Implementation and preliminary outcomes of a comprehensive oral chemotherapy management clinic.

Abstract

Improved outcomes achieved by an oral chemotherapy management (OCM) clinic, including a reduction in the need for medication-related interventions, are reported. A retrospective observational cohort study was conducted to assess the effectiveness of an OCM clinic providing comprehensive medication therapy management (MTM) services, including education on various oral chemotherapy agents, concurrent medications, and symptom management, as well as insurance assistance. Patient demographics, self-rated depression scores, and data on concurrent medication use, types of interventions, and intervention outcomes were collected at baseline and at follow-up visits for up to three months. Thirty clinic patients (9 men and 21 women with a mean age of 64.5 years) were evaluated; the majority had advanced-stage cancer and no live-in caregiver. On average, the patients had 2.8 comorbid conditions, including hypertension (43%), chronic pain (43%), and diabetes (37%), and were taking 12.7 concurrent medications (range, 3-26). In general, OCM clinic interventions in five categories (adverse events, adherence, drug interactions, medication errors, and symptom management) decreased during the measured time periods. About 70% of OCM clinic interventions were associated with positive outcomes (i.e., complete resolution of event or improved response to therapy), with 67% and 36% of interventions resulting in potential cost avoidance and cost savings, respectively. Rates of optimal oral chemotherapy adherence and persistence were estimated at 70%. An OCM clinic with comprehensive MTM services was effective in delivering early interventions, resulting in decreased rates of adverse effects, nonadherence, drug interactions, and medication errors over time.