The advances towards oral chemotherapies have made more convenient treatment options for patients. With advances comes new challenges that are presented for clinicians, particularly in medication adherence.
Nonadherence rates go as high as 46%– a definite cause for concern that urgently needs a call to action. There is no sole cause to nonadherence. It is manifested by a variety of factors that includes individual patient characteristics, disease type, treatment specifics, and provider and system components. Although some of the factors exist beyond the scope of influence, improvement in adherence is nonetheless attainable. It can be improved through a multifaceted approach that consists of strategic interdisciplinary planning, collaborative technology implementation, and dedicated follow-through.
What’s new, what’s not
The approval and availability of oral chemotherapy agents in the course of two decades changed how cancer treatment is delivered. It provided patients the ability and convenience to administer treatments at home, which reduced the frequency of clinic visits for intravenous therapy.
What hasn’t changed is the need for accurate monitoring, ongoing communication, education evaluation, and reassessment of patient response to ensure the best outcomes possible.
Jody Pelusi, PhD, FNP, AOCNP, the first nonphysician member of the FDA’s Oncologic Drugs Advisory Committee and highly regarded expert in oral adherence, once recalled her concerns in an interview with Oncology Nursing News about how the patients would be educated, monitored, and managed when Capecitabine’s initial approval for use in 1998. She realized the importance of establishing a process for community practices to manage patients now taking oral agents.
Adherence, outcomes, and the future
Adherence is the key to achieving optional patient outcomes. “It’s the clinician’s responsibility to make sure patients understand how taking their medications as ordered will help them reach their goal, whether it be for cure, to slow tumor progression, prevention, or palliation,” Pelusi says.
Forming relationships and partnerships with patients and seeking novel ways to help them manage their oral therapy are crucial for treatment to work as intended.
The nurse support system is pivotal in the patient partnership. Oral therapy will only continue to grow from here. This is the future of oncology treatments, and nurses have to embrace this. It goes back to basics of what nursing truly is about. Nurses must assess the patient, educate the patient, and monitor the patient.
As more oral chemotherapy agents are developed and approved, physicians, nurses, pharmacists, and other members of cancer care teams must have a system in place that promotes the same high level of management for patients receiving oral treatment at home as those receiving intravenous therapy in clinic.
The future of medication adherence solutions is also developing in parallel. There have been novel technologies out in the market to combat medication nonadherence. Nurse support teams can leverage these adherence technology solutions as an added layer of support to manage the patient nonadherence issue. There are solutions that help to simply remind the patient when to take the proper dosing, but other technologies have a more multifaceted solution gathering patient data for intelligence so the nurses can establish an actionable plan to improve how they support their patient.
The key to meeting patient and provider goals for treatment is having a workable process in place that weaves care and technology together. Pelusi strongly stated, “Believe it or not, once you have the process, oral therapy can run like clockwork.”