Purpose: The purpose of this evaluation was to assess current lab monitoring and medication adherence in patients on oral oncologic pharmacotherapy at the Milo C. Huempfner CBOC and implement a pharmacist-managed monitoring protocol.
Background: The realm of cancer therapy has changed significantly with the increased availability and use of oral oncologic agents. Oral agents offers patients a convenient, non-invasive option compared with intravenous therapy. In addition, oral agents offers flexibility in timing and location of administration. However, disadvantages of utilizing oral agents include reduced clinical supervision, loss to follow-up, and potentially decreased adherence. Furthermore, oral agents can be associated with significant drug-drug interactions and require lab monitoring to minimize toxicities and treatment lapses. Therefore, regular follow-up of patients on oral agents is crucial. Current practice at the Milo C. Huempfner CBOC does not include a defined monitoring protocol for patients who are on oral oncologic agents.
Methods: A list was generated of all veterans with a current prescription for an oral oncologic agent at the Milo C. Huempfner CBOC between April 2016 to April 2017. Forty-four patients were identified and 29 patients were included. Data was collected via retrospective chart review. Medication adherence and lab monitoring was determined by a refill and labs obtained every 30 days, respectively. Data is being collected to assess the impact of a pharmacist-managed monitoring protocol on medication and lab adherence and pharmacist interventions.
Results: There were 7 agents included in the study, and it was concluded that patients have good medication adherence (97.01%) but poor compliance with lab monitoring (61.92%). Since the implementation of the pharmacist-managed protocol, medication adherence and lab monitoring are 100%. In addition, various interventions have been performed, including but not limited to, dose reductions or withholding therapy secondary to symptoms and/or lab values, elimination of drug-drug interactions, increased blood pressure control, and supplementation for lab abnormalities.
Conclusions: These results illustrate the need for an established lab monitoring protocol for patients on oral oncologic agents and a designated provider to provide routine assessment of labs for appropriateness of therapy and address adherence concerns.
