Oral Chemotherapy Clinic Can Improve Experiences in Community Setting

Establishing a multidisciplinary oral chemotherapy clinic (MOCC) in a community hospital is feasible and could help reduce emergency department (ED) visits, recognize adverse events earlier, and improve staff and patient satisfaction, according to a new study.

Patricia Disperati, MD, of the Michael Garron Hospital in Toronto, discussed her center’s experience (abstract 50) at the American Society of Clinical Oncology (ASCO) 2017 Quality Care Symposium, held March 3–4 in Orlando, Florida. The hospital has an oncology clinic with 4.5 full-time oncologists and limited nursing staff for chemotherapy delivery; she said it has a well-defined IV chemotherapy process, but lacks one for oral chemotherapy.

After conducting interviews, and using process mapping to try and identify barriers to effective oral chemotherapy delivery, they set up an MOCC comprised of a nurse and pharmacist, with physician oversight. Their first step was to standardize the oral chemotherapy protocols.

The new analysis included 30 consecutive patients (17 male, 13 female), with a median age of 69 years. Eleven were starting chemotherapy for the first time, and 19 had previously had some chemotherapy. The median follow-up period was 7 months, and these patients were compared to a baseline cohort of patients before the MOCC based on chart data.

Most of the patients included received lenalidomide, followed by tyrosine kinase inhibitors, ibrutinib, and idelalisib. Four patients discontinued oral chemotherapy during the study, one due to a grade 4 adverse event and three due to disease progression. Before the MOCC, patients averaged 10 months on oral chemotherapy, compared with 7 months after the MOCC was established.

There was a 33% reduction in ED visits in these patients compared with baseline (from 9 to 6 over the first 12 months of therapy), but this did not reach statistical significance. The specific causes of ED visits were slightly different, but Disperati said further work is needed to better establish any differences. Treatment compliance was unknown before the MOCC, and 92% once it was established.

The MOCC resulted in an increase in “interventions,” including unscheduled MD visits (3% before, 20% with MOCC) and dose modifications that would have gone unnoticed without the MOCC. The baseline patient cohort had 0% dose modifications and 0% grade 3/4 adverse events, compared with 8% and 5%, respectively after the MOCC was established.

“The change was sustained,” Disperati said. “The nurses started noticing a lot more issues and brought them to the attention of the doctors, or dealt with it themselves.”

Both staff and patients approved of the new system. Staff appreciated the standardized approach, while patients appreciated the attentiveness and accessibility of nursing staff to address concerns about oral chemotherapy.

The study was limited by its small size and single-institution nature, and it did not measure phone call volume or wait time. It also did not include primary care physicians. Disperati said they plan to expand the program and likely conduct economic analyses to assess the MOCC’s affect on costs.