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Banez MT, Atienza S, Butts A, Derba M, Dicke K, Haverstick K, Heron BB, Cimino SK, Loop MS, Hough S, Merten JA, Moore DC, Shah V, Taucher KD, Zhang JM, Mahmoudjafari Z. Oncology stewardship practice in the United States: A Hematology/Oncology Pharmacy Association national survey. J Oncol Pharm Pract 2024:10781552241265280. [PMID: 39091073 DOI: 10.1177/10781552241265280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2024]
Abstract
INTRODUCTION The treatment of cancer is associated with high risk for toxicity and high cost. Strategies to enhance the value, quality, and safety of cancer care are often managed independently of one another. Oncology stewardship is a potential framework to unify these efforts and enhance outcomes. This landscape survey establishes baseline information on oncology stewardship in the United States. METHODS The Hematology/Oncology Pharmacy Association (HOPA) distributed a 38-item survey composed of demographic, institutional, clinical decision-making, support staff, metrics, and technology sections to 675 HOPA members between 9 September 2022 and 9 October 2022. RESULTS Most organizations (78%) have adopted general pharmacy stewardship practices; however, only 31% reported having established a formalized oncology stewardship team. More than 70% of respondents reported implementation of biosimilars, formulary management, and dose rounding as oncology stewardship initiatives in both inpatient and outpatient settings. Frequently cited barriers to oncology stewardship included lack of clinical pharmacist availability (74%), lack of oncology stewardship training (62%), lack of physician/provider buy-in (32%), and lack of cost-saving metrics (33%). Only 6.6% of survey respondents reported their organization had defined "value in oncology." Lack of a formalized stewardship program was most often cited (77%) as the rationale for not defining value. CONCLUSIONS Less than one-third of respondents have established oncology stewardship programs; however, most are providing oncology stewardship practices. This manuscript serves as a call to action for stakeholders to work together to formalize oncology stewardship programs that optimize value, quality, and safety for patients with cancer.
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Affiliation(s)
- Marisela Tan Banez
- Department of Pharmaceutical Services, University of California, San Francisco, California, USA
| | - Sol Atienza
- Department of Pharmacy, Advocate Health Midwest, Milwaukee, Wisconsin, USA
| | - Allison Butts
- Department of Pharmacy, UK HealthCare, Lexington, Kentucky, USA
| | - Megan Derba
- Department of Pharmacy, Eastern Maine Medical Center, Bangor, Maine, USA
| | - Katie Dicke
- Department of Pharmacy, OhioHealth, Columbus, Ohio, USA
| | - Kimberly Haverstick
- Pharmacy and Therapeutics Service Line, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Bernadette B Heron
- National Pharmacy Benefits Management, Hematology/Oncology, Department of Veterans Affairs, Hines, Illinois, USA
| | - Sarah K Cimino
- Department of Pharmaceutical Services, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Matthew Shane Loop
- Department of Health Outcomes Research and Policy, Harrison College of Pharmacy, Auburn University, Auburn, Alabama, USA
| | - Shannon Hough
- The US Oncology Network, McKesson Specialty Health, The Woodlands, Texas, USA
| | | | - Donald C Moore
- Department of Pharmacy, Atrium Health Levine Cancer Institute, Charlotte, North Carolina, USA
| | - Vishal Shah
- Department of Pharmacy, Mayo Clinic, Phoenix, Arizona, USA
| | | | - Junyu Matt Zhang
- Department of Pharmacy, University of Chicago Medical Center, Chicago, Illinois, USA
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Siegel RD, LeFebvre KB, Temin S, Evers A, Barbarotta L, Bowman RM, Chan A, Dougherty DW, Ganio M, Hunter B, Klein M, Miller TP, Mulvey TM, Ouzts A, Polovich M, Salazar-Abshire M, Stenstrup EZ, Sydenstricker CM, Tsai S, Olsen MM. Antineoplastic Therapy Administration Safety Standards for Adult and Pediatric Oncology: ASCO-ONS Standards. JCO Oncol Pract 2024:OP2400216. [PMID: 38776491 DOI: 10.1200/op.24.00216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 04/04/2024] [Indexed: 05/25/2024] Open
Abstract
PURPOSE To update the ASCO-Oncology Nursing Society (ONS) standards for antineoplastic therapy administration safety in adult and pediatric oncology and highlight current standards for antineoplastic therapy for adult and pediatric populations with various routes of administration and location. METHODS ASCO and ONS convened a multidisciplinary Expert Panel with representation of multiple organizations to conduct literature reviews and add to the standards as needed. The evidence base was combined with the opinion of the ASCO-ONS Expert Panel to develop antineoplastic safety standards and guidance. Public comments were solicited and considered in preparation of the final manuscript. RESULTS The standards presented here include clarification and expansion of existing standards to include home administration and other changes in processes of ordering, preparing, and administering antineoplastic therapy; the advent of immune effector cellular therapy; the importance of social determinants of health; fertility preservation; and pregnancy avoidance. In addition, the standards have added a fourth verification. STANDARDS Standards are provided for which health care organizations and those involved in all aspects of patient care can safely deliver antineoplastic therapy, increase the quality of care, and reduce medical errors.Additional information is available at www.asco.org/standards and www.ons.org/onf.
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Affiliation(s)
| | | | - Sarah Temin
- American Society of Clinical Oncology (ASCO), Alexandria, VA
| | - Amy Evers
- University of Pennsylvania Health System, Philadelphia, PA
| | - Lisa Barbarotta
- Smilow Cancer Hospital and Yale Cancer Center, New Haven, CT
| | - Ronda M Bowman
- American Society of Clinical Oncology (ASCO), Alexandria, VA
| | - Alexandre Chan
- University of California, Irvine, Chao Family Comprehensive Cancer Center, National Cancer Centre Singapore, Irvine, CA
| | | | - Michael Ganio
- ASHP (American Society of Health-System Pharmacists), Bethesda, MD
| | | | - Meredith Klein
- American Society of Clinical Oncology (ASCO), Alexandria, VA
| | - Tamara P Miller
- Emory University/Children's Healthcare of Atlanta, Atlanta, GA
| | | | | | | | - Maritza Salazar-Abshire
- Department of Nursing Education, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | - Susan Tsai
- Ohio State University Comprehensive Cancer Center, Columbus, OH
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Kanter GP, Ozluk P, Chi W, Fisch MJ, Debono D, Parikh RB, Jacobson M, Bekelman JE, DeVries A. Cancer Treatment Before and After Physician-Pharmacy Integration. JAMA Netw Open 2024; 7:e2412998. [PMID: 38780938 PMCID: PMC11117080 DOI: 10.1001/jamanetworkopen.2024.12998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 03/22/2024] [Indexed: 05/25/2024] Open
Abstract
Importance Integration of pharmacies with physician practices, also known as medically integrated dispensing, is increasing in oncology. However, little is known about how this integration affects drug use, expenditures, medication adherence, or time to treatment initiation. Objective To examine the association of physician-pharmacy integration with oral oncology drug expenditures, use, and patient-centered measures. Design, Setting, and Participants This cohort study used claims data from a large commercial insurer in the US to analyze changes in outcome measures among patients treated by pharmacy-integrating vs nonintegrating community oncologists in 14 states between January 1, 2011, and December 31, 2019. Commercially insured patients were aged 18 to 64 years with 1 of the following advanced-stage diagnoses: breast cancer, colorectal cancer, kidney cancer, lung cancer, melanoma, or prostate cancer. Data analysis was conducted from May 2023 to March 2024. Exposure Treatment by a pharmacy-integrating oncologist, ascertained by the presence of an on-site pharmacy or nonpharmacy dispensing site. Main Outcomes and Measures Oral, intravenous (IV), total, and out-of-pocket drug expenditures for a 6-month episode of care; share of patients prescribed oral drugs; days' supply of oral drugs; medication adherence measured by proportion of days covered; and time to treatment initiation. The association between an oncologist's pharmacy integration and each outcome of interest was estimated using the difference-in-differences estimator. Results Between 2012 and 2019, 3159 oncologists (745 females [27.1%], 2002 males [72.9%]) treated 23 968 patients (66.4% female; 53.4% aged 55-64 years). Of the 3159 oncologists, 578 (18.3%) worked in practices that integrated with pharmacies (with a low rate in 2011 of 0% and a high rate in 2019 of 31.5%). In the full sample (including all cancer sites), after physician-pharmacy integration, no significant changes were found in oral drug expenditures, IV drug expenditures, or total drug expenditures. There was, however, an increase in days' supply of oral drugs (5.96 days; 95% CI, 0.64-11.28 days; P = .001). There were no significant changes in out-of-pocket expenditures, medication adherence, or time to treatment initiation of oral drugs. In the breast cancer sample, there was an increase in oral drug expenditures ($244; 95% CI, $41-$446; P = .02) and a decrease in IV drug expenditures (-$4187; 95% CI, -$8293 to -$80; P = .05). Conclusions and Relevance Results of this cohort study indicated that the integration of oncology practices with pharmacies was not associated with significant changes in expenditures or clear patient-centered benefits.
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Affiliation(s)
- Genevieve P. Kanter
- Department of Health Policy and Management, Sol Price School of Public Policy, University of Southern California, Los Angeles
- Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles
| | | | - Winnie Chi
- Elevance Health Inc, Indianapolis, Indiana
| | | | - David Debono
- Carelon Medical Benefits Management, Chicago, Illinois
| | - Ravi B. Parikh
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Penn Center for Cancer Care Innovation, Abramson Cancer Center, University of Pennsylvania, Philadelphia
- Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania
| | - Mireille Jacobson
- Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles
| | - Justin E. Bekelman
- Penn Center for Cancer Care Innovation, Abramson Cancer Center, University of Pennsylvania, Philadelphia
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia
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Kakani P, Cutler DM, Rosenthal MB, Keating NL. Trends in Integration Between Physician Organizations and Pharmacies for Self-Administered Drugs. JAMA Netw Open 2024; 7:e2356592. [PMID: 38373001 PMCID: PMC10877451 DOI: 10.1001/jamanetworkopen.2023.56592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 12/27/2023] [Indexed: 02/20/2024] Open
Abstract
Importance Increasing integration across medical services may have important implications for health care quality and spending. One major but poorly understood dimension of integration is between physician organizations and pharmacies for self-administered drugs or in-house pharmacies. Objective To describe trends in the use of in-house pharmacies, associated physician organization characteristics, and associated drug prices. Design, Setting, and Participants A cross-sectional study was conducted from calendar years 2011 to 2019. Participants included 20% of beneficiaries enrolled in fee-for-service Medicare Parts A, B, and D. Data analysis was performed from September 15, 2020, to December 20, 2023. Exposures Prescriptions filled by in-house pharmacies. Main Outcomes and Measures The share of Medicare Part D spending filled by in-house pharmacies by drug class, costliness, and specialty was evaluated. Growth in the number of physician organizations and physicians in organizations with in-house pharmacies was measured in 5 specialties: medical oncology, urology, infectious disease, gastroenterology, and rheumatology. Characteristics of physician organizations with in-house pharmacies and drug prices at in-house vs other pharmacies are described. Results Among 8 020 652 patients (median age, 72 [IQR, 66-81] years; 4 570 114 [57.0%] women), there was substantial growth in the share of Medicare Part D spending on high-cost drugs filled at in-house pharmacies from 2011 to 2019, including oral anticancer treatments (from 10% to 34%), antivirals (from 12% to 20%), and immunosuppressants (from 2% to 9%). By 2019, 63% of medical oncologists, 20% of urologists, 29% of infectious disease specialists, 21% of gastroenterologists, and 22% of rheumatologists were in organizations with specialty-relevant in-house pharmacies. Larger organizations had a greater likelihood of having an in-house pharmacy (0.75 percentage point increase [95% CI, 0.56-0.94] per each additional physician), as did organizations owning hospitals enrolled in the 340B Drug Discount Program (10.91 percentage point increased likelihood [95% CI, 6.33-15.48]). Point-of-sale prices for high-cost drugs were 1.76% [95% CI, 1.66%-1.87%] lower at in-house vs other pharmacies. Conclusions and Relevance In this cross-sectional study of physician organization-operated pharmacies, in-house pharmacies were increasingly used from 2011 to 2019, especially for high-cost drugs, potentially associated with organizations' financial incentives. In-house pharmacies offered high-cost drugs at lower prices, in contrast to findings of integration in other contexts, but their growth highlights a need to understand implications for patient care.
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Affiliation(s)
- Pragya Kakani
- Department of Population Health Sciences, Weill Cornell Medical College, New York, New York
| | - David M. Cutler
- Department of Economics, Harvard University, Cambridge, Massachusetts
- National Bureau of Economic Research, Cambridge, Massachusetts
| | - Meredith B. Rosenthal
- Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Nancy L. Keating
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
- Division of General Internal Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
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Kenis I, Kinnaer LM, Van Hecke A, Foulon V. How patient-centered is education and counseling of patients treated with oral anticancer drugs? A multicenter cross-sectional study. PATIENT EDUCATION AND COUNSELING 2023; 115:107927. [PMID: 37556896 DOI: 10.1016/j.pec.2023.107927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 07/26/2023] [Accepted: 07/28/2023] [Indexed: 08/11/2023]
Abstract
OBJECTIVE In this multicenter cross-sectional study, the quality of patient-centered education and counseling for patients treated with oral anticancer drugs was examined. METHODS The CONTACT-Patient-Centered Care Questionnaire was administered to 266 patients, recruited in 11 Flemish hospitals. The questionnaire consists of 80 items, each evaluating the degree of performance of a key element in patient-centered education and counseling. RESULTS In total, 15 key elements were seriously underperformed (degree of performance < 50%). Elements regarding adherence monitoring, specific topics in patient education, and involvement of the community pharmacist and home care nurse received a very low score. Only six key elements were systematically performed (degree of performance ≥ 90%), among which the elements on communication style and involvement of the general practitioner. CONCLUSION This study uncovered three major gaps in patient-centered education and counseling of patients on oral anticancer drugs: unmet patient information needs due to shortcomings in patient education, inadequate adherence monitoring, and lacking collaboration with community pharmacists and home care nurses. PRACTICE IMPLICATIONS This study highlights the need for interdisciplinary and patient-centered education and counseling of patients using OACD, including all key stakeholders: physicians, nurses, hospital pharmacists, general practitioners, community pharmacist and home care nurses.
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Affiliation(s)
- Ilyse Kenis
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium; Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.
| | - Lise-Marie Kinnaer
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Ann Van Hecke
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium; Department of Nursing Director, Ghent University Hospital, Ghent, Belgium
| | - Veerle Foulon
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
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Kenis I, Kinnaer LM, Delombaerde C, Van Rompay V, Van Vlierberghe M, Foulon V, Van Hecke A. A self-directed co-creation process for developing a care pathway for patients on oral anticancer therapy: A qualitative process evaluation. Eur J Oncol Nurs 2023; 65:102353. [PMID: 37321129 DOI: 10.1016/j.ejon.2023.102353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 05/16/2023] [Accepted: 05/21/2023] [Indexed: 06/17/2023]
Abstract
PURPOSE To provide in-depth insight in stakeholders' experiences with the self-directed co-creation of a care pathway for patients treated with oral anticancer drugs, and to identify influencing factors for the success of the co-creation process that are persistent throughout the prior pilot phase and the scale-up phase. METHODS This qualitative process evaluation was performed in 11 Belgian oncology departments participating in a scale-up project. Semi-structured interviews with local coordinators (n = 13) and members of the project teams (n = 19), responsible for the co-creation of the care pathway, were conducted. Data were thematically analyzed. RESULTS Despite the external support (including group-level coaching and the use of well-defined supportive tools) to promote self-directedness, the co-creation process was perceived burdensome. Three influencing factors were persistent throughout the pilot and scale-up phase: a) shared leadership among the coordinator, physician and hospital management, b) an intrinsically motivated team driven by additional extrinsic factors, and c) a balance between external support and self-directedness. CONCLUSION This study shows that the self-directed co-creation of a care pathway is feasible on the condition that important prerequisites are met, including shared leadership and team motivation. More concrete tools, such as a model care pathway, seem needed to increase feasibility of the self-directed co-creation of the care pathway. Yet, these tools should allow tailoring to the specific hospital context. The findings of this study can be useful for further scale-up to other oncology centers, but can also be extrapolated to other healthcare settings.
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Affiliation(s)
- Ilyse Kenis
- Department of Pharmaceutical and Pharmacological Sciences, Clinical Pharmacology and Pharmacotherapy, KU Leuven, Leuven, Belgium; Department of Public Health and Primary Care, University Centre for Nursing and Midwifery, Ghent University, Ghent, Belgium.
| | - Lise-Marie Kinnaer
- Department of Public Health and Primary Care, University Centre for Nursing and Midwifery, Ghent University, Ghent, Belgium
| | | | | | | | - Veerle Foulon
- Department of Pharmaceutical and Pharmacological Sciences, Clinical Pharmacology and Pharmacotherapy, KU Leuven, Leuven, Belgium
| | - Ann Van Hecke
- Department of Public Health and Primary Care, University Centre for Nursing and Midwifery, Ghent University, Ghent, Belgium; Ghent University Hospital, Ghent, Belgium
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Kanter GP, Parikh RB, Fisch MJ, Debono D, Bekelman J, Xu Y, Schauder S, Sylwestrzak G, Barron JJ, Cobb R, Qato DM, Jacobson M. Trends in Medically Integrated Dispensing Among Oncology Practices. JCO Oncol Pract 2022; 18:e1672-e1682. [PMID: 35830621 PMCID: PMC9835967 DOI: 10.1200/op.22.00136] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 04/21/2022] [Accepted: 06/15/2022] [Indexed: 01/16/2023] Open
Abstract
PURPOSE The integration of pharmacies with oncology practices-known as medically integrated dispensing or in-office dispensing-could improve care coordination but may incentivize overprescribing or inappropriate prescribing. Because little is known about this emerging phenomenon, we analyzed historical trends in medically integrated dispensing. METHODS Annual IQVIA data on oncologists were linked to 2010-2019 National Council for Prescription Drug Programs pharmacy data; data on commercially insured patients diagnosed with any of six common cancer types; and summary data on providers' Medicare billing. We calculated the national prevalence of medically integrated dispensing among community and hospital-based oncologists. We also analyzed the characteristics of the oncologists and patients affected by this care model. RESULTS Between 2010 and 2019, the percentage of oncologists in practices with medically integrated dispensing increased from 12.8% to 32.1%. The share of community oncologists in dispensing practices increased from 7.6% to 28.3%, whereas the share of hospital-based oncologists in dispensing practices increased from 18.3% to 33.4%. Rates of medically integrated dispensing varied considerably across states. Oncologists who dispensed had higher patient volumes (P < .001) and a smaller share of Medicare beneficiaries (P < .001) than physicians who did not dispense. Patients treated by dispensing oncologists had higher risk and comorbidity scores (P < .001) and lived in areas with a higher % Black population (P < .001) than patients treated by nondispensing oncologists. CONCLUSION Medically integrated dispensing has increased significantly among oncology practices over the past 10 years. The reach, clinical impact, and economic implications of medically integrated dispensing should be evaluated on an ongoing basis.
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Affiliation(s)
- Genevieve P. Kanter
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA
- Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA
| | - Ravi B. Parikh
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA
- Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | | | | | - Justin Bekelman
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA
- Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Yao Xu
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | | | | | | | | | - Dima M. Qato
- Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA
- Program on Medicines and Public Health, School of Pharmacy, University of Southern California, Los Angeles, CA
| | - Mireille Jacobson
- Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA
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Sun Y, Hendrix A, Muluneh B, Ozawa S. Online Pharmacy Accessibility of Imatinib, An Oral Chemotherapy Medication. J Natl Compr Canc Netw 2022; 20:808-814. [PMID: 35830891 DOI: 10.6004/jnccn.2022.7007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 01/24/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Since prices of imatinib (Gleevec) remain high, patients on oral chemotherapy are looking for alternative methods to access this life-saving medication. We assessed the accessibility of imatinib through online pharmacies and analyzed each website for medication safety, price, and marketing tactics. METHODS We searched the term "buy imatinib online" using 4 commonly used internet search engines (Google, Bing, Yahoo!, and DuckDuckGo) and screened web pages displayed in the first 10 pages. Websites were included if they were published in English, sold imatinib, were free to access, and offered shipping in the United States. Websites were classified using LegitScript's categorization as "certified," "unclassified," "unapproved," or "rogue." We analyzed information on websites' patient safety characteristics, marketing techniques, pricing, domain registration information, and IP addresses. RESULTS Of the 44 online pharmacies identified, only 3 (7%) were certified, and the remainder were classified as rogue (52%; n=23), unapproved (30%; n=13), or unclassified (11%; n=5). Thirteen online pharmacies (30%; 9 rogue, 4 unclassified) sold imatinib without a prescription. Nearly one-quarter (n=10) of online pharmacies selling imatinib did not include drug-related warnings on their websites, and nearly half (n=21) did not limit the purchasable quantity. More than three-quarters (n=34) of online pharmacies selling imatinib did not offer pharmacist consultations, even though nearly all websites extended offers to speak with sales associates (91%; n=40). Most online pharmacies selling imatinib claimed price discounts (95%; n=42), but fewer provided bulk discounts (23%; n=10) or coupons (34%; n=15). One-third of rogue pharmacies selling imatinib (n=7) claimed to be registered or accredited on their websites. CONCLUSIONS The lack of safety measures taken by illegitimate online pharmacies endangers patient safety because they allow patients to purchase imatinib without appropriate evaluation for response, drug interactions, and adverse effects. Healthcare providers need to be aware of this practice and should assure patient access to imatinib through safe and legitimate pharmacies.
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Affiliation(s)
- Yujiao Sun
- Division of Practice Advancement and Clinical Education, and
| | - Adam Hendrix
- Division of Practice Advancement and Clinical Education, and
| | - Benyam Muluneh
- Division of Pharmacotherapy and Experimental Therapeutics, UNC Eshelman School of Pharmacy, University of North Carolina, and
| | - Sachiko Ozawa
- Division of Practice Advancement and Clinical Education, and.,Department of Maternal Child Health, UNC Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
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Marineau A, St-Pierre C, Lessard-Hurtubise R, David MÈ, Adam JP, Chabot I. Cyclin-dependent kinase 4/6 inhibitor treatment use in women treated for advanced breast cancer: Integrating ASCO/NCODA patient-centered standards in a community pharmacy. J Oncol Pharm Pract 2022:10781552221102884. [PMID: 35642282 DOI: 10.1177/10781552221102884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Outpatients treated with oral anti-cancer drugs, including selective cyclin-dependent kinase 4/6 inhibitors (CDK4/6i), may benefit from a pharmacy practice setting adapted to support proper oral anti-cancer drug monitoring. This real-world study aimed to characterize patient-centered pharmacy practice aligned with American Society of Clinical Oncology (ASCO)/National Community Oncology Dispensing Association (NCODA) standards and to describe its impact on CDK4/6i treatment use. METHODS This retrospective study included women with confirmed hormone receptor-positive/human epidermal growth factor 2 negative locally advanced or metastatic breast cancer treated with either palbociclib, abemaciclib or ribociclib combined with letrozole or fulvestrant. Pharmacists collected patient characteristics, clinical activities, and treatment patterns using data from the pharmacy chart. CDK4/6i treatment adherence rates were estimated based on medication claims data. Time-to-treatment discontinuation, a proxy for time-to-event, was assessed using the Kaplan-Meier estimate. RESULTS Of the 195 patients assessed for eligibility, 65 were included in this study. The median observation duration was 13.6 months. An average of seven pharmaceutical care activities (range 2.8-21.7) per patient was documented for each treatment cycle. The mean proportion of days covered was 89.6%. The median time-to-treatment discontinuation was estimated at 44.2 months in patients treated with CDK4/6i + letrozole and 17.0 months in patients treated with CDK4/6i + fulvestrant. The average relative dose intensity was 85%, and the benefits of treatment were maintained regardless of the relative dose intensity levels. CONCLUSION A structured patient-centered pharmacy practice model integrating the ASCO/NCODA patient-centered standards and ongoing communication with patients and healthcare providers ensure timely refills, close monitoring, and allows patients to achieve high adherence and persistence rates comparable to those reported in clinical trials.
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Affiliation(s)
| | | | | | | | - Jean-Philippe Adam
- Department of Pharmacy, Centre hospitalier de l'Université de Montréal, Montréal, Canada.,CHUM Research Center, CHUM, Montréal, Canada
| | - Isabelle Chabot
- Faculty of Pharmacy, Université de Montréal, Montréal, Canada
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10
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Darling JO, Starkey AJ, Nubla JJ, Reff MJ. Financial Impact of Medically Integrated Pharmacy Interventions on Oral Oncolytic Prescriptions. JCO Oncol Pract 2022; 18:e1225-e1230. [PMID: 35561289 PMCID: PMC9287285 DOI: 10.1200/op.22.00022] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE: As the utilization of oral cancer medications rises, it is vital that cancer centers track costs associated with these expensive medications. This research seeks to report the cost interventions associated with medically integrated pharmacies (MIPs) and mail-order pharmacies. METHODS: Data collection occurred from October 2016 through May 2021. Volunteers input data from their oncology practice into NCODA's Cost Avoidance and Waste Tracker tool, an innovative easy-to use tool that allows practices to document any cost saving interventions or waste occurrences. RESULTS: The Cost Avoidance and Waste Tracker tool was used by nearly 50 MIPs across the country. Specifically, 26 practices submitted cost avoidance data, and 37 practices tracked waste associated with oral oncolytic therapy. Among the 26 practices, 677 cost avoidance events led to a total cost avoidance of $7,057,053.73 US dollars (USD). The net cost avoidance for the MIP's was $6,510,971.28 USD compared with $546,082.45 USD for the external mail-order pharmacies. Among the 37 practices that reported waste, 768 events were reported, leading to a total drug waste of $11,275,642.16 USD. Of that, $8,935,612.15 USD was attributed waste from external mail-order pharmacies, whereas $2,429,592.01 USD worth of drug waste was reported from MIPs. CONCLUSION: Medically integrated dispensing of oral oncolytic therapies allows for increased pharmacy oversight, leading to increased cost avoidance and reduced waste for patients and third-party payers. Although these data are difficult to compare because of the complexity of workflows at different dispensing sites, the real-world financial differences between medically integrated dispensing and mail-order pharmacies appear to be significant. NCODA's CAWT tool was used by nearly 50 medically integrated practices across the country; specifically, 26 practices submitted cost avoidance data, and 37 practices used the tool to track waste associated with oral oncolytic therapy. 677 cost avoidance events across the 26 practices led to a total cost avoidance of $7,057,053.73 USD, and 768 reported waste events across the 37 practices led to a total drug waste calculation totaling $11,275,642.16 USD.![]()
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Borrelli EP, McGladrigan CG. Five Year Analysis Assessing the Trend in Prescribing and Expenditures of Oral Oncolytics for Medicare Part D: 2013-2017. J Pharm Pract 2021; 35:580-586. [PMID: 33722080 DOI: 10.1177/08971900211000208] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Oral oncolytics are becoming a mainstay in oncology, representing first-line therapies for numerous different malignancies. In addition, the cost of oncology drugs has increased dramatically in recent years. Given the increasing number of oral oncolytics available, as well as the increase in medication costs in recent years, it is important to assess the trend in prescriptions and expenditures of these agents. METHODS A descriptive retrospective analysis of the Medicare Part D Provider Utilization and Payment Data Public Use File (PUF) was conducted for the years 2013 through 2017. Outcomes of interest included total aggregate prescriptions per year, total aggregate expenditures per year, mean expenditure per prescription per year, and mean expenditure per standardized 30-day prescription per year. Chi-square tests were conducted to assess statistical significance of differences in proportions of prescriptions as well as expenditures between 2013 and 2017. RESULTS The number of prescriptions for oral oncolytics dispensed to Medicare Part D beneficiaries increased from 7,017,902 in 2013 to 8,164,883 in 2017. Medicare Part D expenditures for oral oncolytics increased greater than 2.5-fold from $5,631,224,307 in 2013 to $14,422,681,331 in 2017 after adjusting for inflation. The mean expenditure per prescription for oral oncolytics increased from $802 in 2013 to $1,766 in 2017. CONCLUSIONS This study found oral oncolytic utilization has been increasing in recent years with a slight, but statistically significant increase in the proportion of oncolytics for all Medicare prescriptions from 2013 through 2017.
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Affiliation(s)
- Eric P Borrelli
- University of Rhode Island College of Pharmacy, Kingston, RI, USA
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12
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Kaptein AA, Schoones JW, van der Meer PB, Matsuda A, Murray M, Heimans L, Kroep JR. Psychosocial determinants of adherence with oral anticancer treatment: 'we don't need no education'. Acta Oncol 2021; 60:87-95. [PMID: 33151764 DOI: 10.1080/0284186x.2020.1843190] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Given the potentially fatal consequences of inadequate adherence with oral anticancer treatment in persons with cancer, understanding the determinants of adherence is vital. This paper aims at identifying psychosocial determinants of adherence to oral anticancer treatment. METHODS We reviewed the literature on psychosocial determinants of adherence with oral anticancer treatment, based on published literature in English, from 2015 to present. Literature searches were performed in PubMed, Embase, Web of Science, Cochrane library, Emcare, and PsychINFO, with 'cancer', 'medication adherence', 'psychology', and 'oral anticancer treatment' as search terms. The obtained 608 papers were screened by two independent reviewers. RESULTS In the 25 studies identified, illness perceptions, medication beliefs, health beliefs, and depression were found to be the major psychosocial determinants of adherence to oral anticancer treatment; sociodemographic and clinical characteristics were found to be of no major importance. The quality of the identified studies as assessed by two independent reviewers was found to be acceptable overall. The majority of papers were from North America and focused on patients with breast cancer; sample size varied from 13 to 1371; adherence was assessed with questionnaires derived from various theoretical models, pill counts and electronic pharmacy records; illness perceptions reflecting adaptive coping, and medication beliefs reflecting high necessity and low concerns were found to be associated with adherence. CONCLUSION Psychosocial concepts are major determinants of adherence with oral anticancer treatment. 'Beliefs about medicines' and 'illness perceptions' in particular determine adherence with this treatment. Studies aiming at impacting adherence would benefit from interventions with a solid basis in behavioral theory in order to help health care providers explore and address illness perceptions and medication beliefs. Pre-consultation screening of adherence behavior may be a helpful supportive approach to improve adherence. Blaming the victim ('patients should be educated about the importance of adherence') is better replaced by encouraging health professionals to identify and address maladaptive psychosocial determinants of adherence.
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Affiliation(s)
- Adrian A. Kaptein
- Department of Medical Psychology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jan W. Schoones
- Walaeus Library, Leiden University Medical Center, Leiden, The Netherlands
| | - Pim B. van der Meer
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - Ayako Matsuda
- Department of Hygiene and Public Health, School of Medicine, Teikyo University, Tokyo, Japan
| | - Michael Murray
- School of Psychology, Keele University, Newcastle-under-Lyme, UK
| | - Lotte Heimans
- Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Judith R. Kroep
- Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands
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Stanz L, Ulbrich T, Yucebay F, Kennerly-Shah J. Development and Implementation of an Oral Oncology Drug Repository Program. JCO Oncol Pract 2020; 17:e426-e432. [PMID: 33186084 DOI: 10.1200/op.20.00513] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Because of high costs associated with oral oncology drugs, patients are often unable to afford their medications. Developing and implementing an oral oncology drug repository program can provide cost savings and waste reduction opportunities to oncology patients and health care systems. METHODS Strategies to implement an oral oncology drug repository program include the following: (1) define patient eligibility requirements for the collected drug, (2) ensure patients have long-term availability to preferred treatment, (3) identify optimal oral oncology drugs to use, (4) provide safe drug collection with protocol, (5) calculate the amount of resources needed to provide services, (6) obtain adequate space to operate safely and efficiently, (7) establish safe disposal of the drug deemed inappropriate for use, and (8) spread awareness to prospective patient participants. RESULTS To date, The Ohio State University Wexner Medical Center oral oncology drug repository program has received 11 drug collections and has redispensed drugs several times. With additional resources, the plan is to expand the repository program's scope to include other drugs and reach more patients. CONCLUSION Developing and implementing an oral oncology drug repository program for patients was logistically feasible due to strategic planning with many early successes. As national attention continues to be placed on reducing oral oncology drug costs, additional research is needed regarding strategies to best incorporate pharmacy services into innovative patient care opportunities.
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Affiliation(s)
- Lauren Stanz
- Ohio State University Wexner Medical Center, Columbus, OH
| | - Tim Ulbrich
- Ohio State University College of Pharmacy, Columbus, OH
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14
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Pardhan A, Vu K, Gallo-Hershberg D, Forbes L, Gavura S, Kukreti V. Evolving Best Practice for Take-Home Cancer Drugs. JCO Oncol Pract 2020; 17:e526-e536. [PMID: 33079644 DOI: 10.1200/op.20.00448] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Take-home cancer drugs (THCDs) have become a standard treatment of many cancers. Robust guidelines have been developed for intravenous chemotherapy drugs, but few exist for THCDs with a focus on decentralized models. Hence, Ontario Health (Cancer Care Ontario) established the Oncology Pharmacy Task Force (OPTF) to develop consensus-based recommendations on best practices for THCDs to ensure that patients receive safe, consistent, high-quality care in the community once they leave the cancer center/practice with a prescription. METHODS The OPTF included 34 members with comprehensive representation. Guidance from leading authorities was extracted through literature review, thematically analyzed, and synthesized to develop 29 recommendations. The consensus process (> 70% agreement) included a three-step modified Delphi method followed by an extensive review process. RESULTS Sixteen recommendations were developed: training and education for providers (2), drug access (1), prescribing (4), patient and family/caregiver education (3), communication (1), dispensing (3), monitoring for patient adherence and adverse effects (1), and incident reporting (1). CONCLUSION Through a rigorous methodology, the OPTF derived a robust set of recommendations similar to the ASCO/Oncology Nursing Society and ASCO/National Community Oncology Dispensing Association guidelines, further validating and strengthening the applicability across multiple jurisdictions, including those with decentralized models. Unique aspects in a decentralized model include the need for two pharmacy professionals, with one doing cognitive verification of the script and the other dispensing the medication; moreover, they optimize interprofessional communication between community providers and the cancer center/practice health care team.
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Affiliation(s)
- Aliya Pardhan
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada
| | - Kathy Vu
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada.,Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Daniela Gallo-Hershberg
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada.,Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Leta Forbes
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada.,Lakeridge Health, Oshawa, Ontario, Canada
| | - Scott Gavura
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada
| | - Vishal Kukreti
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada.,Princess Margaret Cancer Centre, Toronto, Ontario, Canada
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15
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Dillmon MS, Kennedy EB, Reff M. Patient-Centered Medically Integrated Dispensing: ASCO/NCODA Standards Summary. JCO Oncol Pract 2020; 16:344-347. [PMID: 32048942 DOI: 10.1200/op.19.00668] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | - Michael Reff
- National Community Oncology Dispensing Association, Cazenovia, NY
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16
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Mirda DP. Pharmacy Benefit Managers: Do They Provide the Value Promised? JCO Oncol Pract 2020; 16:273-274. [DOI: 10.1200/op.20.00194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Perez GK, Salsman JM, Fladeboe K, Kirchhoff AC, Park ER, Rosenberg AR. Taboo Topics in Adolescent and Young Adult Oncology: Strategies for Managing Challenging but Important Conversations Central to Adolescent and Young Adult Cancer Survivorship. Am Soc Clin Oncol Educ Book 2020; 40:1-15. [PMID: 32324424 PMCID: PMC7328818 DOI: 10.1200/edbk_279787] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2023]
Abstract
Research on adolescents and young adults (AYAs) with cancer has flourished over the past decade, underscoring the unique medical and psychosocial needs of this vulnerable group. A cancer diagnosis during adolescence and young adulthood intersects with the developmental trajectory of AYAs, derailing critical physical, social, and emotional development. AYAs face these abrupt life changes needing age-appropriate information and resources to offset these challenges. Greater attention is needed to address AYA-specific concerns on reproductive and sexual health, financial security and independence, emotional well-being, social support, and end-of-life care. If these unique needs are unaddressed, this can adversely affect AYAs' health care engagement and overall quality of life, increasing their risk for cancer-related morbidity and early mortality. In particular, health care decisions made during treatment have important implications for AYA patients' future health. Oncology clinicians are well positioned to address AYA patients' concerns by anticipating and addressing the challenges this age group is likely to face. In this paper, we explore several core topics that affect AYAs' quality of life and that can be challenging to address. Starting from the moment of diagnosis, through cancer treatment and post-treatment survivorship, and into end of life, each section highlights critical developmental-centric life domains that are affected by the cancer experience. Specifically, we discuss resources, tools, and strategies to navigate these challenging conversations. Taking a risk-reduction approach that invites two-way communication and facilitates referral to age-appropriate resources would help destigmatize these experiences and, in turn, would support the provision of compassionate and effective age-concordant care to this vulnerable group.
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Affiliation(s)
- Giselle K. Perez
- Harvard Medical School/Massachusetts General Hospital, Boston, MA
- Mongan Institute Health Policy Research Center, Massachusetts General Hospital, Boston, MA
| | - John M. Salsman
- Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC
| | - Kaitlyn Fladeboe
- Seattle Children’s Research Institute, University of Washington, Seattle, WA
| | - Anne C. Kirchhoff
- Huntsman Cancer Institute and Department of Pediatrics, University of Utah, Salt Lake City, UT
| | - Elyse R. Park
- Harvard Medical School/Massachusetts General Hospital, Boston, MA
- Mongan Institute Health Policy Research Center, Massachusetts General Hospital, Boston, MA
| | - Abby R. Rosenberg
- Seattle Children’s Research Institute, University of Washington, Seattle, WA
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