ELIZABETH—The National Comprehensive Cancer Network (NCCN) projects that 25 percent of oncology drugs will be in oral form by 2013. The benefits, risks and efficient management of increasingly available oral chemotherapy for a variety of cancers are currently being evaluated at the Trinitas Comprehensive Cancer Center in Elizabeth.
“The result of the greater emergence of oral chemotherapy regimens is a significant shift on a number of levels for cancer care professionals, as well as their patients,” said Richard Emery, executive director of Trinitas Comprehensive Cancer Center, one of nine hospital-based cancer centers in the Aptium Oncology Network.
“Until recently, health care providers have been accustomed to a considerable amount of control including certainty regarding the administering of the right drug, in the right amount, via the right route—at the right time, to the right patient. In contrast, oral chemotherapy takes much of the control from the clinician and places a greater responsibility on the patient.”
In keeping pace with the ongoing growth of oral chemotherapy use, Emery noted that cancer centers need to develop new infrastructures. Preferably, these would include a comprehensive system designed to select appropriate candidates for oral agents, along with a robust educational component to address safety and adherence practices, while ensuring treatment efficacy.
Additionally, there are a number of other patient-related factors that figure into the oral chemotherapy equation including financial considerations, an ability to manage complex oral chemotherapy regimens and reporting of side effects.
The Trinitas Comprehensive Cancer Center program responds to the intricacies of oral chemotherapy through a team-focused approach to creating infrastructures, polices and procedures that promote collaborative communications among the center’s physicians, nurses and pharmacists. Trinitas is also developing a program to educate local pharmacists regarding the oral agents, toxicity profiles and safe handling.
Key to the program’s success is an in-depth educational component that enables patients to take charge of their therapy and be active participants in their care, while enabling physicians and nurses to maintain significant measures of control and patient engagement.
“Patients receive instruction in safe handling procedures for their medication, as well as information about their specific diagnosis and the oral agent that’s been prescribed for their treatment,” said Jeanette Barefoot, Director, Clinical Operations at Trinitas. “Key to the education process is helping patients understand how to identify, manage and report side effects. Finally, each patient is given round-the-clock contact information for Trinitas staff, ensuring all patient questions receive prompt answers and any problems are reported as soon as possible.”
Barefoot added that patient understanding and adherence is enhanced through printed materials, individualized calendars and even, pre-loaded pillboxes. Concurrently, Trinitas nurses provide ongoing phone interventions, while regular adherence evaluations and documentation help further ensure the success of each patient’s treatment experience.
Significantly, the Trinitas program integrates various components to eliminate potential obstacles for patients. These components include a translation service for non-English speaking patients, measures to help patients circumvent financial barriers including an on-site financial counselor, and a social worker to assist with emotional, social, support or transportation issues.
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