Impact of oncology pharmacist-managed oral anticancer therapy in patients with chronic myelogenous leukemia

Abstract

Background

Studies have identified non-adherence as one of the major contributing factors to treatment failure in chronic myelogenous leukemia (CML) patients receiving imatinib. Published literature has demonstrated a unique role of oncology pharmacists, as part of a multidisciplinary team, in contributing to overall positive outcomes for patients.

Study objective

To evaluate the impact of an oncology pharmacist-managed oral anticancer therapy program on oral medication adherence in CML patients versus usual care.

Methods

Electronic refill history and medical records of patients diagnosed with CML treated with oral tyrosine kinase inhibitors (TKIs) managed by oncology pharmacists during a 6-year period, were retrospectively reviewed. Imatinib adherence rate, as the primary endpoint, was compared with the rate for those in the usual care group within the same organization. The secondary endpoints were descriptive to characterize pharmacist interventions for all TKIs.

Results

A total of 56 patients including 45 who were treated with imatinib, were evaluated. The group managed by oncology pharmacists resulted in a higher percentage of imatinib adherence rate compared to usual care (88.6% vs 65.8%, p = 0.0046). A total of 3432 pharmacist encounters were reviewed, and 567 interventions of six categories including side effect monitoring/management (n = 95; 16.8%); drug interaction detection (n = 109; 19.2%); TKI dose adjustment (n = 82; 14.5%); laboratory monitoring (n = 200; 35.3%); non-CML related drug choice (n = 74; 13.1%); and copay assistance (n = 7; 1.2%), were documented. This resulted in a mean of 10.1 interventions per patient.

Conclusions

Our oncology pharmacist-managed oral anticancer therapy program significantly improved TKI adherence rates in CML patients. We attribute the success of our program to consistent follow-up by utilizing routine phone, and secure email follow-ups, that allowed our oncology pharmacists to build a close and trustworthy relationship with patients and families.

Keywords

Tyrosine kinase inhibitors chronic myeloid leukemia oncology pharmacist-managed oral anticancer therapy

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References

Druker

Guilhot

O'Brien

. Five-year follow-up of patients receiving imatinib for chronic myeloid leukemia. New Engl J Med 2006; 355: 2408–2417.

Deininger M, O'Brien SG, Guilhot F, et al. International Randomized Study of Interferon vs STI571 (IRIS) 8-year follow-up: sustained survival and low risk for progression or events in patients with newly diagnosed chronic myeloid leukemia in chronic phase (CML-CP) treated with imatinib. In: 51st annual meeting of American society of hematolog, New Orleans, LA, USA, 5–8 December 2009. Vol. 114. No. 22. Abstract 1126.

Saglio

Kim

Issaragrisil

. Nilotinib versus imatinib for newly diagnosed chronic myeloid leukemia. New Engl J Med 2010; 362: 2251–2259.

Hagop

Neil

Shah

. Dasatinib versus imatinib in newly diagnosed chronic-phase chronic myeloid leukemia. New Engl J Med 2010; 362: 2260–2270.

Marin

Bazeos

Mahon

. Adherence is the critical factor for achieving molecular responses in patients with chronic myeloid leukemia who achieve complete cytogenetic responses on imatinib. J Clin Oncol 2010; 28: 2381–2388.

Darkow

Henk

Thomas

. Treatment interruptions and non-adherence with imatinib and associated healthcare costs: a retrospective analysis among managed care patients with chronic myelogenous leukaemia. Pharmacoeconomics 2007; 25: 481–496.

Dos

RSR

Quixadá

Nunes

. Adherence to treatment with imatinib in chronic myeloid leukemia: a study of the first decade of responses obtained at a Brazilian hospital. Rev Bras Hematol 2013; 35: 174–179.

Boyle

. Enhancing patient adherence to improve outcomes with oral chemotherapy proceedings from a symposium at the 22007 hematology/oncology pharmacy association annual conference. US Pharm 2007; 32: 1–8.

Holle

Boehnke

. Oncology pharmacists in health care delivery: vital members of the cancer care team. J Oncol Pract 2014; 10: e142–e145.

10.

CSJ

. Role of pharmacists in optimizing the use of anticancer drugs in the clinical setting. Integr Pharm Res Pract 2014; 3: 11–24.

11.

Shah

Dowell

Greene

. Evaluation of clinical pharmacy services in a hematology/oncology outpatient setting. Ann Pharmacother 2006; 40: 1527–1533.

12.

Wong

Mark

Nguyen

. Implementation and preliminary outcomes of a comprehensive oral chemotherapy management clinic. Am J Health Syst Pharm 2014; 71: 960–965.

13.

Campbell C. Outcomes of chronic myelogenous leukemia and adherence to imatinib therapy (CML-AIT) study. Abstract #60; platform category A2. In: 32nd annual meeting of the western state residency conference, Monterey Bay, California 22–25 May, 2012.

14.

Charlson

Pompei

Ales

. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987; 40: 373–383.

15.

Osterberg

Blaschke

. Adherence to medication. New Engl J Med 2005; 353: 487–497.

16.

Viswanathan

Golin

Jones

. Interventions to improve adherence to self-administered medications for chronic diseases in the United States: a systematic review. Ann Int Med 2012; 157: 785–795.

17.

Simchowitz

Shiman

Spencer

. Perceptions and experiences of patients receiving oral chemotherapy. Clin J Oncol Nurs 2010; 14: 447–453.

18.

Mariotto

Yabroff

Shao

. Projections of the cost of cancer care in the United States: 2010–2020. J Natl Cancer Inst 2011; 103: 117–128.

19.

Dusetzina

Winn

Abel

. Cost sharing and adherence to tyrosine kinase inhibitors for patients with chronic myeloid leukemia. J Clin Oncol 2014; 32: 306–311.

20.

Gallo

Leighl

. Symptomatic toxicities experienced during anticancer treatment agreement between patient and physician reporting in three randomized trials. J Clin Oncol 2015; 33: 910–915.