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Kaye DR, Wilson LE, Greiner MA, Spees LP, Pritchard JE, Zhang T, Pollack CE, George D, Scales CD, Baggett CD, Gross CP, Leapman MS, Wheeler SB, Dinan MA. Patient, provider, and hospital factors associated with oral anti-neoplastic agent initiation and adherence in older patients with metastatic renal cell carcinoma. J Geriatr Oncol 2022; 13:614-623. [PMID: 35125336 PMCID: PMC9232903 DOI: 10.1016/j.jgo.2022.01.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 12/16/2021] [Accepted: 01/13/2022] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Oral anti-neoplastic agents (OAAs) for metastatic renal cell carcinoma (mRCC) are associated with increased cancer-specific survival. However, racial disparities in survival persist and older adults have the lowest rates of cancer-specific survival. Research from other cancers demonstrates specialty access is associated with high-quality cancer care, but older adults receive cancer treatment less often than younger adults. We therefore examined whether patient, provider, and hospital characteristics were associated with OAA initiation, adherence, and cancer-specific survival after initiation and whether race, ethnicity, and/or age was associated with an increased likelihood of seeing a medical oncologist for diagnosis of mRCC. PATIENTS AND METHODS We used Surveillance, Epidemiology, and End Results (SEER)Medicare data to identify patients ≥65 years of age who were diagnosed with mRCC from 2007 to 2015 and enrolled in Medicare Part D. Insurance claims were used to identify receipt of OAAs within twelve months of metastatic diagnosis, calculate proportion of days covered, and to identify the primary cancer provider and hospital. We examined provider and hospital characteristics associated with OAA initiation, adherence, and all-cause mortality after OAA initiation. RESULTS We identified 2792 patients who met inclusion criteria. Increased OAA initiation was associated with access to a medical oncologist. Patients were less likely to begin OAA treatment if their primary oncologic provider was a urologist (hazard ratio [HR] 0.62; 95% confidence interval [CI] 0.49-0.77). Provider/hospital characteristics were not associated with differences in OAA adherence or mortality. Patients who started sorafenib (odds ratio [OR] 0.50; 95% CI 0.29-0.86), were older (aged >81 OR 0.56; 95% CI 0.34-0.92), and those living in high poverty ZIP codes (OR 0.48; 95% CI 0.29-0.80) were less likely to adhere to OAA treatment. Furthermore, provider characteristics did not account for differences in mortality once an OAA was initiated. Last, only age > 81 years was statistically and clinically associated with a decreased relative risk of seeing a medical oncologist (risk ratio [RR] 0.87; CI 0.82-0.92). CONCLUSION Provider/hospital factors, specifically, being seen by a medical oncologist for mRCC diagnosis, are associated with OAA initiation. Older patients were less likely to see a medical oncologist; however, race and/or ethnicity was not associated with differences in seeing a medical oncologist. Patient factors are more critical to OAA adherence and mortality after OAA initiation than provider/hospital factors.
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Affiliation(s)
- Deborah R Kaye
- Department of Surgery (Urology), Duke University School of Medicine, Durham, NC, United States of America; Duke-Margolis Policy Center, Duke University School of Medicine, Durham, NC, United States of America; Duke Cancer Institute, Durham, NC, United States of America
| | - Lauren E Wilson
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, United States of America
| | - Melissa A Greiner
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, United States of America
| | - Lisa P Spees
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill (UNC-CH), Chapel Hill, NC, United States of America; Lineberger Comprehensive Cancer Center, UNC-CH, Chapel Hill, NC, United States of America
| | - Jessica E Pritchard
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, United States of America
| | - Tian Zhang
- Duke Cancer Institute, Durham, NC, United States of America; Department of Medicine, Duke University School of Medicine, Durham, NC, United States of America
| | - Craig E Pollack
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Daniel George
- Duke Cancer Institute, Durham, NC, United States of America; Department of Medicine, Duke University School of Medicine, Durham, NC, United States of America
| | - Charles D Scales
- Department of Surgery (Urology), Duke University School of Medicine, Durham, NC, United States of America; Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, United States of America
| | - Chris D Baggett
- Lineberger Comprehensive Cancer Center, UNC-CH, Chapel Hill, NC, United States of America; Department of Epidemiology, Gillings School of Global Public Health, UNC-CH, Chapel Hill, NC, United States of America
| | - Cary P Gross
- Department of Medicine, Yale School of Medicine, New Haven, CT, United States of America; Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, New Haven, CT, United States of America
| | - Michael S Leapman
- Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, New Haven, CT, United States of America; Department of Urology, Yale School of Medicine, New Haven, CT, United States of America
| | - Stephanie B Wheeler
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill (UNC-CH), Chapel Hill, NC, United States of America; Lineberger Comprehensive Cancer Center, UNC-CH, Chapel Hill, NC, United States of America
| | - Michaela A Dinan
- Department of Urology, Yale School of Medicine, New Haven, CT, United States of America.
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Magalhães B, Fernandes C, Martinez-Galiano JM, Santos C. Exploring the use of Mobile applications by cancer patients undergoing chemotherapy: A scoping review. Int J Med Inform 2020; 144:104293. [PMID: 33091832 DOI: 10.1016/j.ijmedinf.2020.104293] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 08/15/2020] [Accepted: 09/30/2020] [Indexed: 11/25/2022]
Abstract
PROPOSE Advancements in mobile technology, primarily through the use of applications, may support the process of monitoring adherence to oral therapies, controlling toxicities, or providing self-care guidelines to patients undergoing chemotherapy treatment. This study aims to assemble the available knowledge regarding the use of mobile applications by cancer patients undergoing chemotherapy treatment. METHODS A literature review based on the Joanna Briggs Institute model(s) for Scoping Review was conducted. All articles published until 30 May 2019, were identified in the MEDLINE®, CINAHL®, and PsycINFO® electronic databases using the related Boolean logical operators and key terms. Extracted data included research aims, methodological design, application name, the functionalities of the applications, and major results. RESULTS A total of 26 articles were included in this study. The search identified 16 different mobile applications, some of which were addressed in various publications, demonstrating different characteristics in design, use, and development. CONCLUSION The use of mobile applications can be seen as an important and effective way to monitor adherence and support in the self-management of complications associated with chemotherapy treatments. Notwithstanding, these applications should be tested outside the academic environment, outreaching this group of people to effectively investigate its applicability, allowing the assessment of the impact of this "new" technological intervention process.
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Affiliation(s)
- Bruno Magalhães
- Portuguese Institute for Oncology of Porto (IPO-Porto), Porto, Portugal; Health School Santa Maria (ESSSM), Porto, Portugal; CINTESIS - Center for Health Technology and Services Research (NursID: Innovation and Development in Nursing), Porto, Portugal.
| | - Carla Fernandes
- CINTESIS - Center for Health Technology and Services Research (NursID: Innovation and Development in Nursing), Porto, Portugal; Nursing School of Porto (ESEP), Porto, Portugal.
| | - Juan Miguel Martinez-Galiano
- Department of Nursing, University of Jaén, Jaén, Spain; Biomedical Research Networking Center for Epidemiology and Public Health (CIBERESP), Spain.
| | - Célia Santos
- CINTESIS - Center for Health Technology and Services Research (NursID: Innovation and Development in Nursing), Porto, Portugal; Nursing School of Porto (ESEP), Porto, Portugal.
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Jacobs JM, Ream ME, Pensak N, Nisotel LE, Fishbein JN, MacDonald JJ, Buzaglo J, Lennes IT, Safren SA, Pirl WF, Temel JS, Greer JA. Patient Experiences With Oral Chemotherapy: Adherence, Symptoms, and Quality of Life. J Natl Compr Canc Netw 2020; 17:221-228. [PMID: 30865917 DOI: 10.6004/jnccn.2018.7098] [Citation(s) in RCA: 70] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 10/15/2019] [Indexed: 01/07/2023]
Abstract
BACKGROUND Oral therapies are increasingly common in oncology care. However, data are lacking regarding the physical and psychologic symptoms patients experience, or how these factors relate to medication adherence and quality of life (QoL). MATERIALS AND METHODS From December 2014 through August 2016, a total of 181 adult patients who were prescribed oral targeted therapy or chemotherapy enrolled in a randomized study of adherence and symptom management at Massachusetts General Hospital Cancer Center. Patients completed baseline assessments of adherence with electronic pill cap, QoL, symptom severity, mood, social support, fatigue, and satisfaction with clinicians and treatment. Relationships among these factors were examined using Pearson product-moment correlations and multivariable linear regression. RESULTS At baseline, the mean electronic pill cap adherence rate showed that patients took 85.57% of their oral therapy. The most commonly reported cancer-related symptoms were fatigue (88.60%), drowsiness (76.50%), disturbed sleep (68.20%), memory problems (63.10%), and emotional distress (60.80%). Patients who reported greater cancer-related symptom severity had lower adherence (r= -0.20). In a multivariable regression, greater depressive and anxiety symptoms, worse fatigue, less social support, lower satisfaction with clinicians and treatment, and higher symptom burden were associated with worse QoL (F[10, 146]=50.53; adjusted R2=0.77). Anxiety symptoms were most strongly associated with clinically meaningful decrements in QoL (β= -7.10; SE=0.22). CONCLUSIONS Patients prescribed oral therapies struggle with adherence, and cancer-related symptom burden is high and related to worse adherence and QoL. Given perceptions that oral therapies are less impairing, these data underscore the strong need to address adherence issues, symptom burden, and QoL for these patients.
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Affiliation(s)
- Jamie M Jacobs
- Massachusetts General Hospital Cancer Center, and.,Harvard Medical School, Boston, Massachusetts
| | - Molly E Ream
- Massachusetts General Hospital Cancer Center, and
| | - Nicole Pensak
- Anschutz Medical Campus, University of Colorado, Denver, Colorado
| | - Lauren E Nisotel
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | | | | | | | - Inga T Lennes
- Massachusetts General Hospital Cancer Center, and.,Harvard Medical School, Boston, Massachusetts
| | | | | | - Jennifer S Temel
- Massachusetts General Hospital Cancer Center, and.,Harvard Medical School, Boston, Massachusetts
| | - Joseph A Greer
- Massachusetts General Hospital Cancer Center, and.,Harvard Medical School, Boston, Massachusetts
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4
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Skrabal Ross X, Gunn KM, Suppiah V, Patterson P, Olver I. A review of factors influencing non-adherence to oral antineoplastic drugs. Support Care Cancer 2020; 28:4043-4050. [PMID: 32335731 DOI: 10.1007/s00520-020-05469-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Accepted: 04/13/2020] [Indexed: 12/31/2022]
Abstract
PURPOSE Adherence to oral antineoplastic drugs is a complex phenomenon, and knowledge about the reasons that people with cancer do not adhere to their prescriptions is essential to inform adherence-related support in clinical and research contexts. This study aims to provide an up-to-date summary of the key reasons for non-adherence to oral antineoplatic drugs (OAD) in people with cancer. METHODS Electronic databases Medline, Embase, Emcare, and PsychINFO were searched for systematic reviews and studies published between January 2010 and March 2018. Data was analyzed and extracted by two independent reviewers. RESULTS Three systematic reviews and two studies were included in the review. Key factors for non-adherence were classified as either modifiable or non-modifiable factors. Side effects, forgetfulness, and poor knowledge about OAD were identified as modifiable factors while co-payment, age, regimen complexity. and time since diagnosis were identified as non-modifiable factors. Most of the included studies focused on breast cancer and chronic myeloid leukemia (CML) patients. Low methodological quality and different adherence cut-off rates were observed in the included literature. CONCLUSIONS More research with rigorous methodology and diverse cancer types is needed to increase evidence on the reasons for OAD non-adherence. However, findings from this study may serve to aid in drafting guidelines and suitable interventions for adherence-related support to OAD users.
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Affiliation(s)
- Xiomara Skrabal Ross
- Cancer Research Institute, University of South Australia, Adelaide, Australia
- School of Health Sciences, University of South Australia, Adelaide, Australia
| | - Kate M Gunn
- Cancer Research Institute, University of South Australia, Adelaide, Australia.
- Department of Rural Health, University of South Australia, Adelaide, Australia.
| | - Vijayaprakash Suppiah
- School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia
- Australian Centre for Precision Health, University of South Australia, Adelaide, Australia
| | - Pandora Patterson
- Faculty of Nursing, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
- Research and Youth Cancer Services, CanTeen Australia, Sydney, New South Wales, Australia
| | - Ian Olver
- School of Psychology, University of Adelaide, Adelaide, South Australia, Australia
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5
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The Critical Assessment of the Quality of Common Clinical Guidelines for Administering Chemotherapy Drugs by Using AGREE II Tool. INTERNATIONAL JOURNAL OF CANCER MANAGEMENT 2019. [DOI: 10.5812/ijcm.91020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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6
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Weingart SN, Zhang L, Sweeney M, Hassett M. Chemotherapy medication errors. Lancet Oncol 2019; 19:e191-e199. [PMID: 29611527 DOI: 10.1016/s1470-2045(18)30094-9] [Citation(s) in RCA: 121] [Impact Index Per Article: 24.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 12/07/2017] [Accepted: 12/14/2017] [Indexed: 11/26/2022]
Abstract
Although chemotherapy is a well established treatment modality, chemotherapy errors represent a potentially serious risk of patient harm. We reviewed published research from 1980 to 2017 to understand the extent and nature of medication errors in cancer chemotherapy, and to identify effective interventions to help prevent mistakes. Chemotherapy errors occur at a rate of about one to four per 1000 orders, affect at least 1-3% of adult and paediatric oncology patients, and occur at all stages of the medication use process. Oral chemotherapy use is a particular area of growing risk. Our knowledge of chemotherapy errors is drawn primarily from single-institution studies at university hospitals and referral centres, with a particular focus on prescription orders and pharmacy practices. Although the heterogeneity of research methods and measures used in these studies limits our understanding of this issue, the rate of chemotherapy error-related injuries is generally lower than those seen in comparable studies of general medical patients. Although many interventions show promise in reducing chemotherapy errors, most have little empirical support. Additional research is needed to understand and to mitigate the risk of chemotherapy medication errors.
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Affiliation(s)
- Saul N Weingart
- Tufts Medical Center and Tufts University School of Medicine, Boston, MA, USA.
| | - Lulu Zhang
- Tufts Medical Center and Tufts University School of Medicine, Boston, MA, USA
| | - Megan Sweeney
- Tufts Medical Center and Tufts University School of Medicine, Boston, MA, USA
| | - Michael Hassett
- Dana-Farber Cancer Institute, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
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7
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Skrabal Ross X, Gunn KM, Patterson P, Olver I. Development of a Smartphone Program to Support Adherence to Oral Chemotherapy in People with Cancer. Patient Prefer Adherence 2019; 13:2207-2215. [PMID: 31908427 PMCID: PMC6930118 DOI: 10.2147/ppa.s225175] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 10/30/2019] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To describe the theoretical, evidence-based and consumer-informed development of a smartphone self-management program aiming to support adherence to oral chemotherapy in adolescents and adults diagnosed with cancer. METHODS The design of the program followed two frameworks for the development and evaluation of mHealth interventions and was conducted in three steps: 1) conceptualization, which involved an extensive literature review and a scoping review that led to the identification of the behavioral change strategies in the program; 2) definition of features and structure, based on a formative study with end-users to explore their preferences about the structure and elements of the program; and 3) selection of program delivery technology, whereby available technology platforms were examined and the most suitable tool to deliver the program was selected. RESULTS Three main reasons for oral chemotherapy non-adherence were identified: forgetfulness, side-effects and poor knowledge about oral chemotherapy. Key behavior change strategies were also identified, namely, medication intake reminders and information about oral chemotherapy and managing side-effects. Based upon end-user feedback the method of delivery of these behavioral strategies that was deemed most appropriate was conventional text messages. The reminders were standard, short, text-only messages sent when each oral chemotherapy dose was due, one way (no need to reply) and addressed the end-users using their first name. Delivery of information about oral chemotherapy and side-effects was tailored to each individual's preferred frequency. CONCLUSION The careful design process described in this paper may serve to inform the development of future mobile phone-based medication adherence-enhancing interventions for people with cancer. A trial to explore end-users acceptability of and satisfaction with the intervention is currently underway.Trial Registration: ACTRN12618001987257p.
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Affiliation(s)
- Xiomara Skrabal Ross
- Cancer Research Institute, University of South Australia, Adelaide, South Australia, Australia
- School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Kate M Gunn
- Cancer Research Institute, University of South Australia, Adelaide, South Australia, Australia
- Department of Rural Health, University of South Australia, Adelaide, South Australia, Australia
- Correspondence: Kate M Gunn University of South Australia, City West Campus, HB Building, 8-25, Adelaide, South Australia, AustraliaTel +61 8 830 22137 Email
| | - Pandora Patterson
- Faculty of Nursing, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
- Research and Youth Cancer Services, CanTeen Australia, Sydney, New South Wales, Australia
| | - Ian Olver
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
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8
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Skrabal Ross X, Gunn KM, Patterson P, Olver I. Mobile-Based Oral Chemotherapy Adherence-Enhancing Interventions: Scoping Review. JMIR Mhealth Uhealth 2018; 6:e11724. [PMID: 30578182 PMCID: PMC6320412 DOI: 10.2196/11724] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Revised: 10/03/2018] [Accepted: 10/08/2018] [Indexed: 12/14/2022] Open
Abstract
Background Adherence to oral chemotherapy is crucial to maximize treatment outcomes and avoid health complications in cancer patients. Mobile phones are widely available worldwide, and evidence that this technology can be successfully employed to increase medication adherence for the treatment of other chronic diseases (eg, diabetes) is well established. However, the extent to which there is evidence that mobile phone–based interventions improve adherence to oral chemotherapy is unknown. Objective This scoping review aims to explore what is known about mobile phone–delivered interventions designed to enhance adherence to oral chemotherapy, to examine the reported findings on the utility of these interventions in increasing oral chemotherapy adherence, and to identify opportunities for development of future interventions. Methods This study followed Arksey and O’Malley’s scoping review methodological framework. Results The review search yielded 5 studies reporting on 4 interventions with adults (aged >18 years) diagnosed with diverse cancer types. All interventions were considered acceptable, useful, and feasible. The following themes were evident: text messages and mobile apps were the main methods of delivering these interventions, the 2 most commonly employed oral chemotherapy adherence–enhancing strategies were management and reporting of drug-related symptoms and reminders to take medication, the importance of stakeholders’ engagement in intervention design, and the overall positive perceptions of delivery features. Areas for future research identified by this review include the need for further studies to evaluate the impact of mobile phone–delivered interventions on adherence to oral chemotherapy as well as the relevance for future studies to incorporate design frameworks and economic evaluations and to explore the moderator effect of high anxiety, poor baseline adherence, and longer time taking prescribed drug on adherence to oral chemotherapy. Conclusions Despite the increasing body of evidence on the use of mobile phones to deliver medication adherence–enhancing interventions in chronic diseases, literature on the oral chemotherapy context is lacking. This review showed that existing interventions are highly acceptable and useful to cancer patients. The engagement of stakeholders as well as the use of a design framework are important elements in the development of mobile phone–delivered interventions that can be translated into oncology settings.
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Affiliation(s)
- Xiomara Skrabal Ross
- Cancer Research Institute, University of South Australia, Adelaide, Australia.,School of Health Sciences, University of South Australia, Adelaide, Australia
| | - Kate M Gunn
- Cancer Research Institute, University of South Australia, Adelaide, Australia
| | - Pandora Patterson
- Cancer Nursing Research Unit, University of Sydney, Sydney, Australia.,Research, Evaluation, and Social Policy Team, CanTeen Australia, Sydney, Australia
| | - Ian Olver
- Cancer Research Institute, University of South Australia, Adelaide, Australia
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9
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Solomon JM, Ajewole VB, Schneider AM, Sharma M, Bernicker EH. Evaluation of the prescribing patterns, adverse effects, and drug interactions of oral chemotherapy agents in an outpatient cancer center. J Oncol Pharm Pract 2018; 25:1564-1569. [DOI: 10.1177/1078155218798150] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose Although oral chemotherapy offers advantages over intravenous chemotherapy, it creates a unique set of challenges. Potential barriers include treatment complexity, patient responsibility for medication adherence and monitoring, reduced healthcare contact, and increased financial burden. The purpose of this study is to estimate the prevalence of drug-related problems among a sample of patients treated with oral chemotherapy agents. Methods A single-center, retrospective chart review was conducted on patients prescribed oral chemotherapy at our institution between 1 January 2017 and 31 August 2017. The primary endpoint was the incidence of drug-related toxicities within 90 days of starting treatment. Secondary endpoints included incidence of drug–drug interactions, proportion of patients receiving medication education by a clinical pharmacist, and quantification of issues related to medication access. Results Charts of 100 patients were reviewed. Median time to oral chemotherapy receipt by the patient from the day the order was written was eight days. Prior to initiating therapy, 27% of patients received education by a clinical pharmacist. Toxicity checks were conducted by the provider at 30, 60, and 90 days for 80%, 65%, and 48% of patients, respectively. Treatment-related toxicities secondary to oral chemotherapy were reported by 79% of patients, with 55% classified as severe. Potential drug interactions were in 55% of the patients. Conclusion Data from this study have highlighted avenues for pharmacists to make an impact on patients newly started on oral chemotherapy. Opportunities exist to increase patient education, ensure appropriate follow-up, and assess adherence while preventing and managing treatment-related toxicities.
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Affiliation(s)
| | - Veronica B Ajewole
- Department of Pharmacy Practice and Clinical Health Sciences, College of Pharmacy and Health Sciences, Texas Southern University, Houston, TX, USA
| | | | - Manvi Sharma
- The University of Texas Health Science Center, Houston, TX, USA
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Vu K, Emberley P, Brown E, Abbott R, Bates JJ, Bourrier V, Djordjevic K, Greenall J, Leung M, Pasetka M, Paquet L, Logan H. Recommendations for the safe use and handling of oral anticancer drugs in community pharmacy: A pan-Canadian consensus guideline. Can Pharm J (Ott) 2018; 151:240-253. [PMID: 30237839 PMCID: PMC6141941 DOI: 10.1177/1715163518767942] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
| | - Philip Emberley
- Cancer Care Ontario (Vu), Toronto
- Leslie Dan Faculty of Pharmacy (Vu, Leung),
Toronto
- the Canadian Pharmacists Association (Emberley),
Ottawa
- the Canadian Association of Provincial Cancer
Agencies (Brown, Logan) Toronto, Ontario
- Eastern Health (Abbott), St. John’s,
Newfoundland
- the Neighbourhood Pharmacy Association of Canada
(Bates), Toronto, Ontario
- CancerCare Manitoba (Bourrier), Winnipeg,
Manitoba
- Shoppers Drug Mart (Djordjevic), Toronto
- the Institute for Safe Medication Practices Canada
(Greenall), Toronto
- McKesson Specialty Pharmacy (Leung), Toronto
- the Canadian Association of Pharmacy in Oncology
(Pasetka), Toronto, Ontario
- Direction québécoise de cancérologie (Paquet),
Ministère de la Santé et des Services sociaux, Montréal, Québec
| | - Erika Brown
- Cancer Care Ontario (Vu), Toronto
- Leslie Dan Faculty of Pharmacy (Vu, Leung),
Toronto
- the Canadian Pharmacists Association (Emberley),
Ottawa
- the Canadian Association of Provincial Cancer
Agencies (Brown, Logan) Toronto, Ontario
- Eastern Health (Abbott), St. John’s,
Newfoundland
- the Neighbourhood Pharmacy Association of Canada
(Bates), Toronto, Ontario
- CancerCare Manitoba (Bourrier), Winnipeg,
Manitoba
- Shoppers Drug Mart (Djordjevic), Toronto
- the Institute for Safe Medication Practices Canada
(Greenall), Toronto
- McKesson Specialty Pharmacy (Leung), Toronto
- the Canadian Association of Pharmacy in Oncology
(Pasetka), Toronto, Ontario
- Direction québécoise de cancérologie (Paquet),
Ministère de la Santé et des Services sociaux, Montréal, Québec
| | - Rick Abbott
- Cancer Care Ontario (Vu), Toronto
- Leslie Dan Faculty of Pharmacy (Vu, Leung),
Toronto
- the Canadian Pharmacists Association (Emberley),
Ottawa
- the Canadian Association of Provincial Cancer
Agencies (Brown, Logan) Toronto, Ontario
- Eastern Health (Abbott), St. John’s,
Newfoundland
- the Neighbourhood Pharmacy Association of Canada
(Bates), Toronto, Ontario
- CancerCare Manitoba (Bourrier), Winnipeg,
Manitoba
- Shoppers Drug Mart (Djordjevic), Toronto
- the Institute for Safe Medication Practices Canada
(Greenall), Toronto
- McKesson Specialty Pharmacy (Leung), Toronto
- the Canadian Association of Pharmacy in Oncology
(Pasetka), Toronto, Ontario
- Direction québécoise de cancérologie (Paquet),
Ministère de la Santé et des Services sociaux, Montréal, Québec
| | - Justin J. Bates
- Cancer Care Ontario (Vu), Toronto
- Leslie Dan Faculty of Pharmacy (Vu, Leung),
Toronto
- the Canadian Pharmacists Association (Emberley),
Ottawa
- the Canadian Association of Provincial Cancer
Agencies (Brown, Logan) Toronto, Ontario
- Eastern Health (Abbott), St. John’s,
Newfoundland
- the Neighbourhood Pharmacy Association of Canada
(Bates), Toronto, Ontario
- CancerCare Manitoba (Bourrier), Winnipeg,
Manitoba
- Shoppers Drug Mart (Djordjevic), Toronto
- the Institute for Safe Medication Practices Canada
(Greenall), Toronto
- McKesson Specialty Pharmacy (Leung), Toronto
- the Canadian Association of Pharmacy in Oncology
(Pasetka), Toronto, Ontario
- Direction québécoise de cancérologie (Paquet),
Ministère de la Santé et des Services sociaux, Montréal, Québec
| | - Venetia Bourrier
- Cancer Care Ontario (Vu), Toronto
- Leslie Dan Faculty of Pharmacy (Vu, Leung),
Toronto
- the Canadian Pharmacists Association (Emberley),
Ottawa
- the Canadian Association of Provincial Cancer
Agencies (Brown, Logan) Toronto, Ontario
- Eastern Health (Abbott), St. John’s,
Newfoundland
- the Neighbourhood Pharmacy Association of Canada
(Bates), Toronto, Ontario
- CancerCare Manitoba (Bourrier), Winnipeg,
Manitoba
- Shoppers Drug Mart (Djordjevic), Toronto
- the Institute for Safe Medication Practices Canada
(Greenall), Toronto
- McKesson Specialty Pharmacy (Leung), Toronto
- the Canadian Association of Pharmacy in Oncology
(Pasetka), Toronto, Ontario
- Direction québécoise de cancérologie (Paquet),
Ministère de la Santé et des Services sociaux, Montréal, Québec
| | - Kathryn Djordjevic
- Cancer Care Ontario (Vu), Toronto
- Leslie Dan Faculty of Pharmacy (Vu, Leung),
Toronto
- the Canadian Pharmacists Association (Emberley),
Ottawa
- the Canadian Association of Provincial Cancer
Agencies (Brown, Logan) Toronto, Ontario
- Eastern Health (Abbott), St. John’s,
Newfoundland
- the Neighbourhood Pharmacy Association of Canada
(Bates), Toronto, Ontario
- CancerCare Manitoba (Bourrier), Winnipeg,
Manitoba
- Shoppers Drug Mart (Djordjevic), Toronto
- the Institute for Safe Medication Practices Canada
(Greenall), Toronto
- McKesson Specialty Pharmacy (Leung), Toronto
- the Canadian Association of Pharmacy in Oncology
(Pasetka), Toronto, Ontario
- Direction québécoise de cancérologie (Paquet),
Ministère de la Santé et des Services sociaux, Montréal, Québec
| | - Julie Greenall
- Cancer Care Ontario (Vu), Toronto
- Leslie Dan Faculty of Pharmacy (Vu, Leung),
Toronto
- the Canadian Pharmacists Association (Emberley),
Ottawa
- the Canadian Association of Provincial Cancer
Agencies (Brown, Logan) Toronto, Ontario
- Eastern Health (Abbott), St. John’s,
Newfoundland
- the Neighbourhood Pharmacy Association of Canada
(Bates), Toronto, Ontario
- CancerCare Manitoba (Bourrier), Winnipeg,
Manitoba
- Shoppers Drug Mart (Djordjevic), Toronto
- the Institute for Safe Medication Practices Canada
(Greenall), Toronto
- McKesson Specialty Pharmacy (Leung), Toronto
- the Canadian Association of Pharmacy in Oncology
(Pasetka), Toronto, Ontario
- Direction québécoise de cancérologie (Paquet),
Ministère de la Santé et des Services sociaux, Montréal, Québec
| | - Mova Leung
- Cancer Care Ontario (Vu), Toronto
- Leslie Dan Faculty of Pharmacy (Vu, Leung),
Toronto
- the Canadian Pharmacists Association (Emberley),
Ottawa
- the Canadian Association of Provincial Cancer
Agencies (Brown, Logan) Toronto, Ontario
- Eastern Health (Abbott), St. John’s,
Newfoundland
- the Neighbourhood Pharmacy Association of Canada
(Bates), Toronto, Ontario
- CancerCare Manitoba (Bourrier), Winnipeg,
Manitoba
- Shoppers Drug Mart (Djordjevic), Toronto
- the Institute for Safe Medication Practices Canada
(Greenall), Toronto
- McKesson Specialty Pharmacy (Leung), Toronto
- the Canadian Association of Pharmacy in Oncology
(Pasetka), Toronto, Ontario
- Direction québécoise de cancérologie (Paquet),
Ministère de la Santé et des Services sociaux, Montréal, Québec
| | - Mark Pasetka
- Cancer Care Ontario (Vu), Toronto
- Leslie Dan Faculty of Pharmacy (Vu, Leung),
Toronto
- the Canadian Pharmacists Association (Emberley),
Ottawa
- the Canadian Association of Provincial Cancer
Agencies (Brown, Logan) Toronto, Ontario
- Eastern Health (Abbott), St. John’s,
Newfoundland
- the Neighbourhood Pharmacy Association of Canada
(Bates), Toronto, Ontario
- CancerCare Manitoba (Bourrier), Winnipeg,
Manitoba
- Shoppers Drug Mart (Djordjevic), Toronto
- the Institute for Safe Medication Practices Canada
(Greenall), Toronto
- McKesson Specialty Pharmacy (Leung), Toronto
- the Canadian Association of Pharmacy in Oncology
(Pasetka), Toronto, Ontario
- Direction québécoise de cancérologie (Paquet),
Ministère de la Santé et des Services sociaux, Montréal, Québec
| | - Louise Paquet
- Cancer Care Ontario (Vu), Toronto
- Leslie Dan Faculty of Pharmacy (Vu, Leung),
Toronto
- the Canadian Pharmacists Association (Emberley),
Ottawa
- the Canadian Association of Provincial Cancer
Agencies (Brown, Logan) Toronto, Ontario
- Eastern Health (Abbott), St. John’s,
Newfoundland
- the Neighbourhood Pharmacy Association of Canada
(Bates), Toronto, Ontario
- CancerCare Manitoba (Bourrier), Winnipeg,
Manitoba
- Shoppers Drug Mart (Djordjevic), Toronto
- the Institute for Safe Medication Practices Canada
(Greenall), Toronto
- McKesson Specialty Pharmacy (Leung), Toronto
- the Canadian Association of Pharmacy in Oncology
(Pasetka), Toronto, Ontario
- Direction québécoise de cancérologie (Paquet),
Ministère de la Santé et des Services sociaux, Montréal, Québec
| | - Heather Logan
- Cancer Care Ontario (Vu), Toronto
- Leslie Dan Faculty of Pharmacy (Vu, Leung),
Toronto
- the Canadian Pharmacists Association (Emberley),
Ottawa
- the Canadian Association of Provincial Cancer
Agencies (Brown, Logan) Toronto, Ontario
- Eastern Health (Abbott), St. John’s,
Newfoundland
- the Neighbourhood Pharmacy Association of Canada
(Bates), Toronto, Ontario
- CancerCare Manitoba (Bourrier), Winnipeg,
Manitoba
- Shoppers Drug Mart (Djordjevic), Toronto
- the Institute for Safe Medication Practices Canada
(Greenall), Toronto
- McKesson Specialty Pharmacy (Leung), Toronto
- the Canadian Association of Pharmacy in Oncology
(Pasetka), Toronto, Ontario
- Direction québécoise de cancérologie (Paquet),
Ministère de la Santé et des Services sociaux, Montréal, Québec
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11
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LeFebvre KB, Felice TL. Nursing Application of Oral Chemotherapy Safety Standards:An Informal Survey. Clin J Oncol Nurs 2017; 20:258-62. [PMID: 27206292 DOI: 10.1188/16.cjon.258-262] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
As the use of oral chemotherapy continues to rise, new approaches are needed to ensure patient safety. To help address this issue, the American Society of Clinical Oncology/Oncology Nursing Society (ONS) Chemotherapy Administration Safety Standards were expanded in 2013 to include additional measures addressing oral anticancer drugs (OACs). Because minimal data assessing the application of these standards exist, ONS conducted an independent survey of oncology nurses to evaluate the application of these standards in practice as they relate to several areas of OAC use: assessment, consent, patient education, drug verification, and monitoring. The data revealed that, although the standards are followed in many settings, a large number of settings do not have processes in place to support safety standards and ensure patient safety when administering OACs. Information gained in this informal survey can be used to guide additional research and educational initiatives.
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12
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Care of the Elderly Patient on Oral Oncolytics for Advanced Disease. CURRENT GERIATRICS REPORTS 2016; 5:233-239. [DOI: 10.1007/s13670-016-0183-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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13
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Boucher J, Lucca J, Hooper C, Pedulla L, Berry DL. A Structured Nursing Intervention to Address Oral Chemotherapy Adherence in Patients With Non-Small Cell Lung Cancer. Oncol Nurs Forum 2016; 42:383-9. [PMID: 26148317 DOI: 10.1188/15.onf.383-389] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To evaluate a nurse-led intervention to enhance medication knowledge and adherence using the Multinational Association for Supportive Care in Cancer Oral Agent Teaching Tool (MOATT). DESIGN Longitudinal, descriptive feasibility study. SETTING An ambulatory thoracic oncology disease center located at the Dana-Farber Cancer Institute in Boston, MA. SAMPLE 30 adult patients with lung cancer who received the oral agent erlotinib. METHODS Structured, nurse-led education sessions using the MOATT were provided, with a 72-hour follow-up telephone contact. Participants completed a Knowledge Rating Scale (KRS) and adapted Morisky Medication Adherence Scale-8 (MMAS-8) at the end of the first cycle of oral chemotherapy. MAIN RESEARCH VARIABLES Knowledge and adherence; feasibility. FINDINGS Twenty-seven participants completed the study outcome measures reporting high knowledge levels and MMAS-8 scores. Structured, nurse-led education and follow-up monitoring sessions ranged from 14-30 minutes. Several participants also initiated contact for assistance with prescription procurement and symptom management. Participants reported a median of two side effects. CONCLUSIONS The structured, nurse-led teaching, using the MOATT tool, and follow-up nurse contacts were feasible as integrated into the thoracic oncology setting. Adherence and knowledge outcomes were encouraging. Additional studies should include objective adherence measures and strategies for delivering supportive care to patients at home. IMPLICATIONS FOR NURSING Structured teaching with patients is important to enhance proper oral anticancer medication knowledge and adherence, including follow-up monitoring of administration and side effects at 72 hours.
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Affiliation(s)
- Jean Boucher
- Phyllis F. Cantor Center at Dana-Farber Cancer Institute in Boston, MA, and the University of Massachusetts Worcester Graduate School of Nursing
| | - Joan Lucca
- Lowe Center for Thoracic Oncology at Dana-Farber Cancer Institute
| | - Catherine Hooper
- Lowe Center for Thoracic Oncology at Dana-Farber Cancer Institute
| | | | - Donna L Berry
- Phyllis F. Cantor Center at Dana-Farber Cancer Institute
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14
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Greer JA, Amoyal N, Nisotel L, Fishbein JN, MacDonald J, Stagl J, Lennes I, Temel JS, Safren SA, Pirl WF. A Systematic Review of Adherence to Oral Antineoplastic Therapies. Oncologist 2016; 21:354-76. [PMID: 26921292 DOI: 10.1634/theoncologist.2015-0405] [Citation(s) in RCA: 227] [Impact Index Per Article: 28.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Accepted: 12/08/2015] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Oral antineoplastic therapies not only improve survival but also reduce the burden of care for patients. Yet patients and clinicians face new challenges in managing adherence to these oral therapies. We conducted a systematic literature review to assess rates and correlates of adherence to oral antineoplastic therapies and interventions aimed at improving adherence. METHODS Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we conducted a comprehensive literature search of the Ovid MEDLINE database from January 1, 2003 to June 30, 2015, using relevant terminology for oral antineoplastic agents. We included observational, database, and intervention studies. At least two researchers evaluated each paper to ensure accuracy of results and determine risk of bias. RESULTS We identified 927 records from the search and screened 214 abstracts. After conducting a full-text review of 167 papers, we included in the final sample 51 papers on rates/correlates of adherence to oral antineoplastic therapy and 12 papers on intervention studies to improve adherence. Rates of adherence varied widely, from 46% to 100%, depending on patient sample, medication type, follow-up period, assessment measure, and calculation of adherence. Of the intervention studies, only 1 of the randomized trials and 2 of the cohort studies showed benefit regarding adherence, with the majority suffering high risk of bias. CONCLUSIONS Although no reliable estimate of adherence to oral antineoplastic therapies can be gleaned from the literature, a substantial proportion of patients struggle to adhere to these medications as prescribed. The few intervention studies for adherence have notable methodological concerns, thereby limiting the evidence to guide practice in promoting medication adherence among patients with cancer.
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Affiliation(s)
- Joseph A Greer
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Nicole Amoyal
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Lauren Nisotel
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Joel N Fishbein
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - James MacDonald
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Jamie Stagl
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Inga Lennes
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Jennifer S Temel
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | | | - William F Pirl
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
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15
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Patil VM, Chakraborty S, Bhattacharjee A, Dessai S. Survey of the State of Implementation of the American Society of Clinical Oncology/Oncology Nursing Society Safety Standards for Chemotherapy Administration in India. J Oncol Pract 2015; 11:365-9. [PMID: 26265175 DOI: 10.1200/jop.2015.004481] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The American Society of Clinical Oncology and the Oncology Nursing Society have proposed a set of standards for safe chemotherapy administration. The state of implementation of these standards in oncologic practices in India is not understood properly. METHODS An anonymized survey was designed that consisted of items from all 37 standards that were described in the 2013 update of the standards. The survey was distributed via e-mail as well as in paper format among oncologists working in various oncology practices in the country. A standard was considered as fully implemented if more than 90% of the items beneath it had the most positive response (Yes/Always). RESULTS Responses were obtained from 75 of 114 (65.8%) of the institutions surveyed. Only one institution had fully implemented the standards, whereas only six (8.0%) institutions had implemented more than 90% of the standards fully. The general chemotherapy administration-related domain was implemented fully by the least number of institutions. Although characteristics such as location, funding, and type of institution (teaching or not) failed to influence implementation rates, institutions of respondents who were aware of chemotherapy practice-related standards reported full implementation of a larger number of standards. Lack of national-level guidelines/policies was identified as the most common difficulty in implementing standards. CONCLUSION This survey indicates that there is an urgent need to formulate national-level guidelines for safe chemotherapy administration.
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16
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Krzyzanowska MK, Powis M. Extending the Quality and Safety Agenda From Parenteral to Oral Chemotherapy. J Oncol Pract 2015; 11:198-201. [DOI: 10.1200/jop.2015.004002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
This article describes some of the steps that can be taken across the entire oral chemotherapy journey to improve quality and safety by leveraging existing and emerging tools.
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Affiliation(s)
- Monika K. Krzyzanowska
- Princess Margaret Cancer Centre; University of Toronto; and Cancer Care Ontario, Toronto, Ontario, Canada
| | - Melanie Powis
- Princess Margaret Cancer Centre; University of Toronto; and Cancer Care Ontario, Toronto, Ontario, Canada
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17
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Zerillo JA, Pham TH, Kadlubek P, Severson JA, Mackler E, Jacobson JO, Blayney DW. Administration of Oral Chemotherapy: Results From Three Rounds of the Quality Oncology Practice Initiative. J Oncol Pract 2015; 11:e255-62. [DOI: 10.1200/jop.2014.001842] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The collection of oral chemotherapy test measure data is feasible, and improvement opportunities exist for patients who are prescribed oral chemotherapy.
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Affiliation(s)
- Jessica A. Zerillo
- Beth Israel Deaconess Medical Center; Dana-Farber Cancer Institute, Boston, MA; American Society of Clinical Oncology, Alexandria, VA; Michigan Oncology Quality Consortium, Ann Arbor, MI; and Stanford Cancer Institute, Stanford, CA
| | - Trang H. Pham
- Beth Israel Deaconess Medical Center; Dana-Farber Cancer Institute, Boston, MA; American Society of Clinical Oncology, Alexandria, VA; Michigan Oncology Quality Consortium, Ann Arbor, MI; and Stanford Cancer Institute, Stanford, CA
| | - Pamela Kadlubek
- Beth Israel Deaconess Medical Center; Dana-Farber Cancer Institute, Boston, MA; American Society of Clinical Oncology, Alexandria, VA; Michigan Oncology Quality Consortium, Ann Arbor, MI; and Stanford Cancer Institute, Stanford, CA
| | - Jane Alcyne Severson
- Beth Israel Deaconess Medical Center; Dana-Farber Cancer Institute, Boston, MA; American Society of Clinical Oncology, Alexandria, VA; Michigan Oncology Quality Consortium, Ann Arbor, MI; and Stanford Cancer Institute, Stanford, CA
| | - Emily Mackler
- Beth Israel Deaconess Medical Center; Dana-Farber Cancer Institute, Boston, MA; American Society of Clinical Oncology, Alexandria, VA; Michigan Oncology Quality Consortium, Ann Arbor, MI; and Stanford Cancer Institute, Stanford, CA
| | - Joseph O. Jacobson
- Beth Israel Deaconess Medical Center; Dana-Farber Cancer Institute, Boston, MA; American Society of Clinical Oncology, Alexandria, VA; Michigan Oncology Quality Consortium, Ann Arbor, MI; and Stanford Cancer Institute, Stanford, CA
| | - Douglas W. Blayney
- Beth Israel Deaconess Medical Center; Dana-Farber Cancer Institute, Boston, MA; American Society of Clinical Oncology, Alexandria, VA; Michigan Oncology Quality Consortium, Ann Arbor, MI; and Stanford Cancer Institute, Stanford, CA
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18
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Roop JC, Wu HS. Current practice patterns for oral chemotherapy: results of a national survey. Oncol Nurs Forum 2014; 41:185-94. [PMID: 24370897 DOI: 10.1188/14.onf.41-02ap] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To describe current nursing practices in the United States regarding care and safety of patients taking oral chemotherapy. DESIGN This three-phase study consisted of development, validation, and implementation of a national online survey. SETTING Survey of oncology nurses in outpatient settings. SAMPLE 577 oncology nurses. METHODS Surveys were emailed to 5,000 members of the Oncology Nursing Society. The survey included 17 forced-choice items and one free-text item. Descriptive statistics and content analysis were obtained. MAIN RESEARCH VARIABLES Patient care practices, nursing resources, and barriers to medication adherence. FINDINGS Fifty-one percent of the respondents worked in practices that had developed specific policies, procedures, and resources for patients on oral chemotherapy. Barriers to treatment adherence included cost (81%) and adverse effects (72%). Practices with specific policies differed in clinical and statistical significance from practices without policies on almost every survey item. Free-text responses revealed that many practices have erratic procedures and inadequate interdisciplinary communication. CONCLUSIONS Systematic reliable policies and procedures for patient education, documentation, and interdisciplinary communication are urgently needed. IMPLICATIONS FOR NURSING Nurses should provide education and repeated teaching to improve patient safety, adherence to the medication, and self-monitoring for adverse effects.
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Affiliation(s)
- Janna C Roop
- College of Nursing, Wayne State University, Detroit, MI
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19
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Abstract
With the increasing use of oral chemotherapy, there has been heightened appreciation of the unique challenges associated, especially in relation to prescribing, dispensing, reimbursement, adherence, and patient and family education.
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20
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Bourmaud A, Pacaut C, Melis A, Tinquaut F, Magné N, Merrouche Y, Chauvin F. Is oral chemotherapy prescription safe for patients? A cross-sectional survey. Ann Oncol 2014; 25:500-4. [PMID: 24406423 DOI: 10.1093/annonc/mdt553] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Oral chemotherapies are increasingly prescribed. Yet wide variations in prescription practices and in monitoring of toxicity have been underlined despite existing guidelines. There is little recent information available as regard to these practices. We aimed to obtain exhaustive information on oral chemotherapy prescription practices and safety monitoring in French hospitals. METHODS A cross-sectional multicentre survey was carried out to collect information on drug prescription, administration and surveillance: prescribing practices, coordination and monitoring of adherence, safety monitoring and side-effects occurrence prevention. Participants were a large sample of the French oncologists prescribing oral chemotherapy (20%). RESULTS One hundred and fifty-seven oncologists from 112 hospitals (public, comprehensive cancer centres and private) replied (23.7% of cancer hospitals). The majority (56.1%) of the prescriptions were hand-written on a blank sheet. Eighty-four physicians (53.5%) included dose information and 36 (23%) declared having no monitoring procedures for adherence. Only 84 responders (54%) provided education material at first prescription of oral chemotherapy in way to limit avoidable side-effects. Sixty-one (39%) responders stated that they recalled at least one serious adverse event in the previous year declared in their centre. CONCLUSIONS In this 2012 study, the majority of prescribers followed no standards in prescription writing, safety monitoring and toxicity prevention. The implementation of the international recommendations for oral chemotherapy administration should be considered as a top priority-for both prescribers and health authorities-as regards to the dynamic of development of these molecules and their potential side-effects.
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Affiliation(s)
- A Bourmaud
- Department of Public Health, Hygée Centre, Lucien Neuwirth Cancer Institut, Saint Priest en Jarez
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Gullatte M. American Society of Clinical Oncology/Oncology Nursing Society chemotherapy safety standards. J Oncol Pract 2013; 9:3s-4s. [PMID: 24135010 DOI: 10.1200/jop.2012.000862] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Oncology nurses have used chemotherapy standards to develop educational materials and guidelines for standardization and safety and anticipate future opportunities to partner in translating evidence into practice.
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22
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Meisenberg BR, Wright RR, Brady-Copertino CJ. Reduction in chemotherapy order errors with computerized physician order entry. J Oncol Pract 2013; 10:e5-9. [PMID: 24003174 DOI: 10.1200/jop.2013.000903] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To measure the number and type of errors associated with chemotherapy order composition associated with three sequential methods of ordering: handwritten orders, preprinted orders, and computerized physician order entry (CPOE) embedded in the electronic health record. MATERIALS AND METHODS From 2008 to 2012, a sample of completed chemotherapy orders were reviewed by a pharmacist for the number and type of errors as part of routine performance improvement monitoring. Error frequencies for each of the three distinct methods of composing chemotherapy orders were compared using statistical methods. RESULTS The rate of problematic order sets-those requiring significant rework for clarification-was reduced from 30.6% with handwritten orders to 12.6% with preprinted orders (preprinted v handwritten, P < .001) to 2.2% with CPOE (preprinted v CPOE, P < .001). The incidence of errors capable of causing harm was reduced from 4.2% with handwritten orders to 1.5% with preprinted orders (preprinted v handwritten, P < .001) to 0.1% with CPOE (CPOE v preprinted, P < .001). CONCLUSION The number of problem- and error-containing chemotherapy orders was reduced sequentially by preprinted order sets and then by CPOE. CPOE is associated with low error rates, but it did not eliminate all errors, and the technology can introduce novel types of errors not seen with traditional handwritten or preprinted orders. Vigilance even with CPOE is still required to avoid patient harm.
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23
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Weingart SN, Mattsson T, Zhu J, Shulman LN, Hassett M. Improving electronic oral chemotherapy prescription: can we build a safer system? J Oncol Pract 2012; 8:e168-73. [PMID: 23598852 DOI: 10.1200/jop.2012.000677] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2012] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION To prevent oral chemotherapy prescription errors, we enhanced a prescription-writing module in an ambulatory electronic medical record. We sought to describe the enhancement, examine its performance to date, and identify opportunities for improvement. METHODS Enhancements to the oral chemotherapy writing module included weight- and body surface area-based dosing, fields for cancer diagnosis and intent of therapy (curative v palliative), and dose-limit warnings. We studied all prescriptions for 18 oral chemotherapies generated by oncology clinicians during the first 17 months after the safe prescribing enhancements were introduced, from May 1, 2010, to October 1, 2011. We examined the frequency with which clinicians used the new features, the number and type of alerts generated, and clinician actions in response to alerts. RESULTS Six hundred clinicians generated 6,673 prescriptions for 2,043 patients. Six drugs-temozolomide, capecitabine, lenalidomide, hydroxyurea, imatinib, and erlotinib-accounted for 5,512 of all oral chemotherapy prescriptions (83%). Prescribers indicated the intent of therapy 13% of the time and listed the patient's cancer diagnosis 46% of the time. Prescribers customized their instructions using a free-text field in 64% of prescriptions. Clinicians' 6,673 prescription attempts triggered 395 dose-limit warnings (5%), mostly for temozolomide. Clinicians ignored most (96%) warnings, because current dosing recommendations exceeded the dose-limit warnings for the alerted medications. CONCLUSION Oncology clinicians readily accepted features designed to enhance oral chemotherapy safety. Additional enhancements are needed to facilitate prescriptions with complex dosing regimens and to provide dose-limit warnings that reflect current clinical practice.
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Affiliation(s)
- Saul N Weingart
- Center for Patient Safety, Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA 02215, USA.
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