The landscape of oncology treatment has witnessed a remarkable shift toward the use of oral medications over the past 2 decades driven by advancements in the understanding of molecular alterations as well as the ability to identify actionable mutations within cancer cells. The ever-growing use of oral medications in cancer treatment necessitates a holistic and collaborative approach to patient care in which oncology navigators play a crucial role, according to Mary Anderson, BSN, RN, OCN, and Nora Hansen, CPhT, COPh.
Effective communication and collaboration among healthcare disciplines are crucial components of successful oral anticancer therapy. By navigating the complexities of these therapies as a united healthcare team, patients can feel empowered and be active participants in their own care.
At the AONN+ Annual Conference in San Antonio, TX, Ms Anderson, senior manager of nursing initiatives at the National Community Oncology Dispensing Association, and Ms Hansen, oncology pharmacy technician and patient benefit rep at Illinois Cancer Specialists, delved into the complexities associated with oral anticancer medication adherence, emphasizing the need for ongoing support, education, and monitoring to ensure successful treatment outcomes.
While the adoption of oral therapies offers more day-to-day flexibility for people undergoing cancer treatment, it also introduces a significant responsibility for these patients to manage complex treatment regimens and safety protocols. The misconception that oral treatments are inherently easier to administer than infusion therapies can overshadow the often intricate tasks patients must handle on their own, including self-administration, proper medication storage and disposal, and properly identifying and managing side effects (including knowing when to call their doctor).
“Taking oral anticancer medications does allow for more flexibility in regard to schedules, lifestyle, and transportation concerns,” noted Ms Anderson. “But the burden is still placed on the patient.”
Adherence, the extent to which patients follow prescribed medication regimens (including time of day, with/without food, number of pills, etc), is a crucial factor in treatment success, but it can become complicated for patients. Ms Hansen noted that the term “adherence” is preferred over “compliance” to empower patients and recognize the active role they play in managing their own health. Poor adherence can be catastrophic when it comes to oral anticancer medications, as it correlates with adverse outcomes such as increased emergency service utilization and hospital admissions, unmanaged side effects, diminished quality of life, treatment discontinuation, and overall treatment failure.
Patients taking these medications are also responsible for calling in their own refills, and a roadblock as seemingly minor as losing the number to the pharmacy can lead to treatment delays.
Ms Hansen noted that follow-up calls are standard after filling prescriptions at her organization (asking patients how many pills they have left, when they’re ready for a refill, etc), but often, insurance companies mandate which pharmacies patients can use, and they don’t receive the same follow-up calls.
“The responsibility that we put on the patient underscores the need for ongoing support and monitoring throughout the trajectory of the patient’s entire treatment regimen,” Ms Anderson noted. “As a result, practices are challenged to develop workflows that support patients taking oral medications, and to empower them to be active participants in their health care.”
Caring for patients undergoing oral anticancer therapy is a complex, multifaceted process involving multiple prescription and patient touchpoints.
“These touchpoints present operational challenges for the practice, as each facet may vary in terms of who is performing the task, the timing involved, and the outcome of each touchpoint,” said Ms Anderson. “In some instances, one activity cannot be initiated until the other one is completed, while at other times, multiple actions may be occurring simultaneously.”
A reactive approach to these touchpoints can result in prescription errors, treatment delays, or patients falling through the gaps in the healthcare system; therefore, a proactive approach is essential in tracking and communicating touchpoints effectively.
“Without a proactive process, the burden is placed on the patient, and they have to navigate this confusing, scary, seemingly impossible journey to even acquire their medication,” she added.
A multidisciplinary approach involving oncologists, pharmacists, nurses, and navigators is paramount to ensuring a seamless treatment journey for patients. From the moment the prescription is written until the patient acquires the medication, every touchpoint must be meticulously managed to prevent delays in care.
Nursing plays a pivotal role in patient education and support for those undergoing oral anticancer therapy.
“Patients taking oral therapies must have the same—if not more—education, care, and support as our patients receiving infusion therapies,” Ms Anderson emphasized. “We still have to follow that nursing process in which we individualize care for each patient. This is something we really need to pride ourselves on as nurses; we cannot give up this role to pharmacists. We’re the ones that individualize patient care based on our assessments, so early and ongoing contact with nursing is essential.”
A comprehensive nursing assessment identifies barriers to adherence, evaluates the complexity of a treatment regimen, and addresses individual patient needs. This proactive approach allows for early intervention and coordination of care, all while alleviating any potential barriers.
