With the volume of oral oncolytic approvals, cancer programs are quickly adapting patient management. Oral oncolytics are self-administered oral anticancer medications, sometimes abbreviated (OAM). This therapy can be chemotherapy, targeted therapy, or even hormone therapy. Over 1 quarter of the cancer drugs in development are oral agents.
The benefits of these oral therapies are clear. Patients have more independence and control over their care, while decreasing clinic and hospital space and staff time. This advantage became more apparent during the COVID-19 pandemic. As cancer treatments continue to move outside the walls of cancer centers, oncology nurses have a pivotal role in standardizing processes to ensure drug adherence and safety of patients on oral therapies.
Addressing Safety Concerns for Patients on Oral Oncolytics
Without direct clinical supervision, patient adherence and symptom management are significant concerns. With traditional IV medications, oncology nurses administer the drug and monitor the patient for side effects. For oral therapy, side effects often contribute to patients not adhering to their regimen. In addition, the oncology team must ensure that patients understand how drug-drug and drug-food interactions can intensify side effects or cause ineffectiveness of the drug.
“It is a misconception that oral oncolytics do not pose the same risks and side effects as IV medications, and that is not the case,” states Katie Grotzinger, RN, BSN, an oral oncolytic nurse navigator at Advent Health in Hendersonville, North Carolina. Patients on oral medications often underreport side effects or missed doses to their provider, raising concerns that patients on oral oncolytics will “fall between the cracks.” Poor management of symptoms and nonadherence can lead to disease progression and increased mortality rates.
Standardizing Care for Oral Oncolytics
In response to more oral therapies, many cancer centers are creating standardized oral oncolytic programs to improve patient care. Policies and procedures, workflow processes, education, patient tracking tools, and outcomes measurement data are some of these programs’ essential elements. In addition, many cancer programs designate a clinical role for overseeing these patients. “My role is to help patients from start to finish to ensure no patients fall between the cracks,” explains Katie Grotzinger.
Although the health care professional (HCP) performing this role varies by the organization (eg, RN, nurse practitioner, pharmacist, physician associate – formerly known as assistant), a dedicated person performs the following tasks:
- Identify patients starting an oral oncolytic
- Ensure insurance medication coverage or locate financial assistance
- Locate specialty pharmacies to provide medications
- Assess for barriers to medication adherence (eg, cost, access, physical difficulties, poor literacy, lack of support system)
- Provide education (eg, when and how to take the medication, what to do for missed doses, dosing schedules, safe handling, symptom management, reporting uncontrolled symptoms)
- Conduct adherence and symptom assessments through follow-up calls or apps
- Communicate with providers with concerns
A consistent HCP performing these responsibilities rather than sharing the tasks among multiple team members provides consistency in patient care and develops a trusting relationship. According to Katie Grotzinger, “a designated person can develop a rapport with patients, helping them feel more comfortable and make them feel that it is okay to call with concerns.”
Achieving Cancer Accreditation Success
Clinical guidelines and cancer accreditation programs support organizations’ efforts to standardize oral oncolytic care. The American Society of Clinical Oncology’s (ASCO)/Oncology Nursing Society’s (ONS) Chemotherapy Administration Safety Standards and Quality Oncology Practice Initiative (QOPI) include oral oncolytic standards. QOPI is a voluntary certification program for outpatient oncology practices to help them achieve high-quality care. QOPI surveyors review policies, observe patient care, and review oral oncolytic clinical documentation to ensure a safe process. “A consistent person in this role is key to passing this accreditation and providing the very best patient care that we can,” states Katie Grotzinger.
Oral oncolytics are the present and the future of cancer care. Oncology nurses have a crucial role in developing, implementing, and evaluating patient safety as a top priority. Standardizing oral oncolytic processes is one vital way to make this priority a reality.