Revolution at the Corner Drugstore

An expanding armamentarium of oral oncologic drugs represents a revolution in the treatment of cancer but also presents significant challenges to adherence and the management of costs, side effects, and a growing clinician workload. Most often, identifying the urgent needs of cancer patients, including financial support and education, falls to the health care giver, whichincludes advanced practitioners, put forth participants in a panel discussion at JADPRO Live at APSHO. Panelists agreed that the search for resources needs to be comprehensive and should involve specialty pharmacy, community pharmacy, foundations, and even social workers. Panel moderator Pamela Hallquist Viale, RN, MS, CNS, ANP, set the stage for the discussion by noting the sea change in the treatment of cancer, namely, a transition from mostly or all-intravenous medications to oral agents. The current crop of oral medications is just the tip of the iceberg, as a large proportion of oncology drugs in the pipeline are orals. Although oral medications are easier for patients to take, they can be costly, and unlike infusions, no nurse is present for administration. This creates opportunities for noncompliance and nonadherence, said Ms. Viale. The expense attached to oral drugs has not only affected adherence but also nurse workload, as these agents often require preauthorization and the need to connect patients with funding sources if they cannot afford the drugs, said Wendy Smith, RN, MSN, ACNP, AOCN®, Director of Interprofessional Education, Meniscus Educational Institute. At her previous institution, processes were established in 2012 to identify staff that would be responsible for patient education once a prescription is written for an oral drug. “Doctors were writing prescriptions for oral medications and patients were not getting the teaching for chemotherapy because the nurses didn’t even know they got the prescriptions,” she said. “I’m a proponent of advanced practitioners. We can take the leadership, being creative and coming up with innovative processes,” Ms. Smith commented. For those who need help developing these processes, she advised visiting the AssoFrom Oncology Disease State Management at Walgreens; CancerCare; UCHealth–Memorial Hospital, Colorado Springs, Colorado; Meniscus Educational Institute, Lawrenceville, New Jersey