Donadio, Alyssa

Figueroa, Maria

Lamarque, Michelle

Shwin, Moe

English

Scholarly Commons@Baptist Health South Florida

Baptist Health South FloridaScholarly Commons @ Baptist Health South FloridaAll Publications12-5-2018Retrospective review of oral oncolytic agent usewithin a community hospitalAlyssa DonadioBaptist Hospital of Miami, AlyssaD@baptisthealth.netMoe ShwinMiami Cancer Institute, moes@baptisthealth.netMaria FigueroaBaptist Hospital of Miami, MariaF1@baptisthealth.netMichelle LamarqueBaptist Hospital of Miami, MichelleLam@baptisthealth.netFollow this and additional works at: https://scholarlycommons.baptisthealth.net/se-all-publicationsPart of the Chemical Actions and Uses Commons, Neoplasms Commons, and the PharmacyAdministration, Policy and Regulation CommonsThis Conference Poster -- Open Access is brought to you for free and open access by Scholarly Commons @ Baptist Health South Florida. It has beenaccepted for inclusion in All Publications by an authorized administrator of Scholarly Commons @ Baptist Health South Florida. For moreinformation, please contact Carrief@baptisthealth.net.CitationDonadio, Alyssa; Shwin, Moe; Figueroa, Maria; and Lamarque, Michelle, "Retrospective review of oral oncolytic agent use within acommunity hospital" (2018). All Publications. 3101.https://scholarlycommons.baptisthealth.net/se-all-publications/3101• Increasing availability of oral medications for the treatment of cancer offers many advantages.• Delivery of these agents presents challenges including food and drug interactions, unique toxicities, education, and monitoring.• At Baptist Hospital of Miami (BHM), parenteral chemotherapy administration occurs in the setting of strict prescribing standards, extensive verifications, and safe handling practices.• The process of ordering, dispensing, and administration of oral chemotherapy agents has not been standardized throughout the institution.• Quality and safety related to oral chemotherapy delivery has been recognized by organizations such as the American Society of Clinical Oncology (ASCO) as an important area of opportunity.• Few studies currently exist to inform best practices, particularly among hospitalized patients.To assess whether oral chemotherapeutic agents are being appropriately utilized in hospitalized patients and to determine potential areas for process improvement to ensure their safe and effective use.• Single-center, IRB-exempt, retrospective chart review• Inclusion criteria:o Hospitalized adult patients > 18 years of ageo Order for an oral chemotherapy agent between May 1, 2018 and June 30, 2018• Exclusion criteria:o Non-oncology indication for oral chemotherapy• Primary outcome:o Appropriateness of oral chemotherapy orders (defined as appropriate dose and treatment day, lack of major drug interactions or treatment-related toxicities) • Secondary outcomes:o Total number of missed doseso Time to oncology consultation• Drug interactions were identified using the Lexicomp® Drug Interaction Tool• Appropriate dose, treatment day, and treatment-related toxicities were evaluated based on available documentation in electronic medical recordBackgroundPurposeMethodsDiscussionConclusionDisclosuresReferences1. Sica RA, Sidani A, Domingo GC, et al. A multidisciplinary quality improvement project to improve the safety of oral chemotherapy in hospitalized patients.J Clin Oncol. 2016; 34(7): suppl 110.2. Bursua A, Sica RA, Sencion K, et al. A novel auditing procedure for an oral chemotherapy process improvementa project. J Clin Oncol. 2016; 34(7): suppl 164.3. Krzyzanowska MK, Powis M. Extaending the quality and safety agenda from parenteral to oral chemotherapy. J Clin Oncol. 2015; 11(3): 198-2014. Neuss MN, Gilmore TR, Belderson KM, Billett AL, Conti-Kalchik T, Harvey BE, et al. 2016 updated American Society of Clinical Oncology/Oncology Nursing Society chemotherapy administration safety standards, including standards for pediatric oncology. J Oncol Pract 2016;12:1262–1271.ResultsRetrospective review of oral oncolytic agent use within a community hospitalAlyssa Donadio, PharmD, BCPS1; Moe Shwin, PharmD, BCOP2; Maria C. Figueroa, PharmD, BCOP1; Michelle Lamarque, PharmD, BCPS11Baptist Hospital of Miami, Department of Pharmacy, Miami, FL 2Miami Cancer Institute, Department of Pharmacy, Miami, FLAll authors of this presentation have nothing to disclose concerning possible financial or personal relationships with commercial entities that may have direct or indirect interest in the subject matter of this presentation.• This study demonstrated the need to standardize the process for oral chemotherapy ordering, dispensing, and administration at BHM.• Most common reasons for inappropriate therapy included drug interactions, medication dose, and continuation of therapy despite treatment-related toxicities.• Formulary agents and cases with oncology provider consultations were associated with increased likelihood of appropriate prescribing.• Limitations:o Information to assess outcomes was limited to documentation in electronic medical recordo Small sample size limited ability to assess most common agents• Future directions/considerations based on study results:o Pilot program for pharmacy-led inpatient oral chemotherapy monitoring serviceo Request common non-formulary chemotherapy agents to be built into pharmacy system to allow clinical checking and hazardous drug alertso Provide education to pharmacistso Recommend oncology consult in cases of potential medication related adverse eventsTable 1. Patient Characteristics N=36DemographicsMedian age, yearsGender—female, n (%)72 (range, 26-89)24 (67%)Median length of stay, days 6 (range, 1-104) Location: Oncology Unit, n (%) 12 (33)Oncology Consult, n (%) 25 (69)Oral Chemotherapy Indication, n (%)Chronic Myeloid Leukemia (CML)Acute Myeloid Leukemia (AML)Breast CancerLung CancerAcute Lymphoblastic Leukemia (ALL)Multiple MyelomaMyelodysplastic Syndrome (MDS)Other7 (19)6 (17)6 (17)3 (8)3 (8)2 (6)2 (6)7 (19)Table 2. Oral Chemotherapy Agents N=36Formulary, n (%)ImatinibHydroxyureaCapecitabineTemozolomide9 (25)5 (14)2 (6)1 (3)1 (3)Non-Formulary, n (%)MidostaurinLenalidomideDasatinibPalbociclibNilotinibRibociclibOther27 (75)3 (8)3 (8)3 (8)3 (8)2 (6)2 (6)11 (31)• 58% oral chemotherapy orders were appropriate• Variety of opportunities for pharmacists to intervene, including:o Optimizing administration with regard to foodo Identifying and managing major drug interactionso Ensuring correct dose and day of treatmento Recognizing significant treatment-related toxicities Table 3. Outcomes N=36Primary Outcome, n (%)Appropriate Therapy 21 (58)Secondary OutcomesMissed doses, total numberMedian time to oncology consult, hrs3413 (range 0.5-23)Suboptimal Therapy Categories, n (%)Drug interactions (category D-X)Inappropriate doseTreatment-related toxicityWrong treatment dayFood interaction8 (22)5 (14)5 (14)1 (3)16 (44)587852722742224828730102030405060708090Overall Formulary Non-Formulary Oncology Consult No ConsultPercentage of PatientsAppropriateness of Therapy (%)Appropriate InappropriateTable 4. Subgroup Analysis of Appropriate TherapyFormulary Agent, n (%) 7/9 (78)Non-Formulary Agent, n (%) 14/27 (52)Oncology Consult, n (%) 18/25 (72)No Oncology Consult, n (%) 3/11 (27)

Retrospective review of oral oncolytic agent use within a community hospital

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Retrospective review of oral oncolytic agent use within a community hospital

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