As the number of patients taking oral chemotherapy increases, the need to develop safe and effective administration and management of these anti-cancer agents is crucial.
Although it is more convenient for patients to be able to take oral chemotherapy in the comfort of their own home, this shift in paradigm is affecting patient safety. Despite the growing use of oral chemotherapy, there is a lack of comprehensive literature surrounding oral chemotherapy delivery programs. The result is that clinicians are left without proper guidelines on best practices and struggle to determine the best way to care for patients undergoing treatment.
Typically, chemotherapy is delivered intravenously in outpatient clinics under the supervision and guidance of nurses and oncologists. The process of oral chemotherapy treatment is susceptible to a number of opportunities where variability and errors can occur from prescription to administration to disposal. For example, poor adherence to treatment could decrease the effectiveness of the therapy and have an impact on the patient’s survival. Another potential issue is the toxicity of these anti-cancer agents, which in some cases may be greater than what has been reported in clinical trials.
A systemic review recently published by Zerillo and colleagues in The Journal of the American Medical Association, Oncology looked at peer-reviewed and grey literature on the concepts of oral chemotherapy, cancer, interventions and outcomes. All ages were included in the population of interest (3612 patients) and the review was limited to cytotoxic and targeted oral anticancer agents.
The literature review showed that the most recent improvements have been made in the area of toxicity and safety in oral chemotherapy administration and care as opposed to patient adherence to treatment. Studies which focused on intervention and improving e-Health (healthcare supported by electronic services and communication) education and remote telephone use to monitor patients interestingly failed to improve outcomes and had no clear impact on adherence.
When treatment is initiated, technology intervention such as phone calls with nurses and pharmacists is important and appeared to reduce the severity of side effects but the optimal frequency and call duration is not well defined and whether all patients benefit remains to be seen. Furthermore, many of the educational programs are institutionally designed materials and while they can be successful in educating patients, they could potentially benefit from more focused education on standardized tools and developing clearer guidelines.
Due to limitations in study designs, such as inconsistent outcome definitions, it is difficult to draw definitive conclusions on the best practices for patient care. In order to bridge this gap, particularly for specific aspects such as prescribing and storage/disposal of oral chemotherapy, there is a need for a more structured research. Other limitations of current research include methodological shortcomings, where sample size is too small, issues with the quality of reporting and differences in comparison groups that impact ability to analyse the results quantitatively.
It is evident that future research is required to establish best practices and improve patient health outcomes associated with oral chemotherapy. Specific guidelines describing methods for care, support and successful outcomes are essential. This program would ideally include more detailed and focused initial education, an increase in patient monitoring by phone calls in the first few weeks of treatment and possibly an increase in personal contact. The goal is to improve not only adherence but also toxicity, safety and ultimately patient survival.
Written By: Lacey Hizartzidis, PhD