Improving Patient Adherence to Oral Oncolytic's

With rates of patient adherence to oral oncolytic therapy dipping as low as 20% in some studies, care providers, patients and family members, and other patient stakeholders (such as health insurance payers and pharmacists) need to more closely work together to ensure the patient receives the full benefit of their prescribed treatment.

“Stakeholders” are those other people and organizations with reason to see the patient healthy and happy. Friends and family of the patient obviously want to see the patient productive and enjoying life as does the care provider whose mission is to support the health and well-being of their community. Other organizations have a similar interest in patients as well. Healthcare insurers face lower cost and reduced risk with patients properly taking their medications, and pharmaceutical manufacturers improve production forecast and lower cost when patients complete timely refills and don’t stop taking their meds early.

Anticancer medications account for the lion’s share of total global drug spending. Oral medications are reported to account for up to 35 percent of the current oncology pipeline.[ii] They are one of the fastest-growing areas of cancer treatment, comprising more than 25 percent of anti-cancer therapies.

An estimated 15.5 million Americans are living with cancer, and 1.69 million Americans were expected to be diagnosed with some form of cancer over the past year. The historical mainstay of pharmacologic treatment has been ambulatory, infusion-based chemotherapy; typically involving many hours of stressful treatment such as intravenous chemotherapy sessions that are time consuming, costly, and emotionally draining. Significant investment by pharmacy research and development corporations and accelerated approvals by the Food and Drug Administration (FDA) have generated a new wave of major advancements in oral anticancer therapies in the U.S., and given patients an alternative to the traditional infusion-based treatment with medications that can be administered in the privacy and comfort of their home and perhaps continuing even to work throughout their treatment.

However, there are also significant downsides: self-administration of powerful toxic therapies in an unsupervised home setting can lead to sub-optimal drug adherence and poor management of side effects, and potential adverse reactions and unintended drug interactions. The self-administration of oral oncolytic requires patients to be “organized” and “disciplined” to properly take their meds, over both the short term and long term, without oversight and to promptly report side effects. And to seek consultation when they encounter impediments to taking their meds, as the potential wastage due to premature drug discontinuations is significant.

The use of oral oncolytic by cancer patients continues to grow, despite challenges of cost and self-administration. Healthcare professionals should anticipate operational system changes and needed strategies and procedures (e.g., communications, task flow, relationship building and team coordination) to effectuate improved adherence, planned therapeutic outcomes, and high-value care. Increased oncology services with increased utilization of specially trained oncology pharmacists, nurses, nurse practitioners and physician assistants can help optimize cancer care and help address projected workforce needs in cancer management.

A 2016 survey by the Association of Community Cancer Centers showed that less than half of the cancer centers reported to have a formal oncolytic program or protocol established within their cancer program.

NotifiUs offers a solution to discuss how care providers, patients, and other patient “stakeholders” can coordinate through a program called the “Quality Improvement for Oral Oncolytic Adherence (QIOOA)”  to leverage current clinical practices with ubiquitous and low cost mobile communications, data analytics and rewards, to measure real-time patient progress toward fulfilling their prescribed medication requirements.