Pharmacist-Urologist Collaborative Management Improves Clinical Outcomes in Patients With Castration-Resistant Prostate Cancer Receiving Enzalutamide

Abstract

Background: Enzalutamide is useful for the treatment of castration-resistant prostate cancer (CRPC). Despite its usefulness, adverse events (AEs) sometimes force patients to discontinue treatment. To maximize patient care, we developed an ambulatory care pharmacy practice that allows collaboration between a pharmacist and urologist to manage patients with CRPC receiving enzalutamide. In this study, we investigated the efficacy of this collaborative management.Methods: A retrospective chart review of 103 patients with CRPC receiving enzalutamide in our hospital between May 2014 and December 2020 was performed. Our collaborative management was implemented in October 2016. Before being examined by urologists, patients visited the oncology pharmacy consultation room for a face-to-face consultation, wherein the oncology pharmacists assessed factors such as adherence to enzalutamide, any AEs and their grades, and provided their suggestions to the urologists. The time to enzalutamide discontinuation and prostate-specific antigen progression were compared between patients who started enzalutamide before (n = 41) and after (n = 62) the implementation of the collaborative management. A multivariate Cox regression analysis was performed to analyze the factors associated with enzalutamide discontinuation.Results: After implementing collaborative management, the pharmacists had 881 patient consultations. Among the 476 suggestions from pharmacists, 345 were accepted by urologists. The most frequent suggestion was supportive care in enzalutamide treatment (224 suggestions). Multivariate analysis showed that collaborative management [hazard ratio (HR) 0.53, 95% confidence interval (CI) 0.31–0.89, p = 0.017] and higher prostate-specific antigen (PSA; HR 2.41, 95% CI 1.36–4.28, p = 0.003) were significantly associated with enzalutamide discontinuation. The median time to discontinuation (18.9 vs. 7.6 months, p = 0.012), time to discontinuation due to AEs (not reached in both groups, p = 0.001), and time to PSA progression (13.3 vs. 5.8 months, p = 0.002) were all significantly longer in the after group.Conclusions: We implemented a pharmacist-urologist collaborative management program for outpatients with CRPC receiving enzalutamide. The results revealed that collaborative management was useful for prolonging the time to enzalutamide discontinuation.

Pharmacist–Urologist Collaborative Management for Patients with Renal Cell Carcinoma Receiving Pazopanib Monotherapy

“…Numerous studies have shown the effectiveness of pharmacist-led team care in pharmacotherapies. [6][7][8][9][10][13][14][15][16][17][18][19] The results of this study also supported the usefulness of pharmacisturologist collaborative pharmacotherapy management in an ambulatory care setting. In our ambulatory care pharmacy practice, pharmacists performed a variety of responsibilities, including patient education, suggesting appropriate supportive care, suggesting pazopanib dose modifications to physicians if necessary, managing drug-drug interactions, and encouraging patients to take their medication as prescribed.…”

“…The objectives of our collaborative management were to support urologists in patient care. [6][7][8] Three board-certified oncology pharmacists in Japan worked in the ambulatory care pharmacy practice. Their average experience as pharmacists was 21.7 and 15.3 years in general practice and oncology, respectively.…”

“…The scheme of an ambulatory care pharmacy practice has already been reported previously. [6][7][8] Briefly, before examination by a urologist, patients had a 15-min face-to-face consultation with a pharmacist in the oncology pharmacy, where the pharmacist evaluated: (1) adherence to pazopanib through patient interviews (patients' self-report based on residual medication tablet counts); (2) any AEs and their grades in accordance with the National Cancer Institute Common Terminology Criteria for Adverse Events (CTC AE) version 5.0; (3) whether the patient could take appropriate medication for supportive care; (4) any modifications to concurrent medications or supplements from the perspective of drug-drug interactions. The pharmacists then informed the urologists of their findings (evaluations and suggestions) primarily by reporting in the electronic medical record (EMR) system or by phone call if needed.…”

“…We established an ambulatory care pharmacy practice in October 2016 that enables pharmacist-urologist collaboration for the treatment of patients with urologic cancer taking oral anti-cancer medications, such as pazopanib. 6) Pharmacists meet patients, provide education, evaluate AEs and medication adherence in each patient, and suggest urologists with prescription recommendations based on the medical needs of each patient. [6][7][8] To date, only few studies have shown the prolongation of treatment duration following pharmacist interventions in patients with cancer receiving molecular targeting agents.…”

“…6) Pharmacists meet patients, provide education, evaluate AEs and medication adherence in each patient, and suggest urologists with prescription recommendations based on the medical needs of each patient. [6][7][8] To date, only few studies have shown the prolongation of treatment duration following pharmacist interventions in patients with cancer receiving molecular targeting agents. 9,10) Todo et al implemented a comprehensive pharmaceutical care strategy for metastatic RCC outpatients treated with pazopanib, and evaluated the usefulness of the collaborative management.…”