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General Discussions

Oral Chemotherapy

By Lisa Schulmeister, MN, RN, ACNS-BC, OCN, FAAN
Increased use of oral chemotherapy has prompted various procedures for assessing patients’ toxicities and adherence. An office practice in Michigan conducted a baseline chart audit of prescription date, actual start date, and any documented problems with the oral chemotherapy for patients treated from May of 2011 to July 2013. The practice subsequently joined the Michigan Oncology Quality Consortium’s oral chemotherapy collaborative and began identifying all patients on oral chemotherapy, implemented the Edmonton Symptoms Assessment System, and offered a self-care management education program that included patient self-monitoring of symptoms. A post-intervention audit was conducted from August 2013 to March 2014.

The practice staff identified 25 patients taking oral chemotherapy in the first time period and 13 in the second. In the first time period, they found that only 13 of the 25 patients had an actual start date documented, and of these 13, 10 had a 4 week or longer delay prior to starting therapy, and 3 of the 13 had a 2-4 week delay prior to start of therapy. Twelve of the 25 patients experienced toxicities and discontinued their oral chemotherapy within the first month without consulting their physician. After participating in the quality initiative, the staff identified only one patient without a documented start date, only 1/13 that had longer than a 4 week delay from prescription date to starting the oral chemotherapy. Most (12/13) had a less than 2 week lapse. Staff also found that no patients discontinued the oral chemotherapy and only one dose reduction occurred, which was directed by the patient’s physician. The office practice staff concluded that simple measures can be implemented to improve assessment of toxicities and adherence to oral chemotherapy.

Mahmood t, et al. Oral oncolytics: Patient-monitoring improvements in private practice. J Clin Oncol 2014; 32: suppl 31; abstr 215.
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