A University of California, Davis, Comprehensive Cancer Center program designed to better manage cancer patients taking oral chemotherapy drugs has demonstrated that one-on-one counseling, education, and monitoring can improve adherence to therapy.
Issues in Adherence
The rise in oral chemotherapy use has heightened the need for coordinated cancer care. Oncology pharmacists and physicians worked together at UC Davis Comprehensive Cancer Center to create the Medication Adherence Pilot Program to ensure that patients stick to their regimens to safely maximize the drugs’ effectiveness and minimize or manage side effects.
Oral chemotherapy prescriptions are on the rise because many newer drugs, which target individual genes involved in tumor growth, are being developed in oral formulations, said Ted Wun, MD, a medical oncologist and Chief of the Division of Hematology and Oncology.
In addition, oral chemotherapy agents are created to allow for more continuous exposure of the drug in the patient over time, which can be more effective and may be less toxic. When oral treatment is prescribed exclusively, patients require fewer office visits and may get a greater sense of control over their treatment, Dr. Wun said.
Patients taking oral chemotherapy may experience potentially life-threatening side effects without the immediate support they need. Or, patients may stop taking the medication or not follow the directions correctly, which can affect treatment efficacy, produce misleading treatment results, and cause higher mortality.
“Patients are monitored when they’re here, but when they go home, it’s harder to monitor,” said Josephine Lai, PharmD, the cancer center’s pharmacy supervisor, who has been assessing oral chemotherapy adherence rates since 2012. “Unlike other chronic care medications, oral chemotherapy drugs can be more complicated.
Dr. Lai and colleagues in the UC Davis Departments of Pharmacy and Internal Medicine, and the Division of Hematology and Oncology launched the Cancer Center Medication Adherence Pilot Program in September 2013.
Patients enrolled in the program can make an appointment with a pharmacist or a nurse practitioner anytime they have a question about their drug regimen. Pharmacists also check in regularly each month to monitor patients’ progress, notify oncologists of any issues and offer practical tips, such as how to maintain a medication calendar or handle a missed dose.
Early indications suggest the program is working. In one assessment of 44 patients enrolled in the pilot program, 92% adhered to their drug regimens. Today, 80 patients at UC Davis Comprehensive Cancer Center are enrolled in the program. Beginning this fall, the Cancer Center will employ a full-time pharmacist dedicated to the program, offering the services to all UC Davis cancer patients. ■