Abstract
There has been an increase in the development of oral cancer agents in recent years. This has created a paradigm shift in the management of the adult oncology/hematology population as patients must assume increased responsibility for understanding and adhering to the prescribed plan. An area of interest for the Oncology Nursing Society (ONS) and the American Society of Clinical Oncology (ASCO) is oral chemotherapy adherence. The Quality Oncology Practice Initiative (QOPI) sets standards for certification of oncology practices based upon key outcome measures. One area of focus is improving continuity of care and adherence for patients prescribed oral agents. A team of advanced oncology nurses at a QOPI-certified institution created a standardized process to monitor adherence in adult oncology/hematology patients taking oral oncolytic medications. We explored: 1) To what degree do patients adhere to the prescribed schedule when taking oral agents; and 2) What percentage of patients require an intervention by the healthcare team due to side effects or patient concerns? The team developed a standardized process to monitor patients prescribed oral agents. This included ensuring timely acquisition of drug and investigating possible roadblocks to payment, providing appropriate and timely education regarding dosing and side effects, and creating a telephone call system. To assess adherence, the validated eight-item Morisky Medication Adherence Scale (MMAS) was utilized to ensure standardization and to prompt routine follow-up phone calls with patients. Patients were called two weeks after initiating therapy, and either two weeks following the first call or two weeks after follow-up in the office. Discussion included tolerance, concerns, and side effects. This communication determined the need for intervention. Analysis of information obtained from phone calls showed a “high level adherence” (MMAS score 8/8) of 82% (N=162) on the first follow-up call, and 86% (N=123) on the subsequent call. Seventeen percent of patients required an intervention to address patient concerns or side effects. The MMAS score was independent of the need for intervention, with no correlation identified based on MMAS scores. A consistent systemic approach is necessary to assess adherence in patients taking oral oncolytics. There appears to be no correlation between self-reported adherence and the need for clinician intervention. Our findings suggest that follow-up phone calls and clinician assessment may be an effective approach to identify which patients need support with adhering to therapy. Examination of MMAS scoring and the link to intervention is an area of interest for future study.
