The shift in from intravenous to oral therapies for cancer requires that clinical sites set standards and procedures to support patients receiving oral anticancer medication (OAM). Processes for prescribing, educating, documenting, and monitoring patients on OAM need to be implemented at the point of care.
Several professional organizations have worked to provide guidance to clinicians. The Oncology Nursing Society and the American Society of Clinical Oncology developed standards of practice to guide chemotherapy administration. These standards include safe administration and management of OAM. Specific to OAM, the standards include education related to the storage, handling, preparation, administration, and disposal of OAMs; drug-drug or drug-food interactions; a plan for missed doses; and an educational plan that includes care partners when appropriate. The standards also include an initial assessment of adherence that includes a plan for clinical staff to address issues identified related to adherence.
The Oncology Nursing Society also published guidelines to support patient adherence to OAMs. These guidelines recommend strategies that can be incorporated into practice, including assessment of risk, education specific to adherence, standardized assessment, follow-up, and adding motivational interviewing or coaching to usual care. In addition, the ONS guidelines recommend that health care organizations develop structured programs to support patients on OAMs. The Hematology/Oncology Pharmacist Association (HOPA) has published practice standards for the management of OAM therapy. The standards include prescribing, education, dispensing, distribution, monitoring of symptoms and adherence, and follow-up. The HOPA practice standards highlight the important role of the interprofessional oncology team in OAM management. While these national standards and best practices are important for patient management, incorporating them into practice remains a challenge.
Coordinating and supporting patients who are on OAMs is critical and depends on interventions and practice change at the patient, provider, and system levels. OAMs have a wide variety of recommended schedules. Some are simple regimens that involve taking one pill once a day, whereas others are complex regimens involving multiple pills to be taken more than once a day with weeks on therapy and off therapy. Whether the regimen is simple or complex, patients require support to maximize adherence. When patients experience side effects, adherence can be affected, making close management of side effects critical.
A variety of best practices have been explored to support adherence to OAMs. Nursing phone contacts within the first days following treatment initiation and standardized toxicity management protocols have been shown to improve adherence. Technology-based interventions—such as text messages, automated voice response, and smartphone apps—that increase contact between the patient and the care team may benefit some patients but not others. Interventions such as education, treatment monitoring, pharmacy-based programs, and counseling are effective and should be considered for provider- and system-level change. A combination of strategies and practice changes may be needed to support patients. Research on adherence to endocrine therapy for patients with breast cancer identified that education alone was not effective but showed that a combination of education and communication (printed and verbal) or bidirectional communication improved adherence.
Patients receiving an OAM for treatment need support, and best practices are available to help maintain optimal adherence. Effective interventions often involve multiple components and are delivered by a multidisciplinary team. Practices such as risk assessment, ongoing assessment of adherence, and proactive follow-up, as well as interventions that include coaching or motivational interviewing, may be effective. Health care professionals should work to incorporate these at the point of care.
Learn more about OAM adherence and what nurses need to know here.
2013 updated American Society of Clinical Oncology/Oncology Nursing Society chemotherapy administration safety standards including standards for the safe administration and management of oral chemotherapy