Care Coordination Standardizes Monitoring for Patients Prescribed Oral Cancer Agents
By Kristin Ferguson, DNP, RN, OCN®
Use of oral therapies requires healthcare teams to monitor patients for issues such as unreported side effects, medication nonadherence, and incorrect administration of medications (https://www.ncbi.nlm.nih.gov/pubmed/26957614). Although many patients do very well with this form of treatment, some patients, even with a significant amount of education before starting therapy, may have challenges.
Some may wait until their next clinic appointment at the cancer center before reporting potentially serious side effects such as peripheral neuropathy or diarrhea. Other patients who have high copays may not relay their concerns to their medical team and instead try to cut costs by taking the medication improperly (https://doi.org/10.1200/JOP.2013.000971) (e.g., every other day as opposed to every day, fewer tablets than prescribed). Others may repeatedly forget to take their medication and then feel guilty and not report it to their medical team. Taking a medication differently than it is prescribed can affect a patient’s prognosis (https://doi.org/10.1200/JOP.2013.000874).
Studies recommend (https://doi.org/10.1093/annonc/mdt553) that hospitals have specific oral chemotherapy policies or structured guidelines to help clinicians in monitoring patients (https://doi.org/10.1016/j.pedhc.2016.06.004) who self-administer oral cancer agents at home for compliance and side effects in between visits (https://doi.org/10.1188/13.CJON.512-516). However, many clinics do not standardize (https://doi.org/10.1188/14.ONF.41-02AP) the way providers monitor patients for treatment adherence or side effects.
The Role of Care Coordination and Navigation
At the Lombardi Comprehensive Cancer Center at MedStar Georgetown University Hospital, oncology nurse coordinators closely monitor patients prescribed oral cancer agents. We work with medical oncologists to educate patients on how to take the medication, what side effects may occur, and when to call the office. We provide printed education that patients can take home to read.
After the medical oncologist prescribes an oral cancer agent to a specialty pharmacy, the oncology nurse coordinator communicates with the pharmacy to ensure it has what it needs to process the medication, including insurance information and prior authorization. If patients’ copays are high, the nurse may work with the specialty pharmacy to find copay assistance so they are not paying too much for their medication.
After patients receive a medication, they call a care coordinator to document their start date in the electronic medical record.
Developing a Standardized Approach to Monitoring
The focus of my doctoral project was standardizing the process that oncology nurse coordinators at our hospital use to monitor our patients prescribed oral cancer agents. Using evidence-based guidelines, I created a tracking tool spreadsheet that oncology nurse coordinators could use to monitor their patients receiving oral therapy. The tool guided the care coordinators to check in with patients 7–14 days after they started therapy, monitor them for medication adherence (by patient self-report), and review common side effects to be on the lookout for.
After trialing the tool for three months, we found that 80% of oncology nurse coordinators felt that the tool was useful in helping monitor patients prescribed oral cancer agents.
Cancer centers around the country are developing different programs and processes to monitor the increasingly higher volumes of this patient population. More new oral cancer agents are being approved by the U.S. Food and Drug Administration than ever before. In response, oncology nurse navigators and coordinators are at the forefront of monitoring patients for medication adherence and side effects as well as providing them with education throughout their treatment.