Outcome assessment of an oral chemotherapy management clinic: A preliminary report.

Abstract

105 Background: Many oral chemotherapy (OC) drugs are used in the United States. The dosage regimens of OC increase the risks of nonadherence and drug interactions leading to potential adverse consequences affecting therapeutic outcomes and patient safety. A new OC management clinic was developed where patients (pts) receive comprehensive OC and concurrent medication (CM) education and symptom management services. Follow-up cares are provided to assure continual patient education, monitoring, and safety assessments. Currently there are no published data in OC clinic practice model and outcomes. We design this evaluation to measure the effectiveness of this practice model in patient care. Methods: Pts referred to the OC management clinic by the medical oncologists were enrolled. Pt demographics, depression scores, CMs, and types and outcome of interventions at initial, 3-day, 7-day, and 3-month follow-ups were collected. Adherence and persistence rates were monitored. Results: Retrospective cohort analyses were performed in 30 pts (9 males and 21 females, mean age 64.5). Majority of pts were college and high school graduates; social drinkers; non-smokers; with advanced stage cancer (stage III = 37%, IV = 27%); and no caregiver. Pts were predominately not depressed with Zung self-rating mean score of 36 (SD, 7.72) at baseline. The most common cancer diagnosis was breast (20%), followed by colon (17%), rectal (13%), and lung (6.7%). Capecitabine was the most common agent prescribed. Pts had an average 12.7 CMs and co-morbid conditions of hypertension (43%), chronic pain (43%), and diabetes (37%). Number and complexity of interventions (categories: adverse events (ADR), adherence, drug-interactions, medication error, symptom management) decreased over measured time periods. Complete resolution or improved response seen in 67% of interventions resulting in cost avoidance (49%). Optimal adherence (no missed dose) and persistence (completion of therapy) of OC were detected in at least 67% of patients. Conclusions: This evaluation demonstrated the effectiveness of OC management clinic in delivering early interventions, resulting in decreased incidence of ADR, non-adherence, drug interactions, and medication errors over time.