related Changes
Presenter: Kwanza Price, MPH, Jazz Pharmaceuticals
Co-Authors: Zhun Cao, Premier; Craig Lipkin, Premier; Scott Robinson, Premier; Deb Profant, Jazz Pharmaceuticals
Background: CPX-351 is a fixed combination of daunorubicin and cytarabine at a synergistic 1:5 molar ratio, encapsulated in a liposome to provide synergistic delivery of the 2 drugs. It was approved for the treatment of adults with newly diagnosed, therapy-related acute myeloid leukemia (AML) or AML with myelodysplasia-related changes (MRC) as the alternative to the mainstay chemotherapy regimen of cytarabine plus daunorubicin 7+3. Currently there is no real-world evidence on the healthcare costs and resource utilization (HCRU) associated with CPX-351 compared with 7+3.
Objective: To evaluate the HCRU associated with CPX-351 compared with 7+3 regimen.
Method: This retrospective, observational study included patients aged ≥18 years from Premier Healthcare Database, with ≥1 AML-related hospital visits who received 7+3 or CPX-351 between August 1, 2017, and February 28, 2019. The patients receiving 7+3 who had therapy-related AML or AML-MRC within 1 year before the first treatment were defined as CPX-351-eligible and served as the comparison group. The primary outcome was total inpatient length of stay. The secondary outcomes included total nonpharmacy costs, number of days receiving white blood cell (WBC) colony-stimulating factors (CSF), number of days receiving anti-infectives, number of red blood cell (RBC) transfusions, and the number of platelet transfusions. The outcomes were annualized to patient per-year values. Generalized linear models were used to adjust for differences in patient and hospital characteristics. The full regression models included covariates such as demographics, Charlson Comorbidity Index, therapy-related AML, AML-MRC, previous use of anthracycline or hypomethylating agent, urbanicity, teaching hospital, census region, and bed size. Backward selection was used to select the final model. Adjusted outcomes were estimated using recycled prediction method.1 The analysis was powered for the primary outcome, length of stay, using a Wilcoxon test at α = 0.05. The P values for all outcomes were nominal, except length of stay.
Results: The study included 195 qualifying patients receiving CPX-351 and 160 patients receiving 7+3. The regression-adjusted total length of stay was shorter in the CPX-351 cohort (mean 183.7 days) versus 7+3 cohort (197.1 days), P <.001. This was most pronounced for patients with therapy-related AML, with mean adjusted length of stay of 168.9 days for CPX-351 versus 192.5 days for 7+3 (nominal P <.001). The adjusted nonpharmacy cost was similar: $374,960 for the CPX-351 cohort and $401,975 for the 7+3 cohort (nominal P = .426). The mean adjusted number of WBC CSF administrations was 2.0 and 3.0 for the CPX-351 group and 7+3 group, respectively (nominal P = .053). The utilization of RBC, platelets, and anti-infectives were similar between the 2 groups.
Conclusion: Treatment with CPX-351 was associated with shorter inpatient length of stay compared with patients treated with 7+3. These patients may also require numerically fewer WBC CSF administrations. There was no evidence for increased nonpharmacy costs, use of blood products or anti-infectives.
1. Li Z, Mahendra G. Using “recycled predictions” for computing marginal effects. Paper presented at the SAS Global Forum; April 11-14, 2010; Seattle, WA.
CLINICAL/TRANSACTIONAL TRACK: COMPLETED RESEARCH
Abstract #CT06
Quality of Life, Medication Adherence, and Actigraphy in Community Patients with Multiple Myeloma Undergoing an In-Class Transition from a Parenteral to an Oral Proteasome Inhibitor in the US MM-6 Study
Presenter: Stephen J. Noga, MD, PhD, Millennium Pharmaceuticals, a wholly owned subsidiary of Takeda Pharmaceutical Co, Cambridge, MA
Co-Authors: Robert Rifkin, Rocky Mountain Cancer Centers, US Oncology Research, Denver, CO; Sudhir Manda, Arizona Oncology, US Oncology Research, Tucson, AZ; Roger M. Lyons, Texas Oncology, US Oncology Research, San Antonio, TX; Presley Whidden, Millennium Pharmaceuticals; Robert L. Schlossman, Millennium Pharmaceuticals; Bingxia Wang, Millennium Pharmaceuticals; Ralph V. Boccia, Center for Cancer and Blood Disorders, Bethesda, MD; Ruemu E. Birhiray, Hematology Oncology of Indiana, PC, Indianapolis, IN
Background: US MM-6 is a community-based study investigating an in-class transition from a parenteral (bortezomib) to an oral (ixazomib) proteasome inhibitor (PI) in patients with multiple myeloma to increase PI-based treatment duration and adherence, maintain quality of life (QOL), and improve outcomes.
Objective: To report on the novel aspects of the study, including the use of digital devices/wearables to evaluate QOL, medication adherence, and actigraphy, for the first 55 patients.
Method: Transplant-ineligible or transplant-delayed (>24 months) patients with ≥stable disease after 3 cycles of bortezomib-based induction are receiving ixazomib, lenalidomide, and dexamethasone (IRd): ixazomib 4 mg, days 1, 8, 15; lenalidomide 25 mg, days 1-21; dexamethasone 40 mg (those aged >75 years, 20 mg), days 1, 8, 15, and 22 for up to 26 of 28-day cycles or until disease progression or toxicity. The primary end point is progression-free survival. Among the secondary or exploratory end points to capture patients’ real-world experience in the community setting, electronic patient-reported outcomes (PROs) are used to assess medication adherence and QOL; patients record medication adherence and actigraphy via wearable digital devices or smartphones.
Results: Patient and disease characteristics revealed a difficult-to-treat population, with a median age of 72 years (42% ≥75 years), 40% had International Staging System (ISS) stage III disease, and 42% had lytic bone disease. Most common comorbidities at study start were hypertension (51%), anemia (44%), and fatigue (42%). During treatment with IRd, the average compliance with completing the electronic PRO questionnaires was 96% (≥87% in all cycles). There was a trend toward improved treatment satisfaction and QOL. The mean change (95% confidence interval) from baseline in the EORTC QLQ-C30 score was 5.12 (–13.79-24.02; N = 13), and in the Treatment Satisfaction Questionnaire for Medication-9 subscale, “effectiveness” was 7.54 (–1.84-16.91) by cycle 5 (N = 14), with similar patterns for the subscales “convenience” and “global satisfaction.” The mean change from baseline in the EORTC QLQ-MY20 score for peripheral neuropathy component was 0.0-2.0 throughout all cycles. Patients recorded their medication adherence for the previous 4 weeks: 81% of evaluable patients (N = 32) in cycle 1, 81% in cycle 2 (N = 27), 77% in cycle 3 (N = 22), 96% in cycle 4 (N = 24), and 94% in cycle 5 (N = 18) reported “excellent” or “very good” adherence. Actigraphy data for 24 patients (2086 compliant days; ≥12 hours of data) revealed normal levels of activity and sleep1,2: mean (SD) of 3236 (3540) steps per day and 8.35 (3.21) hours of sleep.
Conclusion: Preliminary electronic PRO and actigraphy data from this community study suggest that long-term treatment with the all-oral IRd regimen has no impact on health-related QOL or on lifestyle. High electronic PRO compliance indicates that real-world studies using wearable electronic data collection devices are feasible in this mostly elderly, comorbid population, and may have a positive impact on medication adherence.
1. Tudor-Locke C, Craig CL, Aoyagi Y, et al. How many steps/day are enough? For older adults and special populations. Int J Behav Nutr Phys Act. 2011;8:80. doi.org/10.1186/1479-5868-8-80.
2. Coleman EA, Goodwin JA, Coon SK, et al. Fatigue, sleep, pain, mood, and performance status in patients with multiple myeloma. Cancer Nurs. 2011;34:219-227.
CLINICAL/TRANSACTIONAL TRACK: COMPLETED RESEARCH
Abstract #CT07
Real-World Patients with Multiple Myeloma Are Under-Represented in Clinical Trials Based on Standard Laboratory Parameters and Baseline Characteristics: Analysis of More Than 3000 Patients in the INSIGHT MM Global Study
Presenter: Dawn Marie Stull, PharmD, BCOP, Millennium Pharmaceuticals, a wholly owned subsidiary of Takeda Pharmaceutical Co, Cambridge, MA
Co-Authors: [Click here for a list of the Co-Authors]
Background: Phase 3 randomized controlled trials (RCTs) in multiple myeloma have strict eligibility criteria, mostly related to a patient’s comorbidity or performance status, resulting in populations that do not reflect real-world patients with multiple myeloma. Data suggest that 22% to 40% of real-world patients are ineligible for RCTs,1,2 and a recent analysis shows only 25% to 47% of US real-world patients with relapsed or refractory multiple myeloma (RRMM) would be eligible for specific phase 3 RCTs, based on their differing eligibility criteria.3 RCT ineligibility is associated with poorer long-term outcome1; thus, it is important to characterize real-world patients with multiple myeloma and understand discrepancies versus RCT populations.
Objective: To analyze RCT eligibility of patients in the INSIGHT MM (NCT02761187) study, the largest prospective observational study in multiple myeloma to date.
Methods: In INSIGHT MM, patients’ demographics and disease characteristics, including medical history, comorbidities, performance status, and frailty status (per IMWG Frailty Index criteria4), are collected using electronic case report forms at study baseline visit. For this analysis, patient data were reviewed versus 20 standard RCT laboratory or performance status and medical history exclusion criteria.
Results: Of 3201 patients (1761 patients with newly diagnosed multiple myeloma [NDMM] and 1440 with RRMM) analyzed, 39.2% patients overall would have been ineligible for RCTs based on not meeting ≥1 eligibility criteria, including 38.8% patients with NDMM and 39.7% patients with RRMM. Criteria excluding patients were generally similar in patients with NDMM or RRMM, the most common (>4%) including: a previous malignancy (7.5%), creatinine clearance ≤30 mL/min (6.4%), cardiac arrhythmias (5.4%), platelets ≤75,000/mm3 (5.1%), hemoglobin <8.0 g/dL (4.8%), and chronic pulmonary disease (4.7%). Per study team evaluation, applying the IMWG Frailty Index parameters, 320 of 1685 (19%) evaluable patients were determined to be frail in the INSIGHT MM study, of whom (applying the 20 standard eligibility criteria) 74.7% would have been RCT-ineligible. Of 126 evaluable frail patients receiving first-line therapy, 30 (24%) and 83 (66%) received doublet and triplet therapy, respectively, with median durations of treatment (Kaplan-Meier analysis) of 5.4 and 6.2 months. Of 48 evaluable patients in the second- to fourth-line treatment, 26 (54%) and 21 (44%) received doublet and triplet therapy, respectively, with median duration of treatment of 4.4 and 5.3 months, respectively. Further analyses of RCT eligibility criteria, treatments received, reasons for treatment discontinuation, and duration of treatment by frailty status and RCT eligibility will be presented.
Conclusions: A high proportion of patients in the INSIGHT MM study were RCT-ineligible; our analysis suggests that frail patients are particularly underrepresented in RCTs. These findings emphasize the importance of real-world data in evaluating effectiveness of treatment options. Initiatives are also ongoing to broaden oncology clinical trial eligibility criteria.
- Shah JJ, Abonour R, Gasparetto C, et al. Analysis of common eligibility criteria of randomized controlled trials in newly diagnosed multiple myeloma patients and extrapolating outcomes. Clin Lymphoma Myeloma Leuk. 2017;17:575-583.e2.
- Fiala M, Dukeman J, Stockerl-Goldstein K, et al. The real-world characteristics and outcomes of newly diagnosed myeloma patients ineligible for clinical trials. Clin Lymphoma Myeloma Leuk. 2017;17(1 suppl): Abstract PS-099.
- Chari A, Romanus D, Farrelly E, et al. Randomized clinical trial (RCT) representativeness & outcomes in relapsed/refractory multiple myeloma (RRMM) real world (RW) patients: comparison of ASPIRE, TOURMALINE-MM1, POLLUX, & ELOQUENT RCTs. Hemasphere. 2018;2(S1):Abstract PS1336.
- Palumbo A, Bringhen S, Mateos MV, et al. Geriatric assessment predicts survival and toxicities in elderly myeloma patients: an International Myeloma Working Group report. Blood. 2015;125:2068-2074. Errata in: Blood. 2016;127:1213; Blood. 2016;128:1020.
CLINICAL/TRANSACTIONAL TRACK: COMPLETED RESEARCH
Abstract #CT08
Comparison of Direct Oral Anticoagulants versus Warfarin for the Treatment of Venous Thromboembolism in Morbidly Obese Patients: A Retrospective Analysis
Presenters: Kristin I. Brower, PharmD, BCPS, and Tracy Wiczer, PharmD, BCOP, The James Cancer Hospital, The Ohio State University Wexner Medical Center
Co-Authors: Meghan Ritchey, PharmD Candidate, and Bridgette Zickefoose, PharmD Candidate, The Ohio State University College of Pharmacy; Caitlin Yocum, PharmD, University of Texas M.D. Anderson Cancer Center; Tzu-Fei Wang, MD, The Arthur G. James Cancer Hospital, The Ohio State University; Anthony Gerlach, PharmD, BCPS, FCCM, FCCP, The Ohio State University Wexner Medical Center
Background: Although direct oral anticoagulants (DOACs) represent a convenient alternative to vitamin K antagonists in the treatment of venous thromboembolism (VTE), controversy exists regarding their efficacy and safety in obese patients.
Objective: To compare the composite of recurrent VTE or major bleeding in obese patients (weight ≥120 kg, or body mass index ≥40 kg/m2) who are receiving treatment with a DOAC or warfarin for VTE.
Methods: Patients aged 18 to 89 years treated for VTE with a DOAC (apixaban or rivaroxaban) or warfarin between December 2010 and July 31, 2017, were included in the study. Exclusion criteria included receipt of thrombectomy or a thrombolytic agent; concurrent dual antiplatelet therapy; indication for anticoagulation other than VTE; creatinine clearance 1 week after diagnosis of VTE; absence of ≥2 documented follow-up encounters; and platelet count <50,000 µL-1. Data were collected for 24 months from the date of the index VTE and included baseline patient demographics, clinical characteristics of index VTE and anticoagulation therapy, major bleeding, and clinically relevant nonmajor bleeding. Nominal data were presented as frequency and percentages and analyzed using the Fisher’s exact test or chi-square test, as appropriate, continuous data presented as median (25%-75% interquartile range [INR]). Two-tailed statistical tests were used with a significance level set at P <.05. The primary outcome consisted of a composite of recurrent VTE or major bleeding. Secondary outcomes included each individual component of the primary outcome and clinically relevant nonmajor bleeding.
Results: Of 1859 patients screened, 77 were included in the analysis, of whom 32 received a DOAC and 45 received warfarin. Rivaroxaban was used in 71% of the patients who received a DOAC. For patients receiving warfarin, the median percent of time in the targeted therapeutic range was 47.1% (INR, 30.3%-57%). The primary composite outcome of recurrent VTE or major bleeding occurred in fewer patients receiving a DOAC than warfarin (6.5% vs 23.9%, respectively; P = .045). There was a trend toward less recurrent VTE in patients receiving a DOAC than warfarin (6.5% vs 21.7%, respectively; P = .07). Major bleeding occurred in only 1 patient who received warfarin and suffered intracerebral hemorrhage. Clinically relevant nonmajor bleeding was low and similar between the groups (12.5% vs 8.7%, respectively; P = .71). For patients who received a DOAC, clinically relevant nonmajor bleeding occurred in 0% and 18.2% of those receiving apixaban and rivaroxaban, respectively (P = .71).
Conclusion: Obese patients who are receiving a DOAC for VTE treatment had significantly less recurrent VTE or major bleeding than those receiving warfarin. Only 1 patient had a major bleeding event, and the rates of clinically relevant nonmajor bleeding were similar between the groups.
PRACTICE MANAGEMENT TRACK: COMPLETED RESEARCH
Abstract #PM04
Decreasing Inpatient Cancer-Directed Medication Expenditures Using a Novel Interdisciplinary Formulary Pathway
Presenter: Jocelyn Mohs, PharmD, BCOP, Sanford Roger Maris Cancer Center
Co-Authors: Jesse Breidenbach, Senior Director of Pharmacy, Sanford Health; David Leedahl, Director of Pharmacy, Sanford Medical Center Fargo; Nathan Leedahl, Pharmacy Manager, Sanford Medical Center Fargo; Lisa Narveson, Senior Oncology Pharmacist, Sanford Roger Maris Cancer Center
Background: In 2017, our hospital observed a linear increase in cancer-directed medication inpatient expenditures. Since medications used to treat cancer are increasing in efficacy and in cost, it is prudent to determine which patients will benefit, and what healthcare setting is most appropriate for administration.1 The answers to these questions are complicated by inpatient billing and reimbursement structure, wherein a bundled payment for an inpatient stay may not account for the cost of cancer-directed therapy. Clear guidance to navigate the clinical, operational, and financial questions related to the utility of anticancer therapy in hospitalized patients became a critical need for our oncology practice and health system.
Objective: To decrease the cost of inpatient cancer-directed therapy by establishing a streamlined formulary pathway.
Methods: Our Oncology Formulary Committee and our Medical Hematology/Oncology providers established a list of formulary parenteral and oral cancer-directed medications with associated clinical criteria for use. A peer-hematologist/oncologist review pathway was established for any “nonformulary” request, using a form that was circulated to hematology/oncology physician peers. Nonformulary request forms, regardless of whether the request was approved or denied, were circulated back to the Oncology Formulary Committee for evaluation and feedback. Our medical center consisted of 13 full-time, institutionally employed adult oncologist physicians (3 with hematology specialty) throughout the 2017-2019 time frame.
Results: The formulary pathway for inpatient cancer-directed therapy has been used from January 2018 to the present (data available for query through June 2019). Despite an increase in monthly inpatient discharges annually (2017, 2258; 2018, 2339; 2019, 2424), the average monthly cost of nonformulary inpatient cancer-directed therapy decreased from $27,965 monthly in 2017 to $10,217 in 2018 through June 2019, a 63% reduction in monthly expenditures sustained for 18 months. This calculation assumed that nonformulary agents in the intervention period would also have been nonformulary in the 2017 preintervention period. Our aggregate inpatient cancer-directed expenditures decreased from $139,681 per month to $121,429 per month in the 2018 to June 2019 period (13% decrease).
Conclusion: Our formulary pathway successfully decreased inpatient cancer-directed medication expenditures. A primary strength of the program included interdisciplinary collaboration for development and execution of the formulary list and pathway. Clear roles for team members, timely circulation of nonformulary requests, and monthly review of nonformulary requests were critical to the success of this program. Opportunities to improve the program going forward include separating nonformulary requests for hematologic malignancies for review by hematology physician specialists.
- Kopolovic I, Conter HJ, Hicks LK. ‘Choosing Wisely’ campaigns from ASCO and ASH: a review for clinicians in haematology and oncology. Am J Hem Oncol. 2015;11(12):25-29.
PRACTICE MANAGEMENT TRACK: COMPLETED RESEARCH
Abstract #PM05
The Impact of Pharmacist-Based Patient Education Program on Patients’ Satisfaction and Medication Beliefs in an Ambulatory Care Oncology Setting
Presenter: Reem Alharbi, PharmD, Clinical Pharmacist, Adult Hematology/Oncology, King Faisal Specialist Hospital & Research Center
Co-Authors: Hadeel Hadeel Samarkandi, PharmD, Clinical Pharmacist, Adult Hematology/Oncology, King Faisal Specialist Hospital & Research Center; Madona Yahia, PharmD, BCPS, Assistant Professor, Princess Noura Bint Abdulrahman University; and Athkar Alanazi, PharmD Candidate; Arwa Almuhareb, PharmD Candidate; Bashaer Alorayyidh, PharmD Candidate; Monirah Almubaddel, PharmD Candidate; Noura Abalkhail, PharmD Candidate; and Wasaal Alquaydhib, PharmD Candidate, all at Princess Noura Bint Abdulrahman University
Background: The growing demand for cancer care services in the ambulatory care setting and limited numbers of medical oncologists require cancer clinics to be extra productive and efficient, and other healthcare professionals to work to their limits. Oncology pharmacists have the potential to assume a greater role in patient care as part of a multidisciplinary team in such a setting, where they can be responsible for patient care through recommending, monitoring, and providing patient-specific treatment and education to ensure optimal outcomes.
Objective: To assess the impact of oncology clinical pharmacist counseling and education on patients’ satisfactions, medication beliefs, and quality of life (QOL).
Methods: This was a cross-sectional, survey-based study using an adapted self-administered questionnaire. The study was conducted at an oncology infusion center from September 2018 to April 2019. Patients aged ≥14 years with newly diagnosed or with recurrent or relapsed solid tumors and lymphoma who have completed at least 2 cycles of chemotherapy or immunotherapy were targeted for inclusion. The analysis was done using t-test for normally distributed data and chi-square test for non–normally distributed data or categorical data. Correlation analysis was conducted between the study outcomes, with level of significance set at P = .01. The study was approved by the Office of Research Affairs in the center.
Results: A total of 178 patients responded to the survey, representing a response rate of 87%. About 94% of the respondents were satisfied with their counseling sessions provided by the oncology clinical pharmacist. In addition, 35.71% of the patients believed that their chemotherapy or immunotherapy was effective for them, whereas 54.49% of the patients were uncertain, and 6.16% did not believe in their treatment regimens. A negative correlation was detected between medications disbelief and patients’ satisfaction (r = –0.169; P = .002). No significant difference was found in mean score concerning medication beliefs between previously treated patients compared with newly diagnosed patients (55.3 ± 1.7 vs 52.3 ± 1.1, respectively; P = .346). By contrast, a positive correlation was detected between patients’ satisfactions and all domains of QOL, including general (r = .223; P = .000), physical (r = .195; P = .000), psychological (r = .251; P = .000), social (r = .159; P = .005), and environmental (r = .230; P = .000) domains, respectively. The top 3 chemotherapy regimens with best reported QOL were doxorubicin, bleomycin, vinblastine, dacarbazine (ABVD; 85.45%, N = 13), rituximab, prednisone, vincristine, cyclophosphamide, doxorubicin (RCHOP; 82.81%, N = 6), and docetaxel, cyclophosphamide (TC; 81.17%, N = 5).
Conclusion: Based on the study findings, a majority of the patients were satisfied with the counseling sessions provided by the oncology clinical pharmacist, which correlated with better QOL. However, that did not affect the patients’ beliefs about their treatment regimens.
PRACTICE MANAGEMENT TRACK: COMPLETED RESEARCH
Abstract #PM06
Innovative Active Learning Increases Confidence and Knowledge of Pharmacists Managing CDK4/CDK6 Inhibitors in HR-Positive, HER2-Negative Advanced Breast Cancer
Presenter: Amy H. Seung, PharmD, BCOP, FHOPA, Pharmacy Times Continuing Education
Co-Authors: Neha Mangini, PharmD, BCOP, Oncology Clinical Specialist, The Johns Hopkins Hospital; Danielle Roman, PharmD, BCOP, Manager, Clinical Pharmacy Services, Allegheny Health Network Cancer Institute; Jim Palatine, RPh, MBA, President, Pharmacy Times Continuing Education
Background: Pharmacists in multiple practice settings manage patients who are receiving oral oncolytic drugs. A great need exists for effective education to match the annual growth and complexity of US Food and Drug Administration approval of oncology drugs. CDK4/CDK6 inhibitors used in the treatment of patients with HR-positive, HER2-negative advanced breast cancer demonstrate benefit to the treatment paradigms but add to the complexity of care. Pharmacists’ education is essential to assess treatment options, differentiate clinical trial results, and build confidence of the pharmacist’s role in managing adverse effects. Best practices in multiple settings must be demonstrated to show pharmacists’ collaboration with one another and with other professionals to improve patient outcomes. Programs were developed to meet learners’ needs based on practice settings.
Objective: To develop education to increase confidence and knowledge of pharmacists who are managing CDK4/CDK6 inhibitors.
Methods: In early 2019, 2 distinct but collaborative programs were launched. A 2.5-credit-hour electronic article incorporated cases with patient counseling videos. Case studies fostered the application of clinical strategies to practice scenarios with interactive decision trees to simulate real-life management of adverse events. A 1.5-hour live virtual symposium embedded counseling videos based on real-life scenarios in 3 settings of patient-centered pharmacist care. Videos highlighted significant practice scenarios with interactive decision trees to simulate real-life management of adverse events and showed therapy-specific challenges in various settings. Education objectives used included:
- Distinguish current treatment strategies for HR-positive, HER2-negative advanced breast cancer.
- Examine the efficacy, safety, and mechanism of action of CDK4/CDK6 inhibitors.
- Identify appropriate adverse events management, including communication strategies for patients receiving CDK4/CDK6 inhibitors.
Results: Data were analyzed 12 months after the program launch in February 2020, with 1888 pharmacists completing activities for ACPE credit. Self-identified practice settings included 803 (42.5%) retail, 479 (25.3%) health-system, and 226 (12.0%) specialty pharmacy. Correlating pre- and postassessment case-based questions focused on a laboratory value adverse event showed a knowledge increase from 51% correct responses to 88% with use of simulated decision case and video. Pre- and postassessment case-based questions on counseling for a clinically significant interaction demonstrated a knowledge increase from 34% to 75% with use of a video-embedded case and simulation. Preactivity, 51% of the learners identified themselves as moderately, very, or extremely confident in using treatment strategies for HR-positive, HER2-negative advanced breast cancer compared with 85% postactivity.
Conclusion: Pharmacists increased confidence, knowledge, and competence after completing 1 or 2 educational activities. Education based on specific roles and practice settings is necessary to manage diverse needs and enhance patient outcomes. This initiative focused on the use of innovative videos and adaptive case simulation and sets a precedent in designing active education utilizing clinical scenarios applicable to multiple oncology practice settings.