DENVER, CO—Predications for the next 3 to 5 years indicate that 50% of all oncology/hematology treatments will be oral oncolytics. Oncology practices need to develop programs to manage the treatment of patients following these regimens, said Jody Pelusi, PhD, FNP, AOCNP, of Arizona Oncology Associates in Sedona, Arizona, in her presentation at the 2015 Oncology Nurse Advisor Navigator Summit.
Ninety-two oral drugs are currently approved for treatment of cancers, and there are more in the pipeline. Guidelines that support the shift to oral treatment are in place. It is up to oncology practices to take on a philosophy of a team approach to patient- and family-centered oncology/hematology oral treatments. “We have to begin to think about how everyone in the practice has to have a piece of the pie,” explained Pelusi. Her oral medical management program includes 13 specific elements that are consistent for providing quality cancer care.
Although each oncology practice is unique in terms of personnel and skills, oncology nurse navigators have a critical role in matching and supporting the staff for each element. Initiating the process involves evaluating what components you already have in your practice, what are patient and caregiver needs and expectations, what are your staff needs and expectations, and what are the needs and expectations of the practice.
This program has a role for everyone in the practice. It is up to navigators to evaluate what they currently have in their practice, then fill in the gaps and connect the dots.
Staff education This is an important first step. “You cannot provide your service if you don’t have a competent staff,” stressed Pelusi. Your staff needs to know the process and what each staff person’s role is in that process. Education must be both ongoing and periodically evaluated. In addition, whatever you decide to do in terms of ongoing staff education—in house, self-learning modules, online conferences—make it part of the competencies, suggested Pelusi.
Patient/caregiver selection Not every patient is a suitable candidate for oral drug therapy. Patient/caregiver selection should consider what is going on in the patient’s life that could compromise their ability to adhere to an oral drug regimen needs to be in place.
Patient/caregiver education Discuss the treatment options with the patient and the caregiver, as well as the oncology care team. Ensure that patients and caregivers know this is a partnership; they have a role and responsibilities toward the success of their treatment plan.
Pretreatment evaluation Navigators should check for any labs and imaging studies needed for baseline evaluation and dosing, and if there are, see that they are obtained and documented. In addition, evaluate the patient and home environment.
Medical acquisition Navigators will need to work with insurers and oncology pharmacists to complete authorization processes, identify who will fill the prescription, understand the refill policy, confirm when the medication will be delivered to the patient, and determine a start date.
Informed consent This step needs to emphasize the unique characteristics of an oral drug treatment plan, including the patient’s role in managing their drug administration, awareness of side effects, and responsibilities to report these effects to the oncology care team. At her practice, Pelusi’s team changed the consent forms to incorporate the patient’s role in maintaining a successful oral program. “This is a partnership,” she explained.