Pharmacists in shared care model reduce ambulatory patient visits for oncologists

The introduction of oral cyclin-dependent kinase 4 and 6 (CDK 4/6) inhibitors for the treatment of breast cancer has contributed to an increase in ambulatory patient visits for oncologists. CDK 4/6 inhibitors, such as palbociclib and ribociclib, are the preferred first-line systemic treatments for metastatic, hormone receptor-positive, HER2-negative breast cancer in patients who are not presenting with life-threatening visceral involvement. They are given concurrently with endocrine therapy. More intensive monitoring is required for patients receiving CDK 4/6 inhibitors compared to patients receiving endocrine therapy alone. Before the introduction of CDK 4/6 inhibitors, metastatic breast cancer patients on single-agent endocrine therapy were assessed approximately every three months. Minimum requirements for patients on CDK 4/6 inhibitors are monthly assessments for the first six months, followed by every one to three months thereafter. With the large metastatic breast cancer population, the introduction of CDK 4/6 inhibitors has resulted in a significant increased workload for medical oncologists. The role of oncology pharmacists is expanding to include more direct patient care. To help alleviate the burden on medical oncologists, oncology pharmacists at the BC Cancer Surrey centre created a program to allow pharmacists to perform medication assessments in a shared care model instead of patients seeing the medical oncologist. The Medication Assessment by Pharmacist (MAP) program evaluated the impact of oncology pharmacists conducting medication assessment visits for ambulatory patients with metastatic, hormone receptor-positive, HER2-negative breast cancer receiving a CDK 4/6 inhibitor. Read: Project that added pharmacists to hemophilia care teams wins award With the MAP program, breast cancer patients receiving a CDK 4/6 inhibitor who were deemed suitable by their oncologist could be booked for a pharmacist medication assessment appointment. These patients were evaluated by a pharmacist at the next clinic visit prior to starting the next treatment cycle. During each MAP clinic visit, the oncology pharmacist used standardized tools alongside provincial protocols to perform the medication assessment. The pharmacist reviewed lab results, assessed medication adherence and tolerance, and counselled on side effect management. The oncologist was contacted if more severe adverse effects developed. Following a satisfactory medication assessment, a medication refill was dispensed. Over a 33-month period, 128 patients (22.7%) were selected for a total of 46 MAP visits. This resulted in 920 minutes (> 15 hours) of clinic time savings for physicians. The study found similar rates of adhering to provincial protocols for scheduling visits in order to achieve timely starts of medication cycles (99% vs. 96%, p = 0.12) and monitoring investigations (98% vs. 98%, p = 0.96) between those enrolled in the MAP program and those not enrolled. Read: Can we afford to be picky when it comes to solving the orphan patient problem? Based on a survey, all nine oncologists felt that the MAP program reduced their workload and wanted the program to be expanded to include additional oncology drugs. All nine oncology pharmacists felt that involvement in the MAP program increased their job satisfaction, and allowed them to further apply their clinical skills and knowledge within their scope of practice, and that this role contributed positively to patient care. The pharmacists and oncologists agreed that patients were receptive to meeting with pharmacists. Survey results also indicated that only 33% of oncologists compared to 100% of pharmacists routinely asked about medication adherence, newly started medications or natural health products at each visit. The authors conclude that integrating pharmacists into a shared care model reduces ambulatory patient visits for oncologists without compromising adherence to provincial protocol guidelines for drug monitoring and scheduling clinic visits for patients on CDK 4/6 inhibitors. Update: The authors note that the MAP program has now been expanded to include more oral cancer therapies across different types of cancer. The program now covers Bruton tyrosine kinase (BTK) inhibitors, capecitabine, poly-ADP ribose polymerase (PARP) inhibitors, venetoclax, lenalidomide, imatinib and dasatinib. The program has also been extended to additional BC Cancer centres. The authors plan to conduct a larger study with increased patient numbers, a longer data collection period and patient satisfaction surveys. Reference 1. Goh E, Labelle S, Chan A. Implementation and evaluation of a shared care model between oncologists and pharmacists for breast cancer patients at a Canadian regional ambulatory cancer centre. J Oncol Pharm Practice 2023; DOI: 10.1177/10781552231179190.

Pharmacists in shared care model reduce ambulatory patient visits for oncologists

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