title: Physician-pharmacist collaboration for oral chemotherapy monitoring: Insights from an academic genitourinary oncology practice.
abstract: BACKGROUND
  Oral chemotherapy is being routinely used in metastatic castrate-resistant prostate and renal cell cancer. Although convenient, these drugs require monitoring for adherence, toxicity, and drug interactions to maximize outcomes. Oncology pharmacists have the training and expertise that place them in an optimal position to collaboratively provide medication therapy management.
  
  
  METHODS
  A board-certified oncology pharmacist, working in collaboration with a medical oncologist, initiated an oral chemotherapy-monitoring program. The pharmacist provided education, completed medication therapy management; monitored for adherence and toxicity; and recommended treatment of toxicity and supportive care issues. Patient encounters included one of the following: collaboration with medical oncologist visit, pharmacist visit, or telephone or email follow-up between visits.
  
  
  RESULTS
  From December 2012 to May 2014, the pharmacist had 123 encounters with 20 patients with either metastatic prostate (n = 17) or renal cell cancer (n = 3). All patients were males (median age 80 years). Most encounters were clinic visits, in collaboration with physician visit or alone (52%); 36% were telephone encounters, and 11.3% were email follow-ups. Medication-related problems were identified in 25% of the 315 assessments made. Problems included: adverse drug reactions, 40%; inappropriate therapy, 20%; and noncompliance, 18%. Recommendations included: modification of laboratory monitoring, 25%; cancer or non-cancer therapy modification, 12%; drug discontinuation, 6.9%. Non-cancer therapy-related drug information and coordination of care accounted for 30% of recommendations.
  
  
  CONCLUSIONS
  Our program led to identification of a number of potentially clinically significant issues for patients on oral chemotherapy and demonstrated the benefit of the pharmacist in the multidisciplinary team to assist in addressing them.
authors.affiliation: Department of Pharmacy Practice, UConn School of Pharmacy, Storrs, CT, USA lisa.holle@uconn.edu.
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Holle
authors.affiliation: Department of Internal Medicine, UConn, Farmington, CT, USA.
authors.forename: Sonam
authors.initials: S
authors.lastname: Puri
authors.affiliation: Carole and Ray Neag Comprehensive Cancer Center, UConn Health, Farmington, CT, USA.
authors.forename: Jessica M
authors.initials: JM
authors.lastname: Clement
mesh_terms: D000284:Administration, Oral; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000379:methods / Q000592:standards; D000970:Antineoplastic Agents / Q000008:administration & dosage*; D003299:Cooperative Behavior; D004347:Drug Interactions; D016903:Drug Monitoring / Q000379:methods / Q000592:standards; D064420:Drug-Related Side Effects and Adverse Reactions / Q000175:diagnosis / Q000517:prevention & control; D006801:Humans; D007680:Kidney Neoplasms / Q000175:diagnosis / Q000188:drug therapy; D008297:Male; D008495:Medical Oncology / Q000379:methods* / Q000592:standards; D054539:Medication Therapy Management / Q000592:standards; D008875:Middle Aged; D010595:Pharmacists / Q000592:standards; D010820:Physicians / Q000592:standards; D064129:Prostatic Neoplasms, Castration-Resistant / Q000175:diagnosis / Q000188:drug therapy; D014565:Urogenital Neoplasms / Q000175:diagnosis / Q000188:drug therapy*
chemical_list: D000970:Antineoplastic Agents
keywords: Oral cancer therapy; genitourinary cancer; medication therapy management