Practice Pearl 2: Patient Adherence to PARP Inhibitors in Ovarian Cancer


Dr Sarah Hayward leads the discussion on optimal approaches to influence patient compliance to PARP inhibitor therapy for frontline maintenance in ovarian cancer.

Jennifer MacDonald, PharmD, BCOP: Let’s talk a little about adherence with patients. Obviously we do it a lot as pharmacists in the education. I feel like there’s a whole spiel for me in the beginning about, “It’s an oral chemotherapy. Here’s how you handle it and how you dispose of it,” and those types of pieces. Sarah, what things do you recommend to help patients stay adherent to these medications? With the benefit that we’ve seen, we’re really trying to keep women on the therapy and maintaining them through it.

Sarah Hayward, PharmD, BCOP: Absolutely. You can give it to them, but if they don’t take it, what good does it do you? You have to set them up for success from the beginning, and that’s proper education, proper expectations, and proper supportive care medications. I vary it patient to patient. For instance, I give something to help combat nausea. Niraparib [Zejula] is once daily. I have patients take it before bed. This seems to help some. I also have patients take prophylactic dosing of their ondansetron or prochlorperazine, whatever it may be, 30 to 60 minutes prior, just at the beginning to keep that stuff at bay. I make sure they know constipation and diarrhea are things that can crop up. Constipation is something that you can already plan for. You need to be drinking more water, maybe add fiber, maybe start a stool softener, things like that. Make sure they know the differences between OK fatigue vs unacceptable fatigue.

And then follow up. We do our best to give a phone call 2 weeks after a patient has started on their oral therapy. One of our pharmacists, whether it be me or one of the other clinical pharmacists to help us with this, will call and say, “How are you doing? How’s it going?” Reinforce some of those things. Reinforce or ask the patient to reinforce to you, “How are you taking it? Are you taking it like this? Are you taking it like that?” Just to make sure that it’s going well. Because even though you tell them, “This is the number you’re going to call me at if you’re having a problem. I need to know this is going on,” some patients are reluctant to do that. I even had a patient who we found out hadn’t been taking her medication for several months and she didn’t want to tell us. She ran out and didn’t tell us she needed a refill. We got lost in the paperwork. She said, “I just felt a little better without it.” I’m like, “OK, let’s back up. What do you mean you didn’t feel good? What was going on?” She just didn’t want to talk about it for whatever reason. Doing your best is important.

Also, if you have the ability, we have our own in-house specialty pharmacy that’s really fantastic because they help keep track of some of those refills. I might get an email like, “Miss Smith’s behind on her refills.”

Jennifer MacDonald, PharmD, BCOP: That’s where I feel like URAC is so great. You might realize, “Oh, someone is reaching out. They haven’t filled in forever.”

Sarah Hayward, PharmD, BCOP: And so you can follow up, “Miss Smith, are you taking it? Are you OK? Are you not taking it appropriately?” There are a lot of different ways both individually and as a team you can approach that to ensure you have good patient adherence, setting them up for success to continue therapy.

Transcript Edited for Clarity

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