Advertisement

Development, Implementation, and Evaluation of an Oral Anticancer Management Program

Published:December 12, 2022DOI:https://doi.org/10.1016/j.nurpra.2022.10.019

      Highlights

      • The use of oral anticancer agents is rapidly increasing.
      • Most oral anticancer medication errors occur during prescribing, dispensing, and monitoring.
      • Error mitigation strategies include the use of order templates, dual-nurse dose verification, and adherence monitoring.
      • An oral anticancer management program was successfully implemented.

      Abstract

      Oral anticancer (OA) agents have become more frequently used for patients diagnosed with cancer. Errors with OA agents can lead to costly and harmful adverse drug reactions and inferior efficacy; however, a standard procedure for prescribing and monitoring OA agents has not been established. An interdisciplinary team of clinicians identified the need for improved safety features in prescribing and monitoring patients prescribed OA agents. The goal of this collaborative project was to develop, implement, and evaluate a standardized program to improve safety for patients newly prescribed OA agents.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to The Journal for Nurse Practitioners
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Finn A.
        • Bondarenka C.
        • Edwards K.
        • Hartwell R.
        • Letton C.
        • Perez A.
        Evaluation of electronic health record implementation on pharmacist interventions related to oral chemotherapy management.
        J Oncol Pharm Pract. 2017; 23: 563-574https://doi.org/10.1177/1078155216665247
        • Kav S.
        Oral agents in cancer treatment: meeting the patients' needs to ensure medication adherence.
        Asia Pac J Oncol Nurs. 2017; 4: 273-274https://doi.org/10.4103/apjon.apjon_49_17
        • Muluneh B.
        • Schneider M.
        • Faso A.
        • et al.
        Improved adherence rates and clinical outcomes of an integrated, closed-loop, pharmacist-led oral chemotherapy management program.
        J Oncol Pract. 2018; 14: e324-e334https://doi.org/10.1200/JOP.17.00039
        • Weingart S.N.
        • Brown E.
        • Bach P.B.
        • et al.
        NCCN Task Force report: Oral chemotherapy.
        J Natl Compr Canc Netw. 2008; 6: S1-S14
        • Neuss M.N.
        • Gilmore T.R.
        • Belderson K.M.
        • et al.
        2016 Updated American Society of Clinical Oncology/Oncology Nursing Society chemotherapy administration safety standards, including standards for pediatric oncology.
        Oncol Nurs Forum. 2017; 44: 31-43https://doi.org/10.1188/17.ONF.31-43
        • Weingart S.N.
        • Zhang L.
        • Sweeney M.
        • Hassett M.
        Chemotherapy medication errors.
        Lancet Oncol. 2018; 19 (doi:S1470-2045(18)30094-9): e191-e199
      1. Knox RA. Doctor’s orders killed cancer patient: Dana-Farber admits drug overdose caused death of Globe columnist, damage to second woman. Boston Globe. March 23, 1995; metro/region:1.

        • Weingart S.N.
        • Toro J.
        • Spencer J.
        • et al.
        Medication errors involving oral chemotherapy.
        Cancer. 2010; 116: 2455-2464https://doi.org/10.1002/cncr.25027
        • Dürr P.
        • Schlichtig K.
        • Kelz C.
        • et al.
        The randomized AMBORA trial: impact of pharmacological/pharmaceutical care on medication safety and patient-reported outcomes during treatment with new oral anticancer agents.
        J Clin Oncol. 2021; 39: 1983-1994https://doi.org/10.1200/JCO.20.03088
        • Schlichtig K.
        • Dürr P.
        • Dörje F.
        • Fromm M.F.
        Medication errors during treatment with new oral anticancer agents: consequences for clinical practice based on the AMBORA study.
        Clin Pharmacol Ther. 2021; 110: 1075-1086https://doi.org/10.1002/cpt.2338
        • Mathaiyan J.
        • Jain T.
        • Dubashi B.
        • Reddy K.S.
        • Batmanabane G.
        Prescription errors in cancer chemotherapy: omissions supersede potentially harmful errors.
        J Pharmacol Pharmacother. 2015; 6: 83-87https://doi.org/10.4103/0976-500X.155484
        • Saad A.
        • Der-Nigoghossian C.A.
        • Njeim R.
        • Sakr R.
        • Salameh P.
        • Massoud M.
        Prescription errors with chemotherapy: quality improvement through standardized order templates.
        Asian Pac J Cancer Prev. 2016; 17: 2329-2336https://doi.org/10.7314/apjcp.2016.17.4.2329
        • Sanchez Cuervo M.
        • Rojo Sanchis A.
        • Pueyo Lopez C.
        • Gomez de Salazar Lopez de Silanes E.
        • Gramage Caro T.
        • Bermejo Vicedo T.
        The impact of a computerized physician order entry system on medical errors with antineoplastic drugs 5 years after its implementation.
        J Clin Pharm Ther. 2015; 40: 550-554https://doi.org/10.1111/jcpt.12305
        • Koyama A.K.
        • Maddox C.S.
        • Li L.
        • Bucknall T.
        • Westbrook J.I.
        Effectiveness of double checking to reduce medication administration errors: a systematic review.
        BMJ Qual Saf. 2020; 29: 595-603https://doi.org/10.1136/bmjqs-2019-009552
        • Institute for Safe Medication Practices
        Independent double checks: worth the effort if used judiciously and properly.
        • Griffin M.C.
        • Gilbert R.E.
        • Broadfield L.H.
        • et al.
        ReCAP: comparison of independent error checks for oral versus intravenous chemotherapy.
        J Oncol Pract. 2016; 12 (e180-187): 168-169https://doi.org/10.1200/JOP.2015.005892
        • Greer J.A.
        • Amoyal N.
        • Nisotel L.
        • et al.
        A systematic review of adherence to oral antineoplastic therapies.
        Oncologist. 2016; 21: 354-376https://doi.org/10.1634/theoncologist.2015-0405
        • Atkinson T.M.
        • Rodríguez V.M.
        • Gordon M.
        • et al.
        The association between patient-reported and objective oral anticancer medication adherence measures: a systematic review.
        Oncol Nurs Forum. 2016; 43: 576-582https://doi.org/10.1188/16.ONF.576-582
        • Jacobs J.M.
        • Ream M.E.
        • Pensak N.
        • et al.
        Patient experiences with oral chemotherapy: adherence, symptoms, and quality of life.
        J Natl Compr Canc Netw. 2019; 17: 221-228https://doi.org/10.6004/jnccn.2018.7098
        • Hirao C.
        • Mikoshiba N.
        • Shibuta T.
        • et al.
        Adherence to oral chemotherapy medications among gastroenterological cancer patients visiting an outpatient clinic.
        Jpn J Clin Oncol. 2017; 47: 786-794https://doi.org/10.1093/jjco/hyx087
        • Krikorian S.
        • Pories S.
        • Tataronis G.
        • et al.
        Adherence to oral chemotherapy: challenges and opportunities.
        J Oncol Pharm Pract. 2019; 25: 1590-1598https://doi.org/10.1177/1078155218800384
        • Eldeib H.K.
        • Abbassi M.M.
        • Hussein M.M.
        • Salem S.E.
        • Sabry N.A.
        The effect of telephone-based follow-up on adherence, efficacy, and toxicity of oral capecitabine-based chemotherapy.
        Telemed J E Health. 2019; 25: 462-470https://doi.org/10.1089/tmj.2018.0077
        • Mackler E.
        • Segal E.M.
        • Muluneh B.
        • Jeffers K.
        • Carmichael J.
        2018 hematology/oncology pharmacist association best practices for the management of oral oncolytic therapy: pharmacy practice standard.
        J Oncol Pract. 2019; 15: e346-e355https://doi.org/10.1200/JOP.18.00581
        • Zerbit J.
        • Chevret S.
        • Bernard S.
        • et al.
        Improved time to treatment failure and survival in ibrutinib-treated malignancies with a pharmaceutical care program: an observational cohort study.
        Ann Hematol. 2020; 99: 1615-1625https://doi.org/10.1007/s00277-020-04045-y
        • Association of Community Cancer Centers
        Steps to success: implementing oral oncolytics.
      2. Bogdanska W, Holle LM, Moran A, Chamberlin K. Improving adherence to recommended laboratory monitoring and adherence assessment in patients receiving oral anticancer therapies. Presented at ASHP Midyear Clinical Meeting & Exhibition, Las Vegas, NV, December 2019.

      3. Oral Chemotherapy Education.
        https://www.oralchemoedsheets.com/
        Date accessed: June 12, 2022
        • Battis B.
        • Clifford L.
        • Huq M.
        • Pejoro E.
        • Mambourg S.
        The impacts of a pharmacist-managed outpatient clinic and chemotherapy-directed electronic order sets for monitoring oral chemotherapy.
        J Oncol Pharm Pract. 2017; 23: 582-590https://doi.org/10.1177/1078155216672314
        • Morgan K.P.
        • Muluneh B.
        • Deal A.M.
        • Amerine L.B.
        Impact of an integrated oral chemotherapy program on patient adherence.
        J Oncol Pharm Pract. 2018; 24: 332-336https://doi.org/10.1177/1078155217703792
        • Muluneh B.
        • Deal A.
        • Alexander M.D.
        • et al.
        Patient perspectives on the barriers associated with medication adherence to oral chemotherapy.
        J Oncol Pharm Pract. 2018; 24: 98-109https://doi.org/10.1177/1078155216679026
        • Wong S.F.
        • Bounthavong M.
        • Nguyen C.P.
        • Chen T.
        Outcome assessments and cost avoidance of an oral chemotherapy management clinic.
        J Natl Compr Canc Netw. 2016; 14: 279-285https://doi.org/10.6004/jnccn.2016.0033

      Biography

      Andrea Moran, DNP, NP is affiliated with UConn Health, and is the Lead Hematology/Oncology APRN at Neag Comprehensive Cancer Center in Farmington, CT, and can be contacted at [email protected]

      Biography

      Joy Elwell, DNP, FNP-BC, CNE, is the DNP program director at the University of Connecticut School of Nursing in Storrs, CT.

      Biography

      Lisa Holle, PharmD, BCOP, is a clinical professor with the University of Connecticut School of Pharmacy in Storrs, CT.

      Biography

      Karen Hook, MD, is a Hematologist with UConn Health, Neag Comprehensive Cancer Center in Farmington, CT.