Uncovering Patient Experiences with Use of Oral Chemotherapy Agents

With the anticipated increase in the number of oral chemotherapy agents over the next several years, understanding patient perceptions and patterns towards oral anticancer therapies will be important to informing how to provide on-target, robust, and effective support for oral chemotherapy patient care.^1,2,3

Of the oncology drugs that are currently in the pipeline, approximately one third are being studied as oral formulations, while in conjunction, the number of oral oncology agents is also expected to grow between 20% and 30% each year.⁴ One of the main drivers in the increase in oral chemotherapy agents has been patient preference, namely due to the convenience associated with this route of product administration.⁵

With oral oncology agents, patients can experience greater convenience by being able to take the medications in the comfort of their own homes or personal space, make fewer work interruptions or travel arrangements for office visits, and spend less time waiting for intravenous set up and infusion. In particular, the preference towards oral oncology medications may be particularly true for patients receiving palliative treatment or for patients who may need to be on treatment for several months to years. As cancer has developed into a chronic illness and patients are able to live longer, the availability of convenient treatment is increasingly important. However, studies also show that patients are not willing to sacrifice treatment efficacy for treatment convenience.^1,5

In addition to convenience, another potential consideration associated with the use of oral anticancer therapies is that a significant part of the responsibility in managing drug regimens and monitoring for dosing/toxicity is shifted from the oncology team to the patient and/or caregiver. For some patients, having this level of direct involvement in their disease management and treatment may be empowering, while for others, this shift in responsibility can be overwhelming, especially if the appropriate family and/or caregiver support is not in place. One important component of oral oncology disease management is adherence and compliance with the prescribed course of treatment, which patients will also need to carefully manage.^1,3,5

In a recent study, researchers explored the perceptions and experiences of patients taking oral oncology medications (including caregivers) during each stage of the medication process, including choosing oral chemotherapy, prescribing, dispensing, administering, and monitoring. Conducted by a research team at the University of California, San Francisco (UCSF), the study assessed 15 current and former patients who used oral oncology medications as well as caregivers who may have administered the medications (e.g., to children, etc.) in the form of two focus group sessions. Based on the data, researchers found that many patients prefer oral oncology treatment due to its convenience, but that at the same time, the shift of care from the hospital to home setting creates concerns as well. In particular, study participants indicated that their concerns during the stages of the medication process included:²

• Lack of preparedness to manage side effects and not being equipped or familiar with possible techniques to alleviate drug toxicity
• Challenges with obtaining medications through retail pharmacies
• Uncertainty around proper administration of oral medication, especially for pediatric patients, as well as the impact of treatment on children's emotional health

To manage these patterns and experiences, study participants recommended more education (especially at the initial prescribing encounter) as well as more frequent follow-up by healthcare providers during the course of therapy.²

For an oral oncology program to be effective, there needs to be an initial assessment at both the organizational level as well as the patient level to determine if an oral regimen is in fact the most appropriate course of treatment. Once an oral regimen has been decided on, the three pillars for both healthcare providers and patients are education, communication, and follow-up. Together, these components allow patients to be involved in their disease management, while still enabling healthcare providers (namely, physicians and nurses) to maintain a significant measure of control throughout the course of treatment.¹

For more information on oral oncology programs, please review the following resources:

http://accc-cancer.org/oncology_issues/articles/mayjune09/MJ09-Barefoot.pdf

http://www.ncbi.nlm.nih.gov/pubmed/20682500

http://www.clinicaloncology.com/download/563SR-Novartis.pdf

http://www.accc-cancer.org/publications/pdf/usoncologywhitepaper.pdf

http://www.nccn.org/JNCCN/PDF/JNSU3_combined_Oral_Chemo_2008.pdf

References:

¹ Jeanette Barefoot, RN, MSSL, ONC; Carol S. Belcher, RN, MS, AOCN, APNC; Richard Emery, MS, MBA, DABR NCCN Keeping Pace with Oral Chemotherapy, NCCN Oncology Issues May/June 2009
http://accc-cancer.org/oncology_issues/articles/mayjune09/MJ09-Barefoot.pdf

² http://www.ncbi.nlm.nih.gov/pubmed/20682500

³ Carolyn Blasdel, RN, FNP, OCN.; Joseph Bubalo, PharmD, BCPS, BCOP. Adherence to Oral Cancer Therapies: Meeting the Challenge of New Patient Care Needs. Oncology Special Edition., April 2006.
http://www.clinicaloncology.com/download/563SR-Novartis.pdf

⁴ Oral Oncology Treatment Regimens and the Role of Medication Therapy Management on Patient Adherence and Compliance.
http://www.accc-cancer.org/publications/pdf/usoncologywhitepaper.pdf

⁵ Saul N. Weingart, MD, PhD; Elizabeth Brown, MD; Peter B. Bach, MD, MAPP; et al. NCCN Task Force Report: Oral Chemotherapy. Supplement JNCCN National Comprehensive Cancer Network Volume 6 Supplement 3, March 2008
http://www.nccn.org/JNCCN/PDF/JNSU3_combined_Oral_Chemo_2008.pdf