Utility and feasibility of pharmacy directed utilization of a symptom assessment tool to reinforce adherence and assess symptom burden between visits in patients receiving oral chemotherapy

Allen, Stefan
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Oncologists are increasingly prescribing oral antineoplastic agents (OAAs) which has benefits and challenges, which can affect patient outcomes. Practice guidelines recommend monitoring symptoms and adherence, but no specific tools or methods. Pharmacists could play an integral role in monitoring and have previously demonstrated success in related areas. This study evaluated a pilot pharmacist-delivered adherence and symptom monitoring program in patients taking OAAs for feasibility through 1) tracking patient enrollment and completed contacts and 2) pharmacist time spent on monitoring patients. Utility was evaluated through 1) patient and provider satisfaction surveys demonstrating perceived benefit and 2) comparison of clinical outcome surrogates to a retrospective cohort. This study was a prospective, interventional study with a retrospective comparator cohort at the Mays Cancer Center in San Antonio, Texas. Over six months patients receiving any of six selected OAAs (capecitabine, sorafenib, regorafenib, osimertinib, afatinib, or erlotinib) were screened to qualify for and participated in the study unless they opted out. A pharmacist was scheduled to contact them twice during each cycle or month between clinic visits for symptom or adherence monitoring over a three-month follow-up. We monitored adherence and symptoms using the Edmonton Symptom Assessment Scale (ESAS-FS). A pharmacist managed or triaged symptoms (diarrhea, mucositis, rash, nausea, and vomiting) per-protocol in collaboration with physicians. Patient contact was recorded directly in the electronic health record. Of the fifty-one patients who were screened for eligibility, 47 (92%) participated. Completed patient contact rate was high at 91% with 213 completed with 235 expected. Patients and physician satisfaction was high, but only 45% of patients indicated improved communication with physicians. Fifty-two symptom management recommendations were made with an acceptance rate of 98%. Patient reported adherence was high (98.5%). Time to first dose and duration of therapy were similar between groups, but differed by drug. The ESAS-FS was administered by pharmacy 102 times with median total score severity remaining stable over time. This study suggests that a pharmacist monitoring program for patients taking OAAs is feasible and provides utility. Further research is needed to evaluate whether this program improves safety, adherence, and outcomes in patients using OAAs.