Impact of a pharmacist-led oral chemotherapy-monitoring program in patients with metastatic castrate-resistant prostate cancer.
BACKGROUND
With the introduction of oral chemotherapy, the paradigm for cancer treatment is shifting. Use of oral chemotherapy agents offers a non-invasive option for patients with metastatic castrate-resistant prostate cancer. However, these medications are not without challenges including strict adherence for optimal effects, novel toxicity profiles, frequent lab parameter monitoring, high cost, and proper handling and disposal methods. Pharmacists are positioned to play a key role in providing patients with the education required to assure an optimal treatment course is carried out.


METHODS
Two cohorts of patients receiving abiraterone, bicalutamide, or enzalutamide for metastatic castrate-resistant prostate cancer seen in our outpatient cancer center 21 months before and 24 months after the implementation of a pharmacist-led oral chemotherapy-monitoring program in December of 2012 were retrospectively compared. Patients were evaluated for number of interventions, adherence to lab parameter monitoring, and overall time on each therapy.


RESULTS
Of the 64 patients identified, 31 patients fulfilled inclusion criteria. A significant increase in the average number of interventions per patient (6.9 vs. 2.6; P = 0.004) and adherence to lab parameter monitoring (10 vs. 3; P = 0.04) in the post-program implementation cohort was found. However, no significant difference in overall time on therapy (10.3 vs. 8.1; P = 0.341) between the two groups was observed.


CONCLUSIONS
These results suggest a potential opportunity exists to maximize oral chemotherapy treatment outcomes with the addition of a formalized monitoring program directed by an oncology pharmacist.
Smilow Cancer Hospital at Yale, New Haven, CT, USA.
Jay M
JM
Patel
UConn School of Pharmacy, John Dempsey Hospital/UConn Health, Storrs, CT, USA lisa.holle@uconn.edu.
Lisa M
LM
Holle
UConn Health, Farmington, CT, USA.
Jessica M
JM
Clement
New England Health Analytics, LLC, Granby, CT, USA.
Thomas
T
Bunz
John Dempsey Hospital/UConn Health, Farmington, CT, USA.
Christopher
C
Niemann
UConn School of Pharmacy, John Dempsey Hospital/UConn Health, Storrs, CT, USA.
Kevin W
KW
Chamberlin
D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000736:Androstenes / Q000008:administration & dosage / Q000009:adverse effects; D000737:Androstenols / Q000008:administration & dosage / Q000009:adverse effects; D000970:Antineoplastic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D001549:Benzamides; D015331:Cohort Studies; D016903:Drug Monitoring / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009570:Nitriles; D010595:Pharmacists; D010669:Phenylthiohydantoin / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives; D024382:Professional Role; D064129:Prostatic Neoplasms, Castration-Resistant / Q000175:diagnosis / Q000188:drug therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome
D000736:Androstenes; D000737:Androstenols; D000970:Antineoplastic Agents; D001549:Benzamides; D009570:Nitriles; D010669:Phenylthiohydantoin; C540278:enzalutamide; C089740:abiraterone
Oral chemotherapy; metastatic castrate-resistant prostate cancer; pharmacist