SALT LAKE CITY—Identifying safety measures for patients receiving oral chemotherapy is of the upmost importance, according to a presentation at the annual meeting of the Hematology/Oncology Pharmacy Association. This includes monitoring the administration of and adherence to the treatment as well as ensuring the prevention of any medication errors.
“In my experience, patients do not think it’s the doctor’s job to educate them about their oral chemotherapy, thinking [the doctors] don’t have the time or don’t want to do that,” said Beth Chen, PharmD, BCOP, oncology clinical specialist at Biologics, Inc, in Cary, North Carolina.
In addition, she noted that patients are flooded with so much new information during an appointment that they often only remember a small portion of what they are told. It is paramount, therefore, that these patients understand exactly what their treatment entails—including how to prepare, administer, and dispose of it safely and properly.
“Having a dedicated appointment for education is really the ideal situation, and we do this by phone,” said Chen, adding that these scheduled, periodic follow-up calls should become routine. “It may not always be the pharmacist who does this but consistency with specific staff to develop a relationship with the patient is good.”
Other helpful recommendations for patients may include a simple dosing calendar, checklists of questions to ask the doctor at their next visit, and a journal to keep track of any treatment-related adverse effects. “We’re really the ones who need to be looking at drug interactions, especially with TKIs [tyrosine kinase inhibitors]. Patients are often dismissive, and physicians may not be the best people to evaluate this,” said Chen.
She noted that patients “very rarely” stop taking their medication because it is something they just want to do. Instead, it is often because the drug makes them feel worse, the cost may be too much after their initial fill, or they weren’t educated appropriately and don’t realize the seriousness of their situation. “Monitoring these situations should be proactive and not reactive.”
A recent study examined the effects of adherence to treatment with imatinib on molecular response in 87 patients with chronic myelogenous leukemia (Marin D, et al. J Clin Oncol. 2010; 28:2381-2387). For those who had an adherence rate higher than 90%, 93.7% had a major molecular response (MMR) and 43.8% had a complete molecular response (CMR). For those who had an adherence rate of 90% or less, only 13.9% had an MMR and none had a CMR. When the adherence was less than 80%, no patient achieved either an MMR or CMR.
Although Chen said that no adherence monitoring method is perfect, it’s important to “select a couple that you can use together.” Possible methods may include:
- Have patients bring in their medication, do a physical pill count, and report to the physician when there is a problem
- Closely monitor refills to check for financial barriers
- Use the microelectronic monitoring system to increase accessibility to healthcare.
Unfortunately, reports of medication errors in regard to oral chemotherapy are common. According to a 2010 study quoted by Chen that looked at 508 incidents, these errors occurred most frequently during the ordering (47.2%) and dispensing (31.1%) phases, and the most common error involved the wrong dose (38.8%). In addition, “the wrong number of days supplied accounted for 11% of errors but resulted in 39.3% of the adverse events reported.”
She recommended that ways to reduce ordering and dispensing errors include not making any verbal orders (unless it’s to hold or discontinue treatment), implementing standardized data entry and a standardized order program, using only a medication’s generic name, including orders for supportive care, implementing bar-code scanning, and setting up a multiple-checkpoint system.
“We should take what we are already doing for IV chemotherapy and translate that to oral therapy,” said Chen. Overall, “the use of oral chemotherapy increases the patient’s control but it also increases the responsibility for their cancer care.”