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Oral Oncolytic Adherence - Challenges and Solutions

February 21, 2019

Over the last decade oral chemotherapy drugs have become an important part of the treatment of many patients with cancer.  Approximately 25% of current chemotherapy treatments are administered orally, and this trend is expected to continue with 35 – 45% of oncology drugs in development projected to be oral dosage forms(1).  Unlike infusion regimens, which requires the patient to travel to a physician’s office, oral therapies enable patients to take their treatment at home.

 

This has several advantages including patient convenience, reduced patient burden of care and overall reduced cost (although improved coverage from Medicare and private insurers  for reduced co-payments may be necessary for the patient to realize the cost savings), as well as evidence of improved outcomes and survival(2).

However, this treatment method also introduces new challenges of patient safety, monitoring, and medication adherence.

 

 

 

30% of patients on oral oncolytics have less-than-optimal adherence to their treatment regimens and studies have shown that medication adherence generally decreases over time(3)  - up to 50% non-adherence, even with patients that are considered low risk for noncompliance. Given the severity of cancer and the negative implication for outcomes with poor adherence, it is imperative for organizations to ensure their patients are adherent to oral oncolytic regimens for the duration of the planned treatment. More specifically, the impact of noncompliance includes:

 

  • Increased visits to physicians over time

  • Longer Hospitalizations due to disease progression

  • Decreased Patient Satisfaction – primarily due to disease progression

  • Poor Patient – Physician Relationships

  • Compromised Patient Outcomes(4)

  • Reduced ability if Physician to determine treatment safety and efficacy(5)

 

Given the possible negative outcomes associated with noncompliance, it is important to understand WHY patients don’t comply, or have a reduction in compliance over time.  The following have been cited as being the main drivers of noncompliance:(4,5)

 

  • Presence of cognitive impairment

  • Presence of psychological problems, especially depression

  • Treatment of asymptomatic disease

  • Inadequate follow-up or discharge planning

  • Adverse effects of medication (possibly driven by toxicity)

  • Patient’s lack of belief in the benefits of treatment

  • Patient’s lack of insight into the illness

  • Missed appointments

  • Poor provider-patient relationship

  • Presence of barriers to medications or care

  • Complexity of treatment

  • Cost of medication, co-payment, or both

 

The combination of all the above leads to patients’ feeling disenfranchised - alone in their “fight” (fewer physician office visits, fewer opportunities for patient education, poorer understanding of patient emotional and social situation). A process and technology solution is required to optimize costs, patient outcomes and education.

 

 

Addressing the issues - Risk Stratification, Adherence Monitoring, Collaboration, Communication and Patient Education

 

 

 

 

It has been shown in several studies that a combination of closer collaboration, communication and patient education significantly reduces the likelihood of non-adherence (4,6,7).

 

One problem to date however has been the difficulty in enabling an effective program for a large cross section of cancer patients in a practical manner, cost effective manner.

The Willowglade Technologies Personal Involvement Platform (PIP) can be easily tailored to support Risk Stratification, Collaboration, Communication and Patient Education, addressing many of the risks and issues associated with typical oral oncolytic programs.

 

 

 

By using a series of communication and collaboration tools such as automated patient texting and/or emailing for alerts and reminders, automated escalation procedures should a patient exhibit poor PROs or decreasing medication or other adherence, or other identified risks, accurate documentation of clinical activity (by both the patient and provider team) it is anticipated that there will be a dramatic improvement in medication adherence and required monitoring of patient symptoms. (7,8,9)

 

PIP can also be levered for programs such as OCM or other value based programs, particularly for patients that require monitoring, high levels of medication adherence or ongoing review of patient outcomes – all leading to improved patient clinical, social and emotional outcomes.

 

The PIP platform was specifically designed with the intent of “involving” the patient in their own care. By taking this unique approach, the patient is an active member of their own “care team”   - contributing data and patient reporting outcomes. As such the patient feels much more a part of their own road to recovery, will adhere to medication regimens more closely and ultimately drive superior outcomes for themselves as well with their surrounding clinical team.

 

To learn more about Willowglade Technologies and our solutions please contact us at info@willowgladetechnologies.com.

 

References:

  1. https://www.specialtypharmacytimes.com/publications/specialty-pharmacy-times/2016/june-2016/adherence-to-oral-oncolytics-requires-a-clinically-integrated-approach-to-specialty-pharmacy

  2. http://www.communityoncology.org/pdfs/avalere-coa-oral-oncolytics-study-summary-report.pdf

  3. http://ascopubs.org/doi/abs/10.1200/JCO.2017.35.8_suppl.190

  4. https://www.mediapost.com/publications/article/293856/elements-of-oral-chemotherapy-compliance.html

  5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5030243/

  6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5008846/

  7. http://ascopubs.org/doi/abs/10.1200/JCO.2017.35.8_suppl.190

  8. http://www.targetedonc.com/publications/targeted-therapy-news/2017/January-2017/collaborative-approach-to-specialty-pharmacy-improves-adherence-to-oral-analytics

  9.  http://nursing.onclive.com/web-exclusives/memory-problems-and-depression-can-predict-nonadherence-to-oral-anticancer-agents

     

     

     

     

     

     

     

     

     

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