Abstract
Oral anti-cancer therapies offer advantages over parenteral therapies in terms of their non-invasive nature and reduced intrusiveness. However, the shift from directly observed administration of these therapies to home administration means that continuous monitoring is needed. The oral anti-cancer therapy market is rapidly growing, with an ever-increasing number of new medicines available for the patients presenting with cancer illnesses. This study aims to (i) evaluate both the cost of providing monitoring consultations of oral anti-cancer therapies, and (ii) to assess the experience of cancer therapy nurses responsible for the monitoring and their opinions of the quality of the service. This study provides a mixed methods evaluation of the monitoring of oral anti-cancer therapies. Nurses were asked to record the time taken for them to perform their monitoring duties, and staff related costs were calculated using publicly available salary data. Patient-related costs were calculated using the Human Capital method. Nurses were asked to discuss their experience of monitoring oral anti-cancer therapies in semi-structured interviews. These interviews were subsequently analysed using thematic analysis. 201 recordings and their associated costs were documented. The median consultation time was 33min, costing €22.10 using Clinical Nurse Specialist salary figures and €26.51 using Advanced Nurse Practitioner salary figures. The associated patient cost was €14.06. Themes of the effect of Covid-19 on the service, expanding and complicated care package requirements, the need for dedicated oral clinics and the future of the service emerged from the interview data. The monitoring service provided by nurses may be undervalued. The commitment to fully dedicated oral anti-cancer therapy clinics and an increase in staff to align with the ongoing increase in service demand is seen as vital for the continued safe and effective delivery of this specialist cancer service.
Highlights
Cancer, as one of the most significant health problems in the world, continues to increase in prevalence
Oral anti-cancer therapies (OATs) administration provides more prolonged drug exposure compared with intermittent IV infusion, which may be important for some anti-cancer drugs with schedule-dependent efficacy (O’Neill and Twelves, 2002; Toffoli et al, 2004)
The median time per monitoring consultation was 33 min, giving a median cost of €22.10 when using the Clinical Nurse Specialist adjusted salary and €26.51 when using the Advanced Nurse Practitioner adjusted salary respectively. This time per visit is broadly in line with the results reported by (Guy and Richardson, 2012) who measured the time per patient visit to an outpatient oncology clinic and reported an average visit time of 24.7 min
Summary
As one of the most significant health problems in the world, continues to increase in prevalence. The Global Cancer Incidence, Mortality and Prevalence (GLOBOCAN) 2018 report estimated 18.1 million new cancer cases and 9.6 million cancer deaths in 2018 (Bray et al, 2018). With these epidemiological data, cancer therapies have come under increased focus for pharmaceutical manufacturers. Oral anti-cancer therapies (OATs) have become more common as part of cancer care due to their improved targeting of cancer cells when compared to traditional chemotherapeutic agents. The number of OATs being approved for patient reim bursement in Ireland has outnumbered the more traditional parenteral therapies (Health Service Executive, 2021a). A recent review of the literature found that 84.1% of patients have a stated preference for OATs rather than parenteral agents (Eek et al, 2016)
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