Seattle—More and more cancer patients are using oral cancer therapies, or oral targeted agents (OTAs), at home instead of always receiving chemotherapy in a hospital or physician’s office.

Because of that, pharmacists are facing new challenges and communication issues with both clinicians and patients, according to a study presented at the 2019 American Society of Clinical Oncology Annual Meeting in Chicago.

A study team from the University of Washington and the Veterans Affairs (VA) Puget Sound Healthcare System points out that dose interruptions impair oral cancer therapy efficacy, adding that “infrastructure to ensure best practices” is being strained by rapid increases in use of those medications by some clinics.

To identify opportunities for quality improvement in prescribing practices and patient education, the authors evaluated adherence to OTAs for management of B-cell malignancies (BCMs) at the VA Puget Sound Health Care System in Seattle.

To do that, they examined by detailed chart review consecutive patients treated with oral therapies for those cancers from 2014 to 2018. Included in the study were patients who used an OTA uninterrupted for 30 days or longer.

OTA adherence was assessed by:
• Identification of medication gaps of 8 or more days not attributable to medication toxicity,
• Disease progression, and
• ReComp, a validated electronic pharmacy refill adherence algorithm.

Overall, 50 patients were evaluated, and 39 met inclusion criteria. Participants were prescribed 42 unique OTAs, including ibrutinib, venetoclax, idelalsib, and acalabrutinib over a total of 33,655 days, with a median duration of 420 days (range 60–1,687).

Results indicate that more than half of the patients, 23 (59%), had at least one medication-adherence gap of 8 days or longer. In fact, five patients (13%) had three or more 8-day gaps. The study team calculated the participants’ ReComp value at 1.02 (median 0.99, standard deviation 0.15).

At the same time, medication oversupply was identified in 46%. One-fourth of the patients were found to be adherent less than 93% of the time. No statistically significant correlations were identified between adherence and either sociodemographics or comorbidities. 

“In our institution, a significant percentage of patients prescribed OTAs for BCMs experienced suboptimal adherence,” study authors write. “These data identify opportunities to improve disease-related outcomes and costs. Initiatives to improve education and automated monitoring of OTA refills are under evaluation.”

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