Outcome Assessments and Cost Avoidance of an Oral Chemotherapy Management Clinic

Restricted access

Background: Increasing use of oral chemotherapy drugs increases the challenges for drug and patient management. An oral chemotherapy management clinic was developed to provide patients with oral chemotherapy management, concurrent medication (CM) education, and symptom management services. This evaluation aims to measure the need and effectiveness of this practice model due to scarce published data. Methods: This is a case series report of all patients referred to the oral chemotherapy management clinic. Data collected included patient demographics, depression scores, CMs, and types of intervention, including detection and management outcomes collected at baseline, 3-day, 7-day, and 3-month follow-ups. Persistence rate was monitored. Secondary analysis assessed potential cost avoidance. Results: A total of 86 evaluated patients (32 men and 54 women, mean age of 63.4 years) did not show a high risk for medication nonadherence. The 3 most common cancer diagnoses were rectal, pancreatic, and breast, with capecitabine most prescribed. Patients had an average of 13.7 CMs. A total of 125 interventions (detection and management of adverse drug event detection, compliance, drug interactions, medication error, and symptom management) occurred in 201 visits, with more than 75% of interventions occurring within the first 14 days. A persistence rate was observed in 78% of 41 evaluable patients. The total estimated annual cost avoidance per 1.0 full time employee (FTE) was $125,761.93. Conclusions: This evaluation demonstrated the need for additional support for patients receiving oral chemotherapy within standard of care medical service. A comprehensive oral chemotherapy management referral service can optimize patient care delivery via early interventions for adverse drug events, drug interactions, and medication errors up to 3 months after initiation of treatment.

Correspondence: Siu-Fun Wong, PharmD, Chapman University School of Pharmacy, Harry and Diane Rinker Health Science Campus, 9401 Jeronimo Road, Irvine, CA 92618-1908. E-mail: sfwong@chapman.edu
  • 1.

    Increased use of oral chemotherapy drugs spurs increased attention to patient compliance. J oncol Pract2008;4:175177.

  • 2.

    WeingartSNBrownEBachPB. NCCN Task Force Report: oral chemotherapy. J Natl Compr Canc Netw2008;6(Suppl 3):S114.

  • 3.

    SharmaSSaltzLB. Oral chemotherapeutic agents for colorectal cancer. Oncologist2000;5:99107.

  • 4.

    DeCardenasRHelfrichJS. Oral therapies and safety issues for oncology practices. Oncology Issues2010;(March/April):4042.

  • 5.

    Ramalho de OliveiraDBrummelARMillerDB. Medication therapy management: 10 years of experience in a large integrated health care system. J Manag Care Pharm2010;16:185195.

    • Search Google Scholar
    • Export Citation
  • 6.

    McKeeMFreiBLGarciaA. Impact of clinical pharmacy services on patients in an outpatient chemotherapy academic clinic. J Oncol Pract2011;17:387394.

    • Search Google Scholar
    • Export Citation
  • 7.

    ManciniRWilsonD. A pharmacist managed oral chemotherapy program: an economic and clinical opportunity. Oncology Issues2012;(Januray/February):2831.

    • Search Google Scholar
    • Export Citation
  • 8.

    HolleLMPuriSClementJM. Physician-pharmacist collaboration for oral chemotherapy monitoring: insights from an academic genitourinary oncology practice[published online ahead of print April 21 2015]. J Oncol Pharm Practpii: 1078155215581524.

    • Search Google Scholar
    • Export Citation
  • 9.

    WongSFBounthavongMNguyenC. Implementation and preliminary outcomes of a comprehensive oral chemotherapy management clinic. Am J Health Syst Pharm2014;71:960965.

    • Search Google Scholar
    • Export Citation
  • 10.

    AldridgeVEParkHKBounthavongMMorrealeAP. Implementing a comprehensive, 24-hour emergency department pharmacy program. Am J Health Syst Pharm2009;66:19431947.

    • Search Google Scholar
    • Export Citation
  • 11.

    DuganWMcDonaldMVPassikSD. Use of the Zung Self-Rating Depression Scale in cancer patients: feasibility as a screening tool. Psychooncology1998;7:483493.

    • Search Google Scholar
    • Export Citation
  • 12.

    GoodinSGriffithNChenB. Safe handling of oral chemotherapeutic agents in clinical practice: recommendations from an international pharmacy panel. J Oncol Pract2011;7:712.

    • Search Google Scholar
    • Export Citation
  • 13.

    Safe Storage and Disposal of Cancer Medications. Available at: http://www.cancer.net/navigating-cancer-care/managing-your-care/safe-storage-and-disposal-cancer-medications. Accessed February 8 2016.

    • Search Google Scholar
    • Export Citation
  • 14.

    Micromedex Healthcare Series [Internet database]. Greenwood Village, CO: Thomson Micromedex. Updated periodically.

  • 15.

    LeeAJBoroMSKnappKK. Clinical and economic outcomes of pharmacist recommendations in a Veterans Affairs medical center. Am J Health Syst Pharm2002;59:20702077.

    • Search Google Scholar
    • Export Citation
  • 16.

    Common Terminology Criteria for Adverse Events (CTCAE). Version 4.0. Available at: http://evs.nci.nih.gov/ftp1/CTCAE/CTCAE_4.03_2010-06-14_QuickReference_5x7.pdf. Accessed February 8 2016.

    • Search Google Scholar
    • Export Citation
  • 17.

    LeapeLLBatesDWCullenDJ. Systems analysis of adverse drug events. ADE Prevention Study Group. JAMA1995;274:3543.

  • 18.

    RaschettiRMorguttiMMenniti-IppolitoF. Suspected adverse drug events requiring emergency department visits or hospital admissions. Eur J Clin Pharmacol1999;54:959963.

    • Search Google Scholar
    • Export Citation
  • 19.

    RuddyKMayerEPartridgeA. Patient adherence and persistence with oral anticancer treatment. CA Cancer J Clin2009;59:5666.

  • 20.

    HowellACuzickJBaumM. Results of the ATAC (Arimidex, Tamoxifen, Alone or in Combination) trial after completion of 5 years' adjuvant treatment for breast cancer. Lancet2005;365:6062.

    • Search Google Scholar
    • Export Citation
  • 21.

    ChlebowskiRTGellerML. Adherence to endocrine therapy for breast cancer. Oncology2006;71:19.

  • 22.

    PartridgeAHArcherLKornblithAB. Adherence and persistence with oral adjuvant chemotherapy in older women with early-stage breast cancer in CALGB 49907: adherence companion study 60104. J Clin Oncol2010;28:24182422.

    • Search Google Scholar
    • Export Citation
  • 23.

    KoppBJMrsanMErstadBLDubyJJ. Cost implications of and potential adverse events prevented by interventions of a critical care pharmacist. Am J Health Syst Pharm2007;64:24832487.

    • Search Google Scholar
    • Export Citation
  • 24.

    BarnettMJFrankJWehringH. Analysis of pharmacist-provided medication therapy management (MTM) services in community pharmacies over 7 years. J Manag Care Pharm2009;15:1831.

    • Search Google Scholar
    • Export Citation
All Time Past Year Past 30 Days
Abstract Views 0 0 0
Full Text Views 153 154 16
PDF Downloads 65 65 5
EPUB Downloads 0 0 0