National Discussion on Proper Use and Support of Oral Chemotherapy in Cancer Care

The growing use of oral chemotherapeutics brings clinical benefits but also raises questions in prescribing, adherence, accessibility and long term follow-up care.

Therfore, US Oncology, Inc. partnered with the Association of Community Cancer Centers, Association of Oncology Social Work, American Society for Clinical Oncology, Community Oncology Alliance, Oncology Nursing Society and the National Patient Advocate Foundation in hosting a panel discussion on Capitol Hill to examine the benefits of oral chemotherapy in cancer care, as well as challenges in its prescribing, accessibility and adherence in the current health care system.

"US Oncology recognizes the benefits of oral chemotherapy treatments and supports their use in that many patients have benefited from their convenience; ease of administration; and in some cases, lessened side effects when compared to traditional chemotherapy," said Leonard Kalman, M.D., Chairman of US Oncology's Public Policy Steering Committee. "As more patients request this therapy option, it is critical that patients and their physicians be fully informed and supported when it comes to effective prescribing, access to care and dosing adherence. We applaud our partners in the oncology community for coming together to address this issue."

Oral Agent in Cancer Care
The panel discussion, entitled "Oral Agents in Cancer: Their Impact on the Treatment of Patients and Providers," featured perspectives from practicing medical oncologists, oncology nurses, oncology social workers and a chemotherapy patient who was unable to access her prescribed oral chemotherapy medication following an insurance coverage denial. As the panelists explained, all healthcare stakeholders must work together to ensure that these life-saving treatments are properly prescribed and administered, effectively covered and financially obtainable for patients as the oral chemotherapeutics market grows.

US Oncology's OncologyRx Care Advantage™ national oral oncology specialty pharmacy service provides this type of financial, administrative and clinical support to cancer patients in need. By working directly with various charitable foundations, the program has provided more than $15 million in drug co-pay assistance to cancer patients since its inception in August 2006. OncologyRx Care Advantage also provides home delivery of prescribed oral cancer therapies, utilizes oncology certified nurses to proactively monitor patient compliance and help manage side effects, and gives patients 24-hour access to oncology certified pharmacists to answer their medication and dosing questions.

Patient Adherence
With intravenous chemotherapy, cancer care providers are able to monitor treatment on site and ensure that patients properly follow to their dosing amount and schedule. However, when patients take their own oral chemotherapy treatments at home, other factors may come into play, such as forgotten doses, omitted doses, emotional factors and other priorities. Adequate patient education and follow-up are critical to make certain patients receive the full treatment they need.

Healthcare providers play a unique and important role in assisting patients' healthy behavior changes. Panelists noted that widespread success in oral chemotherapy treatment will call for improved patient access to treatments; a new level of integration in care among physicians, pharmacists and other clinicians involved with the patient's care; and a new infrastructure in care for prescribing, education and support.

The problem of poor adherence has been a well-recognized problem [1,2,3,4]. Research investigating the effects of nonadherence suggest that in the United States alone, every year more than 125,000 deaths are caused by this phenomenon, accounting for upwards of 10% to 25% of all hospital and nursing home admissions. [5]. These numbers suggest that a patient’s poor or nonadherence is one of the largest and most expensive disease categories in the US. But patient nonadherence is not limited to medications alone. Patients may ‘forget’ to keep their appointments, to follow recommended dietary, adhere to other lifestyle changes, or fail to follow – in some case deliberately sabotage - other aspects of treatment or recommended preventive health practices. As a result, the actual implications of nonadherence go far beyond the financial aspect of patients’ failing to take medication.

"As more cancer patients are likely to look to oral chemotherapy as a more convenient and less invasive treatment option, we need to ensure that systematically, we are ready to meet their needs and providers' needs in terms of ready access to treatment; comprehensive information; and full administrative, clinical and social support throughout the course of treatment," added Dr. Kalman. "We look to the steps we have taken with OncologyRx Care Advantage as a model for this type of support, and we hope the broader healthcare community and policymakers will join us in exploring similar strategies to advance treatment success more broadly in this important area of care."

For more information
[1] Haynes RB. Introduction. In: Haynes RB, Taylor DW, Sackett DL, eds. Compliance in Health Care. Baltimore, Md: Johns Hopkins University Press; 1979:1-18.
[2] Blackwell B. Drug therapy: patient compliance. N Engl J Med. 1973;289:249-252.
[3] Fawcett J. Compliance: definitions and key issues. J Clin Psychiatry. 1995;56(suppl1):4-8.
[4]Davis MS. Variation in patients' compliance with doctors' orders: medical practice and doctor-patient interaction. Psychiatry Med. 1971;2:31-54.
[5] Smith DL. Compliance packaging: a patient education tool. Am Pharm. 1989;NS29(2):42-45, 49-53.

Also:

• Onco’Zine – The International Cancer Network

A Call to Action to Prevent Deaths from Prostate Cancer in Europe

A coalition of influential European advocacy and professional groups are meeting today to call for action by the European Parliament to commit to serious steps to reduce the number of men affected by, and dying from prostate cancer, by ensuring timely access to information, care and support services for men at risk or with prostate cancer.

The call to action is being launched during European Urology Week, as part of a new campaign, the Proactive Prostates Initiative, at a meeting in Antwerp, which is being hosted by Europa Uomo and the European Association of Urology (EAU).

Speaking at the meeting 'Prostate Cancer: Establishing the Facts', where representatives included the European Cancer Patient Coalition (ECPC), the European Association of Urology (EAU) and Members of the European Parliament (MEPs against cancer), Prof Louis Denis of Europa Uomo said: 'We need to do more to combat prostate cancer and stop men dying or living with the burden of the disease, when so much can be done to improve awareness of earlier diagnosis and access to the right resources, services and treatments at the right time.'

Prostate cancer is the third leading cause of cancer death in European men. More than 300,000 men are diagnosed in Europe with prostate cancer every year and approximately one of five will die from the disease. These statistics are similar to breast cancer. Three-quarters of prostate cancer cases are in men over 65 years. With an increasingly ageing population, the prevalence of prostate cancer and the burden associated with this disease is set to rise.

'I urge society to sit up and take notice of prostate cancer so that we can beat this disease, yes we can", said Archbishop Desmond Tutu, the South African Nobel Peace Prize Laureate who has had prostate cancer, and fully supports the call to action.

The future for prostate cancer is not a bright one unless there is societal commitment to changing the way the disease is viewed. An increasingly ageing population means that the burdens associated with the disease will also rise, creating serious social and economic consequences.

The coalition is calling for action from society, governments, healthcare professionals and men in adopting a more proactive stance towards prostate cancer to prevent the serious burden of disease and deaths from prostate cancer.

The call to action emphasizes the need for:

• Recognition by governments of the morbidity and mortality burdens of prostate cancer, so that it can be made a higher priority in their health agenda.
• Commitment from governments to ensuring sustainable support for basic research for a new biomarker and clinical research on treatment comparison.
• Health professionals to educate their patients about the risk factors for prostate cancer, such as family history, ensuring those at risk are given appropriate information
• Physicians to tailor treatment according to the individual patient, avoiding over- and under-treatment, through appropriate use of PSA testing to ensure that men receive the right treatment
• A drive to help society unite and build partnerships in helping to reduce the burden of the disease as well as identify common action and reducing the existing inequalities on access to treatment.

Images courtesy American Society of Clinical oncology (ASCO)