Medication adherence to oral cancer therapy: The promising role of the pharmacist

Felton, Maria; Londen, GJ van; Marcum, Zachary A.

doi:10.1177/1078155214559114

Cited by 28 publications

(25 citation statements)

References 13 publications

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“…19 Communitybased oncology pharmacists play key roles within multidisciplinary teams involving nurses, oncologists, and primary care physicians, in delivering patient education and AE monitoring and management programs aimed at improving the management of AEs. 13,17,19,[21][22][23] Routine implementation of pharmacist-led drug monitoring programs has been shown to have a significant impact on clinical outcomes and health care costs of a number of chronic diseases. 24,25 In oncology, a retrospective observational cohort study of a pharmacist-managed oral chemotherapy management clinic that provided services (including education on oral chemotherapy agents, concurrent medications, symptom management, and insurance assistance) to cancer patients for up to three months found that the program led to reductions in rates of adverse effects, nonadherence, drug interactions, and medication errors over time, as well as potential cost avoidance or cost savings.…”

Section: Introductionmentioning

confidence: 99%

Pharmacist-led patient education and adverse event management in patients with non-small cell lung cancer receiving afatinib in a community-based, real-world clinical setting

Khrystolubova

Shieh

Patel

et al. 2019

J Oncol Pharm Pract

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PurposeTo describe the outcomes of a pharmacist-led multi-center, collaborative patient education and proactive adverse event management program in a community-based oncology setting.MethodsPatients with EGFR mutation-positive (EGFRm+) non-small cell lung cancer, newly prescribed with oral afatinib, and monitored as part of the Florida Cancer Specialists patient management program, were included in a retrospective, observational analysis. During follow-up, data were collected on adverse event frequency, and changes in afatinib dosing. Data analyses were descriptive and exploratory in nature.ResultsThe mean age of the 123 patients included in the analysis was 69 years, and 78% were female. At the time of the analysis, 3 patients had discontinued before receiving treatment, 89 patients had discontinued afatinib treatment, and 31 patients were continuing to receive afatinib treatment. The most common afatinib-related adverse events were diarrhea (85%), rash/skin reactions (58%), stomatitis/mucositis (19%), and paronychia (16%). Overall, 13% of patients discontinued due to afatinib-related adverse events. The median duration of treatment was 4 months in patients who discontinued due to adverse events, 6 months in those who discontinued for other reasons, and 18 months in those who were continuing to receive therapy. Afatinib dose-reductions were more frequent in patients continuing treatment versus those who discontinued due to adverse events (77% vs. 42%, respectively).ConclusionsFindings suggest that adverse events in patients with EGFRm + non-small cell lung cancer receiving afatinib can be successfully managed in a community-based, real-world setting with the help of collaborative pharmacist-led patient education, adverse event monitoring, and continuous support.

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Section: Introductionmentioning

confidence: 99%

Pharmacist-led patient education and adverse event management in patients with non-small cell lung cancer receiving afatinib in a community-based, real-world clinical setting

Khrystolubova

Shieh

Patel

et al. 2019

J Oncol Pharm Pract

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“…Patient education and adherence is an integral part of successful oral chemotherapy treatment and is often a collaborative effort among patients, family members, providers, and pharmacists. Successful patient counseling includes the indication, dosing regimen, supportive care, adverse effects, storage, and administration, as well as medication reconciliation [ 21 ]. One observational study quantified patient satisfaction after an initial pharmacy-led education encounter prior to starting chemotherapy and found that 86% of patients felt that meeting with a pharmacist was “absolutely necessary.” Furthermore, 83% of patients stated that they would be willing to pay for this pharmacy-driven service [ 4 ].…”

Section: Oral Chemotherapy Considerationsmentioning

confidence: 99%

Pharmacists’ Role in Managing Patients with Chronic Lymphocytic Leukemia

et al. 2020

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Chronic lymphocytic leukemia (CLL) is a hematologic malignancy that has seen significant advances in care over the last 5 years with the approval of oral agents such as ibrutinib and venetoclax for the treatment of this disease. As such, there has been a substantial shift away from the traditional chemotherapy infusions which have allowed patients greater autonomy with oral cancer therapies. This paradigm shift poses new challenges for the medical team, including drug–drug interactions, adherence counseling, and financial toxicity. Pharmacists are uniquely trained and equipped to help to manage the changing landscape of CLL care. From identifying common medications which may impair ibrutinib clearance to ensuring patients are on the appropriate anti-infective prophylaxis while receiving obinutuzumab, pharmacists can play a vital role in ensuring the highest quality of patient care. Furthermore, additional credentialing of clinical pharmacists in select states allows for independent visits with the pharmacists, allowing for greater involvement, particularly for initiation of venetoclax and management of ibrutinib-induced toxicities. Pharmacists are essential to both expanding and enhancing the care of patients with CLL and should be leveraged to improve patient outcomes whenever possible.

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“…Educating patients about medication characteristics, administration guidelines, and AEs may help reduce dose-modifying AEs and improve adherence. 70 Improvement in patient medication adherence was observed in a retrospective analysis of 56 patients taking oral TKIs and who were managed by oncology pharmacists. 71 In this study, the adherence rate in patients in the intervention group was 89% compared with 66% in patients receiving the usual care regimen.…”

Section: Follow-up Care Of Patientsmentioning

confidence: 99%

BCR-ABL1 tyrosine kinase inhibitors for the treatment of chronic myeloid leukemia

Cuéllar

Vozniak

Rhodes

et al. 2017

J Oncol Pharm Pract

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The management of chronic myeloid leukemia with BCR-ABL1 tyrosine kinase inhibitors has evolved chronic myeloid leukemia into a chronic, manageable disease. A patient-centered approach is important for the appropriate management of chronic myeloid leukemia and optimization of long-term treatment outcomes. The pharmacist plays a key role in treatment selection, monitoring drug–drug interactions, identification and management of adverse events, and educating patients on adherence. The combination of tyrosine kinase inhibitors with unique safety profiles and individual patients with unique medical histories can make managing treatment difficult. This review will provide up-to-date information regarding tyrosine kinase inhibitor-based treatment of patients with chronic myeloid leukemia. Management strategies for adverse events and considerations for drug–drug interactions will not only vary among patients but also across tyrosine kinase inhibitors. Drug–drug interactions can be mild to severe. In instances where co-administration of concomitant medications cannot be avoided, it is critical to understand how drug levels are impacted and how subsequent dose modifications ensure therapeutic drug levels are maintained. An important component of patient-centered management of chronic myeloid leukemia also includes educating patients on the significance of early and regular monitoring of therapeutic milestones, emphasizing the importance of adhering to treatment in achieving these targets, and appropriately modifying treatment if these clinical goals are not being met. Overall, staying apprised of current research, utilizing the close pharmacist–patient relationship, and having regular interactions with patients, will help achieve successful long-term treatment of chronic myeloid leukemia in the age of BCR-ABL1 tyrosine kinase inhibitors.

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Medication adherence to oral cancer therapy: The promising role of the pharmacist

Cited by 28 publications

References 13 publications

Pharmacist-led patient education and adverse event management in patients with non-small cell lung cancer receiving afatinib in a community-based, real-world clinical setting

Pharmacist-led patient education and adverse event management in patients with non-small cell lung cancer receiving afatinib in a community-based, real-world clinical setting

Pharmacists’ Role in Managing Patients with Chronic Lymphocytic Leukemia

BCR-ABL1 tyrosine kinase inhibitors for the treatment of chronic myeloid leukemia

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