By: Kelly Powers, RN, MS, OCN
Nurse Manager, University of Maryland St. Joseph Medical Center Cancer Institute

The continued increase in the number of patients being prescribed oral chemotherapy regimens remains a challenge for all oncology centers. The majority of new drugs coming down the pipeline are given orally. This presents a challenge, as we have to rely on our patients and their families to be able to comply with often complex dosing schedules, to administer the medication safely at home, and to report side effects in a timely manner. The best way to do this is through close monitoring, and frequent contact. Thus, we have created a program at the Cancer Institute at UM SJMC that involves a patient health and medication adherence assessment at one week, and at one month, after the patient starts the drug. This phone call from the nurse navigator is in addition to any visits they make here to the Cancer Institute. The patients appreciate the additional contact, and we can be more confident that our patients are feeling well, and are taking their drugs as expected. It also gives us a chance to more proactively manage a patient that is having symptoms, rather than relying on them to call.

We have also created educational sheets for oral chemotherapy medications that mirror our IV chemotherapy medication education sheets. We have created oral chemotherapy calendar templates that can also be individualized for patients to ensure that they understand the dosing schedule for their medication. Some patients are using cell phone reminder apps to remember to take their medication.

Another challenge that we face is actually obtaining the drug for the patient. This in itself is a very complex process that involves specialty pharmacies and the patient’s insurance company. We have created a process that has greatly reduced the time it takes to get the drugs into the hands of the patient. We work with our University of Maryland Medical System Specialty Pharmacy, and they help us to determine where the medication can be filled if it cannot be filled there, and any insurance requests for authorizations or documentation. This single contact has greatly reduced our effort here at UM SJMC and streamlined the process for the patient. We have reduced the time that it takes for our patients to receive oral chemotherapy from up to several weeks to less than a week.

In addition, we have created an Epic oral chemotherapy report that provides information on the number of new patients started on oral chemotherapy and the status of the completed follow-up documentation. This provides us with the ability to audit our compliance with the one week and one month phone calls, as well as to assess our patient compliance. A recent improvement includes the creation of a visit type in Cadence called Medication Management, which will be used to schedule the follow up appointments for patients on oral chemotherapy. This will help to alert the staff who receive calls from patients who want to cancel their appointment that the missed appointment needs to be rescheduled within a few days to ensure patient safety.

We are very proud of the work that we have done in relation to the prescribing, procurement and management of patients on oral chemotherapy.

References:

  1. Yagasaki, K. & Komatsu, H. (2013). The need for nursing presence in oral chemotherapy. Clinical Journal of Oncology Nursing, 17(5).
  2. Simchowitz, B., Shiman, L., Spencer, J., Brouillard, D., Gross, A., Connor, M., & Weingart, S.N. (2010). Perceptions and experiences of patients receiving oral chemotherapy. Clinical Journal of Oncology Nursing, 14(4).
  3. Winkeljohn, D. (2010). Adherence to oral chemotherapy. Clinical Journal of Oncology Nursing, 14(4).