NEW ORLEANS -- Patients who completed a questionnaire monitoring the use of their new anticancer medications received more and faster interventions from pharmacists to address adverse events (AEs), a single-center randomized study showed.
Though the number of AE-related interventions by pharmacists within 45 days was not significantly different for patients who received the questionnaire versus those who received usual care only (23% vs 19%; OR 1.2, P=0.394), there was a significant difference for those who actually responded to it, reported Brooke Looney, PharmD, of Vanderbilt University Medical Center in Nashville, Tennessee.
An analysis of patients who completed the questionnaire (responders) versus a group comprised of the control patients plus those who received the questionnaire and did not complete it (non-responders) showed that 38% of responders received an AE-related intervention within 45 days compared with 16% of non-responders (OR 2.8, P<0.001), Looney noted at the American Society of Health-System Pharmacists midyear meeting.
This was also true for time to AE-related interventions, with a nonsignificant difference between the intervention and control groups, and a significantly faster time for responders versus non-responders (HR 2.5, P<0.001).
However, patients in the control arm were twice as likely to have healthcare utilization compared with the intervention patients at 90 days (P=0.005).
"We know that those that did respond, there was a positive result, right? So, we were able to identify those side effects earlier on, make pharmacist interventions," Looney told MedPage Today. "We already know, too, that we saw fewer hospitalizations, fewer [emergency department] visits in those patients, so I feel like ... the more patients we can get to respond to [the questionnaire], the better."
Specialty pharmacists may have a growing role in managing adverse events from oral anticancer treatments, and healthcare systems hope to harness electronic health record (EHR) patient portals as a tool for easier communication with patients and faster correction of medication problems.
Looney said that studies like these help reinforce the advantages of using integrated specialty pharmacies like hers for patients. Patient satisfaction surveys that are often used to make their case aren't always enough, she added. "Moving forward, we're going to definitely look at ... describing our outcomes so that we can show our benefit and value in the academic medical setting."
For this study conducted from September 2023 to January 2024, pharmacists at the Vanderbilt Ingram Cancer Center used proprietary software to identify patients receiving new oral anticancer medications within their EHR system. Patients who never started treatment, discontinued it within 14 days, or those prescribed medications for a hematologic condition were excluded.
In all, 182 patients were randomized to the intervention group (68% ≥60 years, 61% men) and 205 patients were randomized to the control group (70% ≥60 years, 57% men). Most were receiving anti-neoplastic agents, and the largest proportion of patients were being treated for genitourinary cancers, and had stage IV cancers.
The intervention group received usual care plus a pharmacist-assigned questionnaire through the EHR patient portal 7 to 14 days after starting medication, which evaluated treatment initiation, adherence, and adverse effects.
The control group received usual care consisting of initial medication counseling and a phone call for a monthly refill assessment a week before medication end date after starting their medication.
The primary outcome was time to first pharmacist intervention related to adverse effects within 45 days of medication dispensing, and the secondary outcome was pharmacist intervention frequency. Analyses comparing the two groups controlled for age, sex, race, diagnosis, Charlson Comorbidity Index, and medication type. Reasons for interventions were mostly adverse events or toxicity, along with medication adherence, and the pharmacist interventions included patient counseling, chart reviews, and contacting the prescriber, among others.
Limitations to the study included low response rates within the intervention arm, and the possibility that some patients in the intervention group who received the survey were reminded to call their pharmacists for a problem without responding to the questionnaire. In addition, some patients may not have been as technology-savvy as others, which could have prevented them from completing the questionnaire.