Pharmacist Video Consultations May Reduce Polypharmacy in Cancer Care

All patients with cancer who completed the entirety of the survey reported they would meet with a pharmacist in the future.

One-time pharmacist video consultation may address oral anticancer drug-related drug-drug interactions, which would decrease medication complexity and improve treatment adherence in patients with cancer, according to findings from a single-arm telehealth intervention study published in the Journal of Clinical Oncology.

In all 43 patients who completed a video visit, the median number of medications was 9 (range, 4-21), and the median number of medication list errors was 2 (range, 0-16); there was at least 1 error for 76% of patients and more than 1 error for 52%. Changes made during video visits included removing medications (n = 57; 53%), adding a medication (n = 40; 37%), and changing a dose (n = 11; 10%) for a total of 108 overall changes across all medication lists.

Pharmacists observed oral anticancer drug-related drug-drug interactions in 18 patients (42%); they were changes in drug metabolism (n = 8), elimination (n = 1), absorption (n = 3), and other changes (n = 6). The drug-drug interactions were Lexicomp category C, requiring monitoring, in 13 patients (72%); were Lexicomp category D interactions, requiring a medication change or dose adjustment, in 4 patients (22%); and were Lexicomp category X interactions, which should be avoided, in 1 patient (6%).

Of the patients who completed all aspects of the survey, all were reportedly satisfied or very satisfied with the visit; 91% of patients (n = 31) said the amount of information they received was “about right”. All patients were also interested in having another future pharmacist visit and agreed that the intervention was acceptable, appropriate, and feasible.

“Despite the clinical benefits and convenience of [oral anticancer drugs], these new oral options present potential challenges, including polypharmacy, particularly among elderly patients with cancer, and can result in increased toxicities, [drug-drug interactions], inappropriate consumption of medications, and medication nonadherence,” wrote study author Dawn L. Hershman, MD, MS, of Herbert Irving Comprehensive Cancer Center at Columbia University Irving Medical Center, in the paper. “Our results suggest that a one-time video consultation with a pharmacist is feasible and that this intervention can effectively address potential [oral anticancer drug]–related [drug-drug interactions].”

The trial located a total of 251 patients with cancer who had at least 2 standing medications on their medication list and were initially prescribed an oral anticancer drug during the enrollment period. Of this number, 93 patients were eligible after further screening, 43 completed a pharmacist-led video visit, and, ultimately, 33 patients completed all study components.

Eligible patients were 18 years or older with a diagnosis of solid tumor malignancy or hematologic malignancy who had a new oral anticancer drug prescription not as part of a clinical trial within 4 weeks of enrollment and 3 or more prescribed standing oral medications.

The mean age of patients was 71 years (SD, 12.3); the majority were male (60%), had at least 5 standing oral medications (98%), and were non-Hispanic White (54%). Patients had prostate cancer (30%), chronic leukemia (14%), multiple myeloma (12%), breast cancer (12%), pancreatic cancer (9%), and other diseases (23%).

The trial was performed at New York-Presbyterian Hospital/Columbia University Irving Medical Center between June 2021 and April 2023, and patients were recruited by review of a weekly list of oral anticancer drug prescriptions sent to New York-Presbyterian specialty pharmacy.

The 4 main components of the study were as follows: 1, medication reconciliation; 2, a pharmacist-led video visit; 3, an electronic patient-reported outcomes survey; and 4, a research nurse follow-up phone call.

The pharmacist video visit had 2 purposes: identifying polypharmacy and potential drug-drug interactions via Lexicomp and Micromedex, and then patient education on oral anticancer drugs.

The study objectives were feasibility, defined as 50% or more completion of all study interventions; medication list accuracy via phone call by a research nurse 2 weeks or less before video visit; efficacy, defined as 25% or more patients having 1 or more actionable drug-drug interactions; and acceptability.

Reference

Lichtenstein MRL, Campbell P, Raghunathan R, et al. Pharmacist-led video consultation to identify and mitigate drug interactions among patients initiating oral anticancer drugs. JCO Oncol Pract. 2025;21(4):544-551. doi:10.1200/OP.24.00326