Adherence to Oral Anticancer Medications After Implementation of an Ambulatory Adherence Program at a Large Urban Academic Hospital

Abstract

PURPOSE: Oral anticancer medications (OAMs) offer convenient administration, reducing the burden of cancer treatment, but create challenges for patients and practitioners. Using data from the Quality Oncology Practice Initiative analysis, a baseline adherence rate of 30% was identified at a large public, academic hospital. To improve OAM adherence, a quality improvement initiative was conducted. METHODS: The aim was to increase OAM patient adherence by 30 percentage points. Through cause-and-effect analysis, adherence barriers were identified, leading to the development of 2 strategies: low-cost adherence tools and a pharmacist-led adherence program. Prescription refill data were collected before and after the intervention, using prescription-fill data and specialty pharmacy records. Adherence was defined as the patient having the drug available at least 80% to less than 120% of the days evaluated for 4 treatment cycles. Other indicators collected included the number of interventions, OAM-related toxicity, emergency room visits, and hospitalizations. RESULTS: OAM adherence increased from 37% to 85% (n = 20 of 54 v 44 of 52 patients; P < .0001) in 1 year. During the study, 655 interventions were documented by the pharmacist (adherence related, n = 331; treatment related, n = 324). The number of oncology-related emergency room referrals leading to hospitalization increased from 52% (n = 13 of 25) to 62% (n = 23 of 37) during the study period. CONCLUSION: A pharmacist-led adherence program, combined with low-cost adherence tools, exceeded the goal for the adherence initiative, suggesting that a multidisciplinary collaborative approach to OAM adherence can have a significant impact on outcomes.

Satisfaction of Cancer Patients Treated with Oral Anticancer Medications regarding Dispensing by Community Pharmacists: A Cross-Sectional Study

“…Indeed, the presence of adverse efects is strongly associated with poorer adherence [40]. However, a pharmacist-led adherence program can increase the proportion of patients adhering to OAMs [41]. Intentional MMAS-8 scores are also weakly correlated to VAS scores assessing the quality of the information provided by oncologists.…”

Call to Action for Improving Oral Anticancer Agent Adherence

“…This should be performed in coordination with the treating medical oncologist. The involvement of pharmacists has been demonstrated to improve adherence and tolerability 40,41 and increase molecular response to treatment. 42 It also aligns with the position of the International Society of Oncology Pharmacy Practitioners.…”

Evaluation of clinical effects of a multidisciplinary-collaborated cancer support team for gastrointestinal cancer chemotherapy: prospective observational study protocol of M-CAST study

“…AMBORA trial [ 9 ] suggested that pharmacological/pharmaceutical care significantly reduced severe side effects from oral anticancer drugs compared to those who did not receive such care. Additionally, Marjorie et al [ 12 ] indicated that a pharmacist-led multidisciplinary collaborative approach significantly improved medication adherence to oral anticancer agents. As mentioned above, without the intervention of a multidisciplinary-collaborated team, side effects can be exacerbated, and medication adherence can be reduced.…”