Veterans Affairs Central Ohio Healthcare System, Columbus, OH, USA.
Statistical Resource Center at the Geriatric Research, Education & Clinical Center, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH, USA.
J Oncol Pharm Pract. 2023 Dec;29(8):1921-1927. doi: 10.1177/10781552231159870. Epub 2023 Jun 23.
To evaluate the impact that a pharmacist-managed oral anticancer clinic has on patient adherence to oral anticancer therapy in regard to medication adherence and adherence to lab monitoring.
A retrospective chart review was completed for patients prescribed abiraterone, enzalutamide, or ibrutinib within the study time period. The primary outcome was assessing medication adherence by comparing the medication possession ratio (MPR) before (Phase 1) and after (Phase 2) initiation of the pharmacist-led oral anticancer therapy clinic. The secondary outcome was assessing lab monitoring adherence by patients and providers in Phase 1 and Phase 2. This will be done by assessing whether labs were ordered at the appropriate time frame by oncology providers, as well as whether or not the patient came and got these labs drawn. This study will also examine outcomes related to the pharmacist-led oral anticancer therapy clinic (phase 2) for descriptive purposes.
A total of 189 charts were analyzed with 134 excluded and 55 included (25 patients in phase 1 and 30 patients in phase 2). Independent sample -test analyses revealed a statistically significant increase ((30.57) = -1.99; = 0.027) in the MPR ratio between phase 1 (mean = 0.98, SD = 0.13) compared to phase 2 (mean = 1.04, SD = 0.08). For patient adherence to lab monitoring, there was a statistically significant improvement between phase 1 and phase 2 for patients on abiraterone (21.9% vs 67%; (25) = -5.73; < 0.001) and enzalutamide (35.7% vs. 90.5%; (8) = -3.26; = 0.006). However, for patients on ibrutinib, there was a slight decline in lab monitoring adherence between phase 1 and phase 2 but this effect was not statistically significant (56.2% vs. 51%; (17) = 0.58; = 0.283). Similar results were shown for provider adherence to lab monitoring. Descriptive outcomes showed that the pharmacist had, on average, 6.7 encounters per patient with the majority being phone and face-to-face appointments.
Data from this study demonstrated that a pharmacist-led oral anticancer clinic can improve MPR ratios and patient adherence to oral anticancer medication regimens. In addition, patient and provider lab monitoring adherence was improved for abiraterone and enzalutamide. Improvement in patient and provider lab monitoring adherence for ibrutinib was not shown, possibly due to the impact of the COVID-19 pandemic, relatively small sample size, and retrospective nature of this study. The results of this study support that overall, a pharmacist-led oral anticancer clinic can significantly improve patient outcomes, which aligns with previous smaller studies that have shown similar benefits.
评估药剂师管理的口服抗癌诊所对患者口服抗癌治疗依从性的影响，包括药物依从性和实验室监测依从性。
对研究期间开具阿比特龙、恩扎鲁胺或伊布替尼的患者进行回顾性病历审查。主要结局是通过比较口服抗癌治疗诊所启动前后（阶段 1 和阶段 2）的药物占有比（MPR）来评估药物依从性。次要结局是评估阶段 1 和阶段 2 中患者和提供者的实验室监测依从性。这将通过评估肿瘤学提供者是否在适当的时间框架内开实验室检查，以及患者是否来抽取这些实验室检查来完成。本研究还将检查与药剂师主导的口服抗癌治疗诊所（第 2 阶段）相关的结果，仅供描述性目的。
共分析了 189 份病历，其中 134 份被排除，55 份被纳入（25 名患者在第 1 阶段，30 名患者在第 2 阶段）。独立样本 t 检验分析显示，第 1 阶段（均值=0.98，SD=0.13）与第 2 阶段（均值=1.04，SD=0.08）相比，MPR 比值有统计学显著增加（(30.57)=-1.99；=0.027）。对于患者的实验室监测依从性，阿比特龙（21.9%对 67%；(25)=-5.73；<0.001）和恩扎鲁胺（35.7%对 90.5%；(8)=-3.26；=0.006）的患者在第 1 阶段和第 2 阶段之间有统计学显著改善。然而，对于服用伊布替尼的患者，第 1 阶段和第 2 阶段之间的实验室监测依从性略有下降，但这种影响没有统计学意义（56.2%对 51%；(17)=0.58；=0.283）。提供者对实验室监测的依从性也显示出类似的结果。描述性结果表明，药剂师平均每个患者有 6.7 次就诊，主要是电话和面对面预约。
这项研究的数据表明，药剂师主导的口服抗癌诊所可以提高 MPR 比值和患者对口服抗癌药物治疗方案的依从性。此外，阿比特龙和恩扎鲁胺患者和提供者的实验室监测依从性也得到了改善。然而，伊布替尼患者和提供者的实验室监测依从性并没有显示出改善，这可能是由于 COVID-19 大流行、样本量相对较小以及本研究的回顾性性质的影响。本研究的结果支持总体而言，药剂师主导的口服抗癌诊所可以显著改善患者的治疗效果，这与之前的一些小型研究结果一致，这些研究也表明了类似的益处。
