Research Opportunity on Patient Adherence to Orally Administered Chemotherapy

by Amy Smith, as part of her Green Oncology series

Recently, I had the unique opportunity to collaborate with Dr. David Blackburn, a professor at the University of Saskatchewan, on a research project with a focus in patient adherence.  We reviewed de-identified patient data from the Saskatchewan Cancer Agency (SCA) to assess compliance rates to an orally administered chemotherapy agent: abiraterone.       

The Issue:

A shift is occurring in chemotherapy administration from predominately intravenous (IV) to oral.(1)  It is estimated that over a quarter of the anti-cancer products currently being investigated will be administered orally.(1) Certainly oral options have perks – improved patient convenience and decreased “chair time.”  However, as we transition to this method of administration, there are important questions that require answers. 

Oral administration of chemotherapy transfers the responsibility of safe and effective administration from the practitioner to the patient.  Patient adherence critical for effective treatment.Somepatients may perceive oral agents to be less effective or may not consider adherence as vital as IV agents.  As such, a review of patient adherence to abiraterone was undertaken. 

 

Investigating the Solution:

The SCA provides comprehensive data as only two oncology pharmacies in the province (Saskatoon and Regina) dispense abiraterone.  Patients receive the medication at no charge from pharmacists who practice solely in oncology.  As several barriers are removed (e.g. medication costs), it is hypothesized that patient adherence rates are relatively high.  Patients were considered to be adherent to abiraterone therapy if their medication possession ratio (i.e., MPR) is greater than or equal to 80%.  (see below)
 

Medication Possession  =        total days supply          x 100

Ratio (i.e., MPR)                   actual days in period             

 

Keep checking back at the CAPhO Compass as we are hoping to share our published results with you soon.

 

Amy Smith is a graduate of the College of Pharmacy at the University of Saskatchewan.  After completing a hospital residency program with the Regina Qu’Appelle Health Region, Amy began working with the Saskatchewan Cancer Agency in Saskatoon as a pediatric oncology pharmacist.  She is now attending the U of T post-baccalaureate PharmD program. During her time away from work, Amy enjoys traveling, volunteering and participating in a various athletics including powerlifting and running. Amy is a member of CAPhO's Communication Committee. 

 

 

References:

1.   Saul N. Weingart. Journal of the National Comprehensive Cancer Network. NCCN Task Force Report: Oral Chemotherapy [Internet]. Fort Washington, PA; Available from: http://www.nccn.org/JNCCN/PDF/JNSU3_combined_Oral_Chemo_2008.pdf

2.   Saskatchewan Cancer Agency Drug Formulary [Internet]. Saskatchewan: Saskatchewan Cancer Agency; 2014 May. Available from: http://www.saskcancer.ca/Formulary%2005-16-2014

3.   De Bono JS, Logothetis CJ, Molina A, Fizazi K, North S, Chu L, et al. Abiraterone and increased survival in metastatic prostate cancer. N Engl J Med. 2011 May 26;364(21):1995–2005.

4.   Ryan CJ, Smith MR, de Bono JS, Molina A, Logothetis CJ, de Souza P, et al. Abiraterone in metastatic prostate cancer without previous chemotherapy. N Engl J Med. 2013 Jan 10;368(2):138–48.