SAN ANTONIO, Tex.–Follow-up telephone calls and clinician assessment may be an effective strategy to identify early which patients require support with adhering to oral cancer therapy, a study presented at the ONS 41st Annual Congress has shown.1
Because medication adherence is a concern with oral cancer therapies, a team of advanced oncology nurses at Baptist Health CBC Group in Louisville, Kentucky, developed a standardized process to monitor adherence in patients with solid and hematologic malignancies receiving oral agents.
“We explored to what degree do patients adhere to their prescribed schedule and what percentage of patients require an intervention by the health care team due to drug-related toxicities or patient concerns,” said Whitney Perry, APRN, AOCNP, an advanced practice nurse at Baptist Health CBC Group.
At the time of oral therapy prescription, the nurse educates the patient and family about possible side effects and appropriate medication adherence; provides written materials on drug side effects; home management of side effects, and when to call the office, obtains consent; and provides a written copy of the treatment plan.
Two weeks from the anticipated delivery of medication to the patient, the nurse practitioner calls the patient or completes a follow-up office visit. To assess adherence, the nurse practitioner performs the Morisky Adherence Score and documents it in the electronic health record. He or she also checks the patient’s follow-up visit and laboratory/study schedule, and addresses any adverse event or adherence issues as appropriate. The process is completed again 2 weeks later.
The nurse practitioners evaluate adherence by verifying that the patient is taking the drug at the right time, taking the right dose, and with or without food if appropriate. They also confirm that no doses have been missed.
An analysis of the new process showed that 82% of the 162 patients were adherent to their medication regimen on the first follow-up call, and 86% were adherent on the second follow-up call. A total of 17% of patients needed an intervention to address patient concerns or toxicities.
Of note, patients being educated by physicians, thereby bypassing the written treatment summary, is an ongoing concern.
1. Perry W, Cassady S, Mitchell K. Adherence to oral cancer therapies in the adult oncology/hematology patient. Oral presentation at: 2016 Oncology Nursing Society Annual Congress; April 28-May 1, 2016; San Antonio, TX.