Costs of treatment and care coordination are the top challenges when treating cancer patients with combination intravenous (IV) and oral therapies, according to a mixed-methods study of advanced practitioners (APs). These results were presented in a poster at JADPRO Live 2022, the annual APSHO meeting.

Patients undergoing cancer treatment that incorporates IV and oral anticancer agents may experience compound adverse effects and challenges related to treatment adherence, the researchers noted. The Association of Community Cancer Centers (ACCC) conducted a national mixed-methods study to assess how care coordination may be improved for these patients.

The researchers used a sequential quantitative-qualitative study design to answer questions regarding the barriers or challenges associated with combination IV/oral therapy. The quantitative phase was an online survey of health care providers working in community cancer settings. The survey results were further contextualized through focus group discussions and individual interviews in the qualitative phase.

Continue Reading

The survey was completed by 157 health care providers. The current analysis includes responses from nurse practitioners/physician assistants (21 respondents) and pharmacists (27 respondents).

Respondents were asked about the biggest challenges of treating patients with combination IV/oral therapy, effective strategies for improving care coordination, tactics to help patients adhere to oral therapy, and patients’ biggest concerns. The respondents could select up to 3 answers for each question.

Respondents said the biggest challenges of treating patients with combination IV/oral therapy were cost of care to the patient (51%), treatment coordination (45%), health insurance (43%), adherence and/or pill burden (23%), and treatment-related side effects (17%).

The most effective strategies APs identified for improving care coordination were coordination and follow-up by in-house clinicians (57%), adherence education and discussions (36%), use of external assistance programs (33%), frequent communication with specialty pharmacies to ensure timely delivery of oral medications (27%), and use of medically integrated dispensing (20%).

Useful tactics for ensuring patients adhere to their oral therapy included in-person assessment during office visits (53%), calendars and diary sheets (54%), telehealth visits (38%), phone call reminders (26%), and pill reminders (15%).

The respondents said patients’ biggest concerns were financial worry (56%), anxiety (34%), fatigue (31%), inability or decreased ability to work (30%), and patients’ perception of treatment goals (25%).

In focus group discussions, APs highlighted the importance of prioritizing efforts to prevent and mitigate financial toxicity, especially for oral therapies. Medication dispensing, tracking medication delivery, and documenting start dates were identified as challenges to coordinating care, as patients may receive their oral medications from different specialty pharmacies.

The researchers concluded that APs can improve care for patients receiving combination IV/oral therapy by proactively addressing their concerns about treatment cost and side effects. APs can play a pivotal role in improving care coordination by communicating with specialty pharmacies regarding medication dispensing, tracking delivery, and documenting start dates.

“These findings may inform the creation and dissemination of effective practices and quality improvement projects,” the researchers wrote. “These results may also help APs coordinate resources and take proactive steps to address some of the key challenges patients face during combination IV/oral anticancer therapy.”

Disclosures: This study was supported by Pfizer Oncology. The study authors did not disclose any conflicts of interest.


Kottschade LA, Hanna KS, Kim J, Plotkin E, Boehmer L. Care coordination strategies for patients receiving combination IV and oral anti-cancer therapy: Findings for advanced practitioners from a national mixed-methods study. Poster presented at: JADPRO Live 2022; October 20-23, 2022; Aurora, CO. Abstract JL1007C.