Implementation of oral chemotherapy management program in the large integrated health care system and its impact on patient safety
Yoo J, Nhean S, Vogel P, Rybkin II, and Kostoff D. Implementation of oral chemotherapy management program in the large integrated health care system and its impact on patient safety. J Clin Oncol 2018; 36(30)
Background: Oral chemotherapy is a progressively growing portion of antineoplastic agents. Although convenient for the patient, it creates a unique challenges for the drug complacency and safety. To address these issues variety of programs and solutions were proposed, ranging from the smart pill bottles and mobile phone applications to telemedicine monitoring programs. This presentation describes development and implementation of the integrated monitoring program within a large health care system and assess impact of this program on patients safety and compliance. Methods: This is a retrospective, quasi-experimental study that compared outcomes of the patients treated with capecitabine, before and after implementation of OCMP (Oral Chemotherapy Management Program) in the Henry Ford Health System. The primary outcome was incidence of all grade and specifically grade 3-4 toxicities commonly associated with capecitabine. Secondary outcomes included emergency department (ED) visits and hospitalizations due to toxicity, adherence rates, and number of clinical interventions. Results: The incidence of adverse effects of Any Grade was significantly lower in the post-OCMP group compared to pre-OCMP group (70.3% vs 58.9%; 95% CI, 0.39-0.94; P = 0.03). All grade and grade 3-4 nausea, vomiting and diarrhea along with grade 3-4 hand-foot syndrome were significantly lower in the post-OCMP group, as well as decreased ED visits (18.9% vs. 8.6%; P = 0.005) and hospitalizations due to toxicities (17.1% vs. 6.3%; P = 0.002). The study also found higher adherence rates in the post-OCMP group. In the post-OCMP period, more than 50% of the patients required clinical interventions by OCMP nurse, mostly for side effect management. Conclusions: Administration of capecitabine on OCMP reduced rate of higher grade adverse events, most likely due to early intervention. OCMP implementation was associated with decreased rate of ED visits and hospitalizations due to the side effects. Patients who were managed by OCMP had higher adherence rates to the prescribed oral chemotherapy.