Oral Cancer Therapy: Adverse Events — [VODCAST] Ep 13

With the emergence of oral cancer therapies, it is a very exciting time in cancer care. But these treatments can come with adverse events. Dr. Pavani Chalasani from the University of Arizona Cancer Center shares how she educates patients on what to expect from oral cancer therapies and her focus on one of the most underestimated symptoms for patients.

Pavani Chalasani, MD, MPH
Associate Professor of Medicine
University of Arizona Cancer Center
Tucson, AZ

It’s an exciting time in terms of oral treatment for these patients but they do come with side effects, so educating patients…. is important to proactively manage adverse events.

Related Content:

• Addressing Challenges in Oral Therapies for HR+, HER2- Breast Cancer
• Targeted Drug Therapy | Breast Cancer Treatment (American Cancer Society)
• Hormone Therapy for Breast Cancer | Breast Cancer Treatment (American Cancer Society)
• 2018 Hematology/Oncology Pharmacist Association Best Practices for the Management of Oral Oncolytic Therapy: Pharmacy Practice Standard
• Challenges of Caregivers of Cancer Patients who are on Oral Oncolytic Therapy
• Patient and Plan Characteristics Affecting Abandonment of Oral Oncolytic Prescriptions

This is the first video podcast in a series from the “Addressing Challenges in Oral Therapies for HR+, HER2- Breast Cancer” education program.

Funding and support provided by Lilly Oncology. VV-OTHR-US-DEL-0876 © Lilly USA, LLC 2022. All rights reserved.

©2022. Association of Cancer Care Centers. All rights reserved. No part of this production may be reproduced or transmitted in any form or by any means without written permission.

Transcript

CANCER BUZZ: Welcome back to CANCER BUZZ TV. I'm your host Summer Johnson. The use of Oral therapies means more freedom for patients with cancer, but it can also mean increased risk. So, it's particularly important to proactively manage Adverse Events with these treatments. This is the first episode in a four-part series focused on Oral therapies for patients with HR positive HER2 negative Breast Cancer.

To kick things off, our guest today is Dr. Pavani Chalasani. She's an Associate professor of medicine at the University of Arizona Cancer Center in Tucson.

Dr. Chalasani can you talk about the common side effects that you see in patients taking Targeted therapies?

Dr. Chalasani: Yeah. So, there has been a real improvement in research, which has improved outcomes for our patients with hormone receptor positive, HER2 negative Breast Cancer. The novel targeted therapies, the majority are oral, and they are very exciting, like I said, because they've improved outcomes, but they do come with unusual side effects. So, educating patients about what they are.

In general, the classes of agents are called CDK four, six inhibitors, or we have targeted therapies like P I three K kinase mutation targeted drugs. So, these are all available.

It's very exciting times in terms of treatments. But however, like I mentioned, they do come with some side effects. So, educating patients on what is the frequency they need to come in so that we can check their blood counts to make sure their blood counts are not being too low or they're at increased risk of infection. That is important. Again, joint pains, muscle aches, one thing which is underestimated, I think, but which affects the patients on a day-to-day level is fatigue, and fatigue is a very truly disabling symptom, but it is a hard symptom to treat.

So, trying to be on top of that, like I said, the frequent check-ins are helpful. I strongly believe exercise is the key, which is hard when you're tired too, but slow steps, you know, like I always tell them five minutes of quick burst or walking or whatever it takes. And just like fatigue slowly coming on for the patients, the buildup or feeling better is also there. It's never going to be, it never might be a hundred percent and we need to also make sure that the patients are able to readjust to a new level based on how much they can exercise or do other things, but they can still be functional.

So that is the key to make sure that they're able to do day-to-day.

CANCER BUZZ: What's your approach for managing these side effects, for example, is it regular check-ins over telehealth or in person walk us through that process?

Dr. Chalasani: So, I am fortunate that I do work with a team who is amazing, and we do have what in our program, what we call an Oral Therapy Navigator. But having said that, I do think frequent check-ins is the key to make sure we are able to help patients because the side effects are concerning.
It is a day-to-day functioning of their life and how they're able to do stuff or how active they're going to be, how they feel on a daily level. Really, making sure that they feel like they have a clear understanding and are able to know that they're able to discuss with the providers or they've treating physicians and just, and help through the side effects.

So, I do think initially when the patients start frequent calls or check-ins would be good either by the nurse or any member of the team, and then coming up with what they're experiencing, trying to understand, and getting a little bit more details and helping them through is very, very helpful.

CANCER BUZZ: Are there any other side effects you're also looking for from the hormonal therapies?

Dr. Chalasani: So, like we discussed earlier, and I mentioned, you know, so typically with the oral hormonal therapies, since we are doing Hormone blockade, the broad way to describe, or the simplest way to describe the side effects is as experiencing another mini menopause. But obviously if patients are younger and premenopausal and we do these hormonal therapies, we are trying to put them in menopause pretty fast. So, I try to just walk them through with the side effects on how the hormone blockade works.

So, hot flashes, mood swings, skin changes like dryness, vaginal dryness, hair thinning, you know, which patients do not expect, but doesn't happen right away, but come on like six months or sometimes a year and a half later for patients. So, making sure they're aware of the potential side effects and monitoring their cholesterol, their glucose levels, they're bone densities are also helpful.

That way patients are also comfortable that we can take care of the whole picture that we are looking out for them, not only just putting them on a medication for Breast Cancer, but we also want to help make sure that they are able to handle it.

And their bodies are, you know, that the patients are actually handling it. And they are, in addition to the cancer, we are also making sure that the risks are not outweighing the benefits. And so, by ensuring that their cholesterol and you know, like I said, the risk for diabetes and all those things are also being addressed.

CANCER BUZZ: You talked about making sure that the patients are aware of the side effects before they go on the medication. How else can the healthcare team support patients to be as prepared as possible?

Dr. Chalasani: Okay. So, we do, we talk to the patients, we educate them during their visits, but we also give patient handouts which go over their drugs, their mechanism of action, their side effects in a very detailed way. And they're given those handouts.

I personally believe after you give all patient information, giving them a day or two to process, and then a check in by a phone call is very helpful because they had time to process and synthesize and understand and read, you know, talk to your friend or a family member or do whatever they feel comfortable to get information.

And then let us know, oh, you know what? This is what I heard. And, but this is what I, you know, someone is telling me or what I read about, can you confirm? And I think that is so helpful. It does take time, but I think that is a critical piece. So that is something I would strongly think helps a lot in compliance in patient understanding and their decision making.

CANCER BUZZ: What should your colleagues remember when they're looking to better support these patients?

Dr. Chalasani: I think the main thing that I've learned and that of our teams is one size doesn't fit all. So, if we think, okay, we have this method of how we are going to do it. It is something that we have to tweak for every patient. So even though we may have a process implemented, I think it is critical for us to remember that one size doesn't fit all. And that is pretty much for every patient who walks in. So, we want to make sure that we are able to tweak or, how we call the patients.

Do we make phone calls or do we, you know, if they're agreeable, do we, can we do emails? You know, what is comfortable for the patients, you know, is a text check in what exactly works for the patient and what is best so that they feel comfortable, that they have a, a backup someone they can call in and that will increase compliance and their comfort level in taking the medications too.

CANCER BUZZ: Thank you, Dr. Chalasani. If you're enjoying this content, please let us know by sharing it with your colleagues on Twitter or LinkedIn.

This show is a resource of the Association of Cancer Care Centers developed to bring Oncology professionals, the news and the latest trends in cancer care.

This episode was made possible through funding and support provided by Lilly Oncology on behalf of all of us here at CANCER BUZZ TV. Thank you for watching. I am Summer Johnson.