By representing perspectives from the entire cancer care team, collaboration with interprofessional colleagues is one way for oncology nurses to influence the delivery of high-quality patient care.
The American Hospital Formulary Services (AHFS), in association with the American Society of Healthcare Pharmacists, maintains the AHFS Drug Information, a designated federal compendium, and a “comprehensive, authoritative source of evaluative, evidence-based drug information.”
The AHFS Oncology Expert Committee systematically conducts reviews of available evidence on oncology agents for consideration of off-label use. Committee members are tasked with reviewing the evidence quarterly review of studies and voting for level of evidence and AHFS grade of recommendation. They critically appraise the studies, including patient characteristics, interventions, outcome measures, adverse event reporting, and consistency in effect sizes. After voting as a group, the committee develops final determination reports reflecting their decisions.
Decisions about the off-label use of U.S. Food and Drug Administration (FDA)-approved antineoplastics requires the input of the interprofessional team, each looking through their specialized lens to safely expand options for patients with cancer. ONS clinical staff members Kathleen Wiley, MSN, RN, AOCNS®, and Caroline Clark, MSN, APN, OCN®, AG-CNS, EBP-C, represent oncology nursing as members of the AHFS Oncology Expert Committee.
“The inclusion of oncology nurses on the committee reflects the essential role these clinicians possess regarding development of the patient care plan, continuity in cancer care from the inpatient to community settings, and overall patient management including the emotional and support aspects of cancer care,” Michael Gabay, PharmD, JD, BCPS, FCCP, AHFS editor-in-chief and senior editorial director, said.
When analyzing study data about outcomes associated with the agent being evaluated for off-label use, Wiley and Clark closely consider reported:
- Disease outcomes
- Symptom severity
- Psychosocial considerations
- Quality-of-life outcomes
They also look at how studies that granted original FDA approval may or may not be extrapolated to the suggested patient population for off-label use. For example, Wiley and Clark evaluate whether the study’s patient demographics are representative of the population being considered for off-label use.
“Nurses rely on pharmacy colleagues to provide excellent patient care and to optimize safety in antineoplastic administration,” Wiley said. “The relationship between nurses and pharmacists is bidirectional.”
“This collaboration between AHFS and ONS represents a commitment to comprehensive, interprofessional patient care by leveraging the individual expertise of each profession and complimenting their shared mission of advancing quality cancer care,” Clark said.