In outpatient breast cancer clinics, oral chemotherapies are becoming more common as a treatment method for various malignancies. Yet, the hematologic (eg neutropenia) and non-hematologic (eg diarrhea) toxicities that patients experience while taking these oral chemotherapies can cause increased clinic visits, delays in treatment, and non-adherence to treatment, according to a poster presented by Jasmine Patel, PharmD, PGY-2 hematology/oncology pharmacy resident from Boston Medical Center, at HOPA Ahead 2020.

Patel explained that these adverse events (AEs) emphasize the need for pharmacists to conduct further monitoring, follow-ups, and management of these patients. Patel added that such efforts could be supported with adherence counseling, toxicity management, care coordination, and optimization of dosing schedules and regimens. 

In the study, the primary objective was to lessen the median number of days in treatment delay during the initial 6 cycles of treatment. This was achieved through pharmacist clinic visits that were conducted with the participation of breast oncologists and practitioners. 

All the patients in the study who started on treatment with palbociclib, ribociclib, abemaciclib, capecitabine, everolimus, lapatinib, neratinib, olaparib, talazoparib, or alpelisib received counseling from their pharmacist on their initial clinic visit. The pharmacists then managed the receipt of therapy for the patient, which included completing prior authorization (PA) and co-pay assistance coordination, providing dosing calendars to support adherence, and ordering prophylactic supportive medications to prevent toxicity. Following this, pharmacists then scheduled monthly follow-up visits either in-person or over the phone to assess the toxicity of the treatment.

At each in-person follow-up visit, pharmacists conducted thorough medication reconciliation, recorded dates of concomitant breast cancer therapy, provided dosing and supportive care recommendations, and documented all visits in the patients’ electronic medical record.

The study also assessed outcomes such as days of therapy missed due to unscheduled days off, amount of dose modifications performed, qualification of identified barriers to adherence, and quantification of pharmacist interventions aimed at increasing patient adherence and decreasing treatment delays. The pharmacist interventions observed among these outcomes included co-pay assistance, PAs, coordination of patient visits with laboratory personnel and patient navigators, and the identification and management of treatment toxicity.

Following the study period, Patel explained that patients and providers would also be qualitatively surveyed in order to ascertain their level of satisfaction in the pharmacist management. 

Since the study has not yet been completed, Patel expects it will present the optimization of treatment through the reduction of the median number of treatment delays, the expansion of the pharmacist’s role in the clinic, and the improvement of patient and provider satisfaction with pharmacist management. 

Patel also expects the conclusions from her study to address changes in clinic flow and practice, impact on patient outcomes, and future possibilities for implementation of the protocol. Since breast cancer patients are at a greater risk of adherence issues and treatment toxicities, which require closer monitoring and follow-ups, Patel expects pharmacist appointments to effectively support more access to the care these patients need.

REFERENCE
Patel J. Impact of Pharmacist Management of Patients Receiving Oral Chemotherapy in an Outpatient Breast Cancer Clinic. Paper presented at: HOPA’s 16th Annual Conference; March 12, 2020; virtual. eventscribe.com/2020/HOPAahead/PosterTitles.asp?pfp=PosterTitles. Accessed May 8, 2020.