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Current Hematologic Malignancy Reports
Published in: Current Hematologic Malignancy Reports 4/2016

01-08-2016 | Health Economics (N Khera, Section Editor)

Oral Chemotherapy in Patients with Hematological Malignancies—Care Process, Pharmacoeconomic and Policy Implications

Authors: Jeffrey Betcher, Elizabeth Dow, Nandita Khera

Published in: Current Hematologic Malignancy Reports | Issue 4/2016

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Abstract

Patients with hematologic malignancies are increasing being prescribed oral anticancer medications (OAMs) and/or biologics. These newer targeted OAMs are associated with a host of practical and pharmacoeconomic implications for patients and healthcare providers. Issues such as safety, procurement challenges, and the need for proactive involvement of all stakeholders to optimize adherence for successful use of these agents are increasingly being recognized. The current reactive model is negatively impacting the patient experience through delays in care, financial toxicity, and decreased safety. It also impacts the healthcare providers in the form of lost revenue and staff burnout due to labor-intensive procurement and patient financial assistance burdens. In this review, we describe some of the issues identified and discuss potential strategies to improve patient access, minimize healthcare burden, and review current policy initiatives and patient advocacy efforts to reduce financial toxicity.
Literature
1.
DeMario MD, Ratain MJ. Oral chemotherapy: rationale and future directions. J Clin Oncol. 1998;16(7):2557–67.PubMed
2.
Weingart SN, Brown E, Bach PB, Eng K, Johnson SA, Kuzel TM, et al. NCCN task force report: oral chemotherapy. J Natl Compr Canc Netw. 2008;6 Suppl 3:S1–14.PubMed
3.
Liu G, Franssen E, Fitch MI, Warner E. Patient preferences for oral versus intravenous palliative chemotherapy. J Clin Oncol. 1997;15(1):110–5.PubMed
4.
5.
Schwartz RN, Eng KJ, Frieze DA, Gosselin TK, Griffith N, Seung AH, et al. NCCN task force report: specialty pharmacy. J Natl Compr Canc Netw. 2010;8 Suppl 4:S1–12.PubMed
6.
Weingart SN, Flug J, Brouillard D, Morway L, Partridge A, Bartel S, et al. Oral chemotherapy safety practices at US cancer centres: questionnaire survey. BMJ. 2007;334(7590):407.CrossRefPubMedPubMedCentral
7.
Goodin S, Griffith N, Chen B, Chuk K, Daouphars M, Doreau C, et al. Safe handling of oral chemotherapeutic agents in clinical practice: recommendations from an international pharmacy panel. Journal of Oncology Practice. 2011;7(1):7–12.CrossRefPubMedPubMedCentral
8.
Neuss MN, Polovich M, McNiff K, Esper P, Gilmore TR, LeFebvre KB, et al. 2013 updated American Society of Clinical Oncology/Oncology Nursing Society chemotherapy administration safety standards including standards for the safe administration and management of oral chemotherapy. J Oncol Pract. 2013;(2 Suppl):5s–13. * Updated previous ASCO/ONS guidelines to specifically include oral chemotherapy that provide guidance for patient education, adherence and safety practices.CrossRef
9.
Waterhouse DM, Calzone KA, Mele C, Brenner DE. Adherence to oral tamoxifen: a comparison of patient self-report, pill counts, and microelectronic monitoring. J Clin Oncol. 1993;11(6):1189–97.PubMed
10.
Partridge AH, Avorn J, Wang PS, Winer EP. Adherence to therapy with oral antineoplastic agents. J Natl Cancer Inst. 2002;94(9):652–61.CrossRefPubMed
11.
Greer JA, Amoyal N, Nisotel L, Fishbein JN, MacDonald J, Stagl J, et al. A systematic review of adherence to oral antineoplastic therapies. Oncologist. ;21(3):354–76
12.
Ruddy K, Mayer E, Partridge A. Patient adherence and persistence with oral anticancer treatment. CA Cancer J Clin. 2009;59(1):56–66.CrossRefPubMed
13.
McCue DA, Lohr LK, Pick AM. Improving adherence to oral cancer therapy in clinical practice. Pharmacotherapy. 2014;34(5):481–94.CrossRefPubMed
14.
15.
Bhatia S, Landier W, Shangguan M, Hageman L, Schaible AN, Carter AR, et al. Nonadherence to oral mercaptopurine and risk of relapse in Hispanic and non-Hispanic white children with acute lymphoblastic leukemia: a report from the Children’s Oncology Group. J Clin Oncol. 2012;30(17):2094–101. * The study describes the determinants of adherence and has implications for educational and behavioral interventions in patient groups that are high risk for poor disease outcomes due to non-adherence.CrossRefPubMedPubMedCentral
16.
Avorn J, Monette J, Lacour A, et al. Persistence of use of lipid-lowering medications: a cross-national study. JAMA. 1998;279(18):1458–62.CrossRefPubMed
17.
Bedell CH. A changing paradigm for cancer treatment: the advent of new oral chemotherapy agents. Clin J Oncol Nurs. 2003;7(6 Suppl):5–9.CrossRefPubMed
18.
Esposito D, Bagchi AD, Verdier JM, Bencio DS, Kim MS. Medicaid beneficiaries with congestive heart failure: association of medication adherence with healthcare use and costs. Am J Manag Care. 2009;15(7):437–45.PubMed
19.
Barillet M, Prevost V, Joly F, Clarisse B. Oral antineoplastic agents: how do we care about adherence? Br J Clin Pharmacol. 2015;80(6):1289–302.CrossRefPubMed
20.
Bhatia S, Landier W, Hageman L, Kim H, Chen Y, Crews KR, et al. 6MP adherence in a multiracial cohort of children with acute lymphoblastic leukemia: a Children’s Oncology Group study. Blood. 2014;124(15):2345–53.CrossRefPubMedPubMedCentral
21.
Khera N, Chang YH, Hashmi S, Slack J, Beebe T, Roy V, et al. Financial burden in recipients of allogeneic hematopoietic cell transplantation. Biol Blood Marrow Transplant. 2014;20(9):1375–81.CrossRefPubMed
22.
Esper P. Identifying strategies to optimize care with oral cancer therapy. Clin J Oncol Nurs. 2013;17(6):629–36.CrossRefPubMed
23.
Kav S, Schulmeister L, Nirenberg A, Barber L, Johnson J, Rittenberg C. Development of the MASCC teaching tool for patients receiving oral agents for cancer. Support Care Cancer. 2010;18(5):583–90.CrossRefPubMed
24.
Regnier Denois V, Poirson J, Nourissat A, Jacquin JP, Guastalla JP, Chauvin F. Adherence with oral chemotherapy: results from a qualitative study of the behaviour and representations of patients and oncologists. Eur J Cancer Care (Engl). 2011;20(4):520–7.CrossRef
25.
Moody M, Jackowski J. Are patients on oral chemotherapy in your practice setting safe? Clin J Oncol Nurs. 2010;14(3):339–46.CrossRefPubMed
26.
27.
Johnson JL, Moser L, Garwood CL. Health literacy: a primer for pharmacists. Am J Health Syst Pharm. 2013;70(11):949–55.CrossRefPubMed
28.
Roett MA, Coleman MT. Practice improvement, part II: health literacy. FP Essent. 2013;414:19–24.PubMed
29.
Wong SF, Bounthavong M, Nguyen C, Bechtoldt K, Hernandez E. Implementation and preliminary outcomes of a comprehensive oral chemotherapy management clinic. Am J Health Syst Pharm. 2014;71(11):960–5.CrossRefPubMed
30.
Tefferi A, Kantarjian H, Rajkumar SV, Baker LH, Abkowitz JL, Adamson JW, et al. In support of a patient-driven initiative and petition to lower the high price of cancer drugs. Mayo Clin Proc. 2015;90(8):996–1000.CrossRefPubMed
31.
Shen C, Chien CR, Geynisman DM, Smieliauskas F, Shih YC. A review of economic impact of targeted oral anticancer medications. Expert Rev Pharmacoecon Outcomes Res. 2014;14(1):45–69.CrossRefPubMed
32.
Smieliauskas F, Chien C-R, Shen C, Geynisman D, Shih Y-C. Cost-effectiveness analyses of targeted oral anti-cancer drugs: a systematic review. Pharmacoeconomics. 2014;32(7):651–80.CrossRefPubMed
33.
Dusetzina SB, Keating NL. Mind the gap: why closing the doughnut hole is insufficient for increasing medicare beneficiary access to oral chemotherapy. J Clin Oncol. 2016;34(4):375–80
34.
Dusetzina SB, Winn AN, Abel GA, Huskamp HA, Keating NL. Cost sharing and adherence to tyrosine kinase inhibitors for patients with chronic myeloid leukemia. J Clin Oncol Off J Am Soc Clin Oncol. 2014;32(4):306–11.CrossRef
35.
Kircher SM, Meeker CR, Nimeiri H, Geynisman DM, Zafar SY, Shankaran V, et al. The parity paradigm: can legislation help reduce the cost burden of oral anticancer medications? Value Health. 2016;19(1):88–98.CrossRefPubMed
36.
Goodwin JA, Coleman EA, Sullivan E, Easley R, McNatt PK, Chowdhury N, et al. Personal financial effects of multiple myeloma and its treatment. Cancer Nurs. 2013;36(4):301–8.CrossRefPubMedPubMedCentral
37.
Fenn KM, Evans SB, McCorkle R, DiGiovanna MP, Pusztai L, Sanft T, et al. Impact of financial burden of cancer on survivors’ quality of life? J Oncol Pract 2014;10(5):332–8
38.
Ramsey S, Blough D, Kirchhoff A, Kreizenbeck K, Fedorenko C, Snell K, et al. Washington State cancer patients found to be at greater risk for bankruptcy than people without a cancer diagnosis. Health Aff. 2013;32(6):1143–52.CrossRef
39.
Lathan CS, Cronin A, Tucker-Seeley R, Zafar SY, Ayanian JZ, Schrag D. Association of financial strain with symptom burden and quality of life for patients with lung or colorectal cancer. J Clin Oncol. 2016 February 29, 2016
40.
Kent EE, Forsythe LP, Yabroff KR, Weaver KE, de Moor JS, Rodriguez JL, et al. Are survivors who report cancer-related financial problems more likely to forgo or delay medical care? Cancer. 2013;119(20):3710–7.CrossRefPubMedPubMedCentral
41.
Chino F, Peppercorn J, Taylor DH, Lu Y, Samsa G, Abernethy AP, et al. Self-reported financial burden and satisfaction with care among patients with cancer. Oncologist. 2014;19(4):414–20.CrossRefPubMedPubMedCentral
42.
Abboud C, Berman E, Cohen A, Cortes J, DeAngelo D, Deininger M, et al. The price of drugs for chronic myeloid leukemia (CML) is a reflection of the unsustainable prices of cancer drugs: from the perspective of a large group of CML experts. Blood. 2013;121(22):4439–42.CrossRefPubMedCentral
43.
Mailankody S, Prasad V. Five years of cancer drug approvals: innovation, efficacy, and costs. JAMA Oncology. 2015;1(4):539–40.CrossRefPubMed
44.
Sulmasy D, Moy B. Debating the oncologist’s role in defining the value of cancer care: our duty is to our patients. J Clin Oncol Off J Am Soc Clin Oncol. 2014;32(36):4039–41.CrossRef
45.
Khera N. Reporting and grading financial toxicity. J Clin Oncol.;32(29):3337-8
46.
Ubel PA, Abernethy AP, Zafar SY. Full disclosure—out-of-pocket costs as side effects. N Engl J Med. 2013;369(16):1484–6.CrossRefPubMed
47.
Schnipper LE, Davidson NE, Wollins DS, Tyne C, Blayney DW, Blum D, et al. American Society of Clinical Oncology statement: a conceptual framework to assess the value of cancer treatment options. J Clin Oncol. 2015;33(23):2563–77.CrossRefPubMed
48.
Metadata
Title
Oral Chemotherapy in Patients with Hematological Malignancies—Care Process, Pharmacoeconomic and Policy Implications
Authors
Jeffrey Betcher
Elizabeth Dow
Nandita Khera
Publication date
01-08-2016
Publisher
Springer US
Published in
Current Hematologic Malignancy Reports / Issue 4/2016
Print ISSN: 1558-8211
Electronic ISSN: 1558-822X
DOI
https://doi.org/10.1007/s11899-016-0325-2

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