|The following article features coverage from the 2017 ONA Navigation Summit in Austin, Texas. Click here to read more of Oncology Nurse Advisor‘s conference coverage.|
Approximately 25% to 30% of all new drugs for cancer in development are oral agents. This represents a paradigm shift in oncology patient care and practice changes. This shift to oral therapy reflects the chronic nature of cancer care, with patients living with cancer much longer than ever.
Oral therapy brings new challenges to oncology practices, because more of the therapy is taken at home under patient/caregiver control. With fewer office visits and less supervision by health care professionals, efficacy, safety, and adherence are of utmost concern. Very quickly it is realized that oral cancer therapy is “not just a pill,” and has significant consequences if not adhered to properly. Oncology practices are redesigning workflow, to emphasize and put more effort into access to medications for patients, education, monitoring, and adherence.
It has been reported that oral adherence to oncology medications is less than 80%. This problem can begin by a patient never receiving the medication at the outset, or not refilling it at a later date. Treatment and patient outcomes can therefore be affected. Adherence can be defined as the extent of conformity to recommended day-to-day treatment plan with respect to timing, dosing, and frequency. Adherence also implies shared decision-making with the patient and provider.
Several factors have been associated with non-adherence and safety. Patient-related factors include education and income, suboptimal social support, lack of perceived need for the medication, and depressed state. Condition related factors include comorbidities. Therapy-related factors include drug toxicities and polypharmacy issues. Health care related factors include communication, patient/provider relationship, and utilization of emergency department or hospitalizations. Lastly, safety issues related to oral therapy include medication errors (eg, dose, timing), drug toxicities, drug-to-drug interactions, and safe handling of the medications.