Transportation, Logistics of Importance to Community Care With CDK4/6 Inhibitors

Community providers seem to be acclimated to the varied adverse effect (AE) profiles with CDK4/6 inhibitors now, and more concerned with transportation issues for their patients, said Kimberly Podsada, BSN, RN, MSN, NP-C, a nurse practitioner at the University of California San Diego, after moderating a Case-Based Roundtable on CDK4/6 inhibitors in patients with hormone receptor (HR)–positive metastatic breast cancer.

Having moderated a previous meeting of this type before, Podsada said she noticed a shift in the concerns of community advanced practice providers (APPs) from managing difficult AE profiles, which range from gastrointestinal issues to QTc prolongation and neutropenia depending on the agent prescribed, to transportation issues for patients.

Between greater confidence using and understanding how each AEs of each CDK4/6 inhibitor are likely to present, care teams can focus on ensuring patient access to care through coordinated nurse navigators.

Nurse navigators assist the patient and the rest of the care team in ensuring appointments are scheduled for the same day or connecting patients with travel assistance such as vouchers for taxis, Uber, or Lyft as funds permit.

Transcript

I got a sense that people are more comfortable now with managing the CDK4/6 inhibitor adverse effect profile, although that was a big topic of discussion as well. Access to care was what we mostly talked about—and not just for patients in the community or rural, but even more local, to their hospital or clinic, and patients taking their medicine at home.

Now the need to have so many frequent blood draws or EKGs up front can be a burden on the patient, as well as making that that commute, having access to transportation, not having family support, or not being able to afford to take a taxi, Lyft, or Uber.

Most offices now have this nurse navigator role, or someone in the office who was calling patients, checking on them, seeing how they’re tolerating medications, making sure they have their appointments scheduled for their follow-up labs. Some of the offices offered home health services so they could send someone out to the home to do a blood draw. Some offered taxi vouchers, but even those were really limited by how much funding the clinic had to provide transportation costs.

It was interesting to hear some of the different methods of each clinic on how they were trying to help their patient, whether that meant going to a lab that was closer to their home vs having to come into the clinic. Then, of course, when they have to come into the clinic for a visit anyway, trying to consolidate all of those scheduled and necessary events on the same day. If they’re coming in for some other supportive medications, how can we consolidate appointments for the patient on the same day? [There are] still some challenges with that 2-week interval to get blood work done.

This transcript has been edited for clarity and conciseness.