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The development of oral chemotherapy drugs has brought about great advantages for patients who can now forego intravenous therapies; however, compliance with these oral regimens remains a challenging issue.
According to one study examining patients’ experiences with taking oral chemotherapy medication, several factors can play a role in how strictly a patient adheres to a chemotherapy regimen.1 These factors include the patient’s experience with the treatment, how many medications they are taking, and their specific beliefs about the disease and medication.
Even though most of the patients interviewed in this study agreed that strict compliance with a chemotherapy medication schedule was important for overcoming the disease, many admitted to forgetting to take their medication, not taking it exactly as prescribed, or being unsure about whether they remembered to take it.
After oral chemotherapy is prescribed, standard practice is to follow-up with patients to make sure they are taking the medication as prescribed, to see if they need refills, or to monitor for adverse effects. Studies have shown, however, that a lack of established protocols for documenting the prescribing of oral chemotherapy agents, as well as adverse effects and tracking patient adherence, still exist.2
At our center, for example, a recent initiative focused on implementing an oral chemotherapy smart form in an outpatient setting showed that only approximately one-third of patients on oral chemotherapy had a documented oral chemotherapy plan, only 7% were assessed for adherence, and none had documentation reflecting efforts to address when patients were not taking their medication.
To meet this need, 2 nurses designed a smart form tool within the electronic health record (EHR) to provide a standard form for documenting the treatment plan, education, and monitoring for oral chemotherapy. The form was integrated into nursing, pharmacy, and physician workflows.
During the 8-week pilot program, 223 patients on oral chemotherapy were seen in clinic. After this period, 45% of the patients had the smart form completed and 41% had an oral chemotherapy plan documented. In addition, 87% had an administration schedule, compared with 81% prior to implementation.
Strikingly, the number of patients contacted after starting oral chemotherapy increased from 4% to 35%, and documented discussions addressing adherence increased from 0 to 78%.
Oral chemotherapy compliance is key to keeping patients safe as they undergo these difficult treatments. With the development of tools such as this smart form, nurses can have a better picture of how patients are coping with their disease and whether the care provided is effective in keeping patients on track with their oral chemotherapy. Integrated tools such as the one developed and implemented at our center may help to not only make standard care run more smoothly, but ultimately aid in producing better outcomes for patients.
Anna L. Rodriguez is chief nursing officer and vice president of Nursing and Patient Services at Fox Chase Cancer Center.
References
1. Talens A, Guilabert M, Lumbreras B, Aznar MT, López-Pintor E. Medication experience and adherence to oral chemotherapy: a qualitative study of patients’ and health professionals’ perspectives. Int J Environ Res Public Health. 2021;18(8):4266.
2. Greer JA, Amoyal N, Nisotel L, et al. A systematic review of adherence to oral antineoplastic therapies. Oncologist. 2016;21(3):354-376.
