Abstract
Interprofessional care is exhibited in outpatient oncology practices where practitioners from a myriad of specialties (e.g., oncology, nursing, pharmacy, health informatics and others) work collectively with patients to enhance therapeutic outcomes and minimize adverse effects. Historically, most ambulatory-based anticancer medication therapies have been administrated in infusion clinics or physician offices. Oral anticancer medications (OAMs) have become increasingly prevalent and preferred by patients for use in residential or other non-clinic settings. Self-administration of OAMs represents a significant shift in the management of cancer care and role responsibilities for patients and clinicians. While patients have a greater sense of empowerment and convenience when taking OAMs, adherence is a greater challenge than with intravenous therapies. This paper proposes use of a qualitative systems evaluation, based on theoretical frameworks for interdisciplinary team collaboration and systems science, to examine the social interactionism involved with the use of intravenous anticancer treatments and OAMs (as treatment technologies) by describing patient, organizational, and social systems considerations in communication, care, control, and context (i.e., Kaplan’s 4Cs). This conceptualization can help the healthcare system prepare for substantial workforce changes in cancer management, including increased utilization of oncology pharmacists.
Highlights
Pharmacologic anticancer therapies are increasingly shifting from clinic-based infusions to orally-administered medications by patients and/or their informal caregivers, thereby changing patient and health professional roles, responsibilities, and priorities [1,2]
This paper considers IV anticancer therapies and Oral anticancer medications (OAMs) treatment modalities as ‘technologies’, different from but analogous to the health informatics technology originally described in the context of social interactionism
As a result of the complexity of OAM therapies, accreditation standards for specialty pharmacies have been developed by organizations such as the Accreditation Commission for Health Care (ACHC), Center for Pharmacy Practice Accreditation (CPPA), and URAC [102,103,104]
Summary
Pharmacologic anticancer therapies are increasingly shifting from clinic-based infusions to orally-administered medications by patients and/or their informal caregivers, thereby changing patient and health professional roles, responsibilities, and priorities [1,2]. Safe handling of all anticancer medications, including OAMs, is important for patients and their caregivers, in addition to healthcare professionals [16,17,18,19,20]. Consequences of non-adherent behavior include development of resistance, increased burden for patients and caregivers, disease progression, and death [10]. An estimated 10% of patients on newly-prescribed OAMs never pick up the prescription to start treatment, which could lead to dire consequences [36,37]
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