Turning on the lights in gastrointestinal oncology: How digital medicines reveal clinical insights on medication adherence and patient behaviors.

Abstract

e15118 Background: Oral therapies in colorectal cancer (CRC) introduce unique complexities in care. Understanding adherence in patients using capecitabine can be challenging. The Discover Program, a novel digital medicine program (DMP), was integrated into the treatment of CRC patients at Fairview Health Services and University of Minnesota Health, the first ever DMP in the field of oncology. The DMP consists of DigiMeds (medications with ingestible sensors), a small wearable patch, and a mobile app, which enable collection of objective adherence data, alongside biometrics (e.g., steps, rest, resting heart rate) giving patients, caregivers, and providers the ability to confirm treatment start dates, address missed doses and observe changes in physical function. Methods: From September 2018 to December 2018, patients with CRC were enrolled in the DMP. Clinical pharmacists (CPs) monitored adherence data and patient metrics through a secure web portal to enhance regular follow-up, address barriers to adherence, reveal unreported Adverse Events (AE), provide coaching and education, and target therapy adjustments when appropriate. Qualitative data regarding pharmacists’ experiences with the DMP and their evolving interactions with patients were collected. Results: Seven patients were enrolled in the DMP (mean age: 62.1 ± 8.45 years (mean ± SD); 85.7% female; patch wear: 92.4% ± 6.8%; average adherence: 89.7%± 7.8%; average days on DMP: 55.6± 39.2 days). CPs reported that objective medication adherence data eliminated the challenge of navigating patient recall about their medication taking and health overall. The DMP allowed prompt and tailored interventions for patients struggling with adherence to prescribed regimens and/or AEs. These interventions were more focused, personalized, and clinically meaningful with improved shared decision-making, increased patient engagement/adherence, and more efficient/effective AE management. Conclusions: DMP data yielded significant insights that are not available in the absence of this novel technology. Future pragmatic, large real-world studies are recommended to assess the impact of DMP on adherence, AE management, and clinical and economic outcomes.