A UC Davis program designed to better manage cancer patients taking oral chemotherapy drugs has demonstrated that one-on-one counseling, education and monitoring can improve adherence to potentially life-saving cancer treatments.
The rise in oral chemotherapy development and use has heightened the need for coordinated cancer care. Oncology pharmacists and physicians worked together at UC Davis Comprehensive Cancer Center to create the Medication Adherence Pilot Program to ensure that patients stick to their regimens to safely maximize the drugs’ effectiveness and minimize or manage side effects.
Oral chemotherapy prescriptions are on the rise because many newer drugs, which target individual genes involved in tumor growth, are being developed in oral formulations, said Ted Wun, a medical oncologist and chief of the Division of Hematology and Oncology.
In addition, oral chemotherapy agents are created to allow for more continuous exposure of the drug in the patient over time, which can be more effective and may be less toxic. When oral treatment is prescribed exclusively, patients require fewer office visits and may get a greater sense of control over their treatment, Wun said.
Unlike traditional chemotherapy, which takes place in special infusion centers with nursing care, patients taking oral chemotherapy drugs may experience potentially life-threatening side effects without the information or immediate support they need. Or, patients may stop taking the medication or not follow the directions correctly, which can affect treatment efficacy, produce misleading treatment results and cause higher mortality.
“Patients are monitored when they’re here, but when they go home, it’s harder to monitor,” said Josephine Lai, the cancer center’s pharmacy supervisor, who has been assessing oral chemotherapy adherence rates since 2012. “Unlike other chronic care medications, oral chemo drugs can be more complicated. For example, one agent, Xeloda (capecitabine), is taken every 12 hours within 30 minutes of a meal for two weeks followed by a one-week break, before a new cycle begins. Sometimes we see people who didn’t realize they had a break in between their cycles.”
To improve patient care, Lai and colleagues in the UC Davis Departments of Pharmacy and Internal Medicine, and the Division of Hematology and Oncology launched the Cancer Center Medication Adherence Pilot Program in September 2013.
Patients enrolled in the program can make an appointment with a pharmacist or a nurse practitioner anytime they have a question about their drug regimen. Pharmacists also check in regularly each month to monitor patients’ progress, notify oncologists of any issues and offer practical tips, such as how to maintain a medication calendar or handle a missed dose.
Early indications suggest the program is working. In one assessment of 44 patients enrolled in the pilot program, 92 percent adhered to their drug regimens. Today, 80 patients at UC Davis Comprehensive Cancer Center are enrolled in the program. Beginning this fall, the cancer center will employ a full-time pharmacist dedicated to the program, offering the services to all UC Davis cancer patients.
“This is a great example of interdisciplinary collaboration among pharmacists, physicians, nurse practitioners and nurses,” said Lai. “And for our patients, who already face enough challenges, we hope it makes their cancer care a little easier.”
UC Davis Comprehensive Cancer Center is the only National Cancer Institute-designated center serving the Central Valley and inland Northern California, a region of more than 6 million people. Its specialists provide compassionate, comprehensive care for more than 10,000 adults and children every year, and access to more than 150 clinical trials at any given time. Its innovative research program engages more than 280 scientists at UC Davis, Lawrence Livermore National Laboratory and Jackson Laboratory (JAX West), whose scientific partnerships advance discovery of new tools to diagnose and treat cancer. Through the Cancer Care Network, UC Davis collaborates with a number of hospitals and clinical centers throughout the Central Valley and Northern California regions to offer the latest cancer care. Its community-based outreach and education programs address disparities in cancer outcomes across diverse populations. For more information, visit cancer.ucdavis.edu.