Oncology Pharmacy Program Ensures Medication Adherence

Ted Wun, MD

Professor

Chief of Hematology and Oncology

UC Davis Comprehensive Cancer Center,

The rise of oral anticancer agents is revolutionizing cancer treatment for both patients and cancer care providers. Patients can take their medications in the comfort of their own homes without the need for needles, long stints in infusion chairs or intensive nursing oversight. They often require fewer office visits and feel a greater sense of control of their treatment.

But oral chemotherapy and targeted drugs taken orally are often no less potent than infused chemotherapies, and patients still experience side effects that need to be managed. UC Davis Comprehensive Cancer Center has started a program to help monitor patients on these medications.

The Medication Adherence Program, created in 2013 by the UC Davis Departments of Pharmacy and Internal Medicine, and the Division of Hematology and Oncology, is designed to ensure patients receiving any oral anticancer drug stick to their treatment regimens to safely maximize the drugs’ effectiveness and minimize or manage side effects.

A pilot study involving 44 patients enrolled in the program demonstrated that 92% of participants adhered to their regimens, and the UC Davis Comprehensive Cancer Center now employs a full-time pharmacist to administer the program to all interested patients.

The pilot program design was the result of fusing various components of different pharmacy services at UC Davis. To ensure patients understand their oral chemotherapy regimens, for example, the program borrowed a patient education component from the UC Davis Anticoagulation Clinic, which has demonstrated that one-on-one counseling is effective in helping patients adhere to medications for anticoagulation, hypertension, congestive heart failure, and related conditions. The pilot also was influenced by the UC Davis Pharmacy Prescription Renewal Clinic. Implemented at the Cancer Center in 2013, the clinic served as an invaluable model for designing a standardized and efficient method for processing prescription renewals and prior authorization requests.

Oral anticancer agents span the spectrum of hormonal therapies, molecularly targeted therapies, and cytotoxic chemotherapy. In addition, many traditional chemotherapy drugs are also being developed in oral formulations, allowing for more continuous exposure of the drug in the patient over time, which can be more effective and less toxic.

However, studies show adherence to oral chemotherapy drugs varies from 16% to 100% in adult populations and these rates often drop over time with longer treatment regimens. Many patients on oral anticancer drugs either stop taking them because of unwanted side effects, or forget to take them regularly. Stopping the medication or not following the directions correctly can affect treatment efficacy, produce misleading results, and cause higher mortality. It’s important that oncologists have confidence the drug is being taken.

The Medical Adherence Program uses education, monitoring, and one-on-one counseling to help patients manage their medication regimen and help oncologists determine the effectiveness of prescribed cancer treatments.

Pharmacists call patients monthly, asking them how many pills they have left, when they will be back at the cancer center for refills, or whether they would like their medications mailed. They ask about side effects and talk about what to expect. Pharmacists go over drug regimens and offer practical tips, such as how to maintain a medication calendar or handle a missed dose.

Often the pharmacist will follow up by contacting the patient’s oncologist to discuss a possible medication change when symptoms or side effects warrant. Patients enrolled in the program also can make an appointment with a pharmacist or a nurse practitioner at any time to ask a question about their drug regimens.

Patients enrolled in the program say they like the extra layer of protection the program affords them. One 71-year-old patient with metastatic kidney cancer said he appreciates the calls and reminders because his medication regimen already is complicated, with oral chemotherapy in addition to 11 additional medications for other health conditions.

And at UC Davis, where many patients travel as many as 100 miles for cancer care, the program provides a sense of security. Said one 80-year-old metastatic breast cancer patient who lives nearly 60 miles outside of Sacramento, “just knowing someone is checking up on me is comforting.”

The Medical Adherence Program also works with medical insurance companies to ensure patients have access to the drugs they need in a timely manner. Unlike coverage for other medications, administration of insurance benefits for oral chemotherapy agents can be complex, requiring longer prior authorization processes, payments of higher deductibles, and additional steps that can often delay access to critical medications. The pilot program dedicates staff members to serve as liaisons between the patient and the insurance company to expedite medication approvals and to find solutions for patients if they are unable to cover the cost. Staff will contact various resources on the patient’s behalf to fund the medication if the patient is uninsured or unable to make the copayment.