Patient Adherence to Oral Targeted Therapies — [VODCAST] Ep 18

With the emergence of oral cancer therapies, it is a very exciting time in cancer care. But these treatments can come with adverse events.

As oral anticancer medications become a common treatment option, patient adherence to medication is essential to ensuring positive clinical outcomes. CANCER BUZZ spoke to Dr. Maryam Lustberg, MD, MPH, Associate Professor of Internal Medicine and Director, Center for Breast Cancer at the Yale Cancer Center, New Haven, CT, and Sandra Cuellar, PharmD, Clinical Associate Professor, Department of Pharmacy Practice at the University of Illinois at Chicago (UIC) College of Pharmacy, Chicago, IL. Hear as our experts examine challenges with oral anti-cancer therapies and provide methods to better support patients. This is the third episode of a four-part series.

Guests:

Maryam Lustberg, MD, MPH
Director of the Center for Breast Cancer
Yale Cancer Center
New Haven, CT

Sandra Cuellar, Pharm.D., BCOP, FHOPA, FASHP
Clinical Associate Professor, Department of Pharmacy Practice
University of Illinois at Chicago (UIC) College of Pharmacy
Chicago, IL

Related Content:

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

Transcript

CANCER BUZZ: Welcome back to CANCER BUZZ TV. I'm your host, Summer Johnson. Today we'll discuss patient adherence to oral targeted therapies. We're looking at patients in treatment for hormone therapy resistant locally advanced or metastatic HR+, HER2- breast cancer. We'll examine the challenges with oral anticancer therapies and methods to better support patients. This is the third episode in a four-part series on the topic.

Our guests today are Dr. Maryam Lustberg the Director of the Breast Center at Yale and Chief of Breast Medical Oncology at Yale Cancer Center. And Sandra Cuellar, a Clinical Associate Professor in the Department of Pharmacy Practice at the University of Illinois at Chicago, College of Pharmacy, and a Clinical Oncology Pharmacist at UI Health. Thank you both for joining me today. Now, Dr. Lustberg, can you talk about some of the common barriers to oral therapy adherence that you see in your practice?

Maryam Lustberg, MD, MPH:Oral therapies pose a number of different challenges, including remembering to take the pills, the cost of the medication can be a barrier for some patients, as well as the various toxicities and side effects that they experience. So for each patient, I think is a unique blend of these various challenges. I've also heard some patients say that it's a constant reminder that they have cancer or undergoing cancer treatment. So, the idea of taking a pill can be challenging for that reason.

CANCER BUZZ: Can you tell us about an instance where one of your patients struggled with oral therapy adherence?

Sandra Cuellar, Pharm.D., BCOP, FHOPA, FASHP: I had one patient who had lymph node positive breast cancer, so she underwent chemotherapy, then surgery, then radiation. And then I talked to her about starting an anti-estrogen therapy and she would've benefited from starting a class of CDK4/6 Inhibitor Therapy, and the idea of just that one more thing after she had been through a long series of treatments was a struggle for her and she needed some time to wrap her mind around it and really understand the benefit of doing more therapy.

CANCER BUZZ: Dr. Cuellar, how do you and your team support patients to take their medications as prescribed?

Sandra Cuellar, Pharm.D., BCOP, FHOPA, FASHP: So what my team and I do to assure that our patients are taking the medications as prescribed as first is that there, that important pivotal therapy initiation session and recognizing if this patient needs any additional assistance with making sure they're taking their medication on time. We do that two week follow up. So, if that's a point where if there was a challenge or an issue, we could address it relatively within the first two weeks of initiation, providing good patient education information that's both written and verbal and looping in any caregiver that can also provide that additional layer of guidance for this patient to start these medications.

It really hinges on patient, you know, the patient, the information, verbal and written and as needed. You know, having that extra set of ears to really understand and comprehend information we're disseminating to our patient. And then these follow up phone calls I think are also vital in making sure that we're following up with that patient, calling that patient and that the patient has our information and then can call us if there's any issues or problems that may arise.

CANCER BUZZ: Dr. Lustberg, how and when do you and your team assess whether patients are taking their medications as prescribed?

Maryam Lustberg, MD, MPH:So one way to monitor adherence and persistence is we do rely outside of a research setting by simply asking our patients if they're taking their medications and making sure that it's a safe environment where if there are struggling for whatever reason, they're able to report it to us. Another approach is looking at rates of refills through, you know, their pharmacy accounts. So those are the main ways. There are definitely innovative research strategies for more objectively monitoring adherence. But in a, in a routine clinic, essentially, we rely primarily on our patients to tell us whether they're taking it or not.

CANCER BUZZ: Dr. Cuellar, what are some helpful practical tools and approaches that teams can offer to patients?

Sandra Cuellar, Pharm.D., BCOP, FHOPA, FASHP: Tools that we use at our practice, I think the, the medication education sheets we use are absolutely incredible. They were designed by ACCC, HOPA, ONS, and CODA. So for prestigious oncology organizations that collaborated together to put together these patient education sheets that really is nuts to bolts all the information they need, when to call, what side effects at a health literacy level that most patients, if not all patients should be able to understand.

So that's one of the resources. Other resources we look at is what the manufacturer offers for resources, whether it's calendars, journals, anything that we can download. At the moment, we're not endorsing any particular medication reminder apps with the generation of patients that we're currently, you know, generally treating 60 and 70 year-olds, there are not as app savvy as, as maybe my younger generations of patients.

So right now we're, we're at least at our practice, we're not doing any pill reminder apps yet. But I think as we move forward that could be something we incorporate, but we're just, it hasn't hit prime time yet.

CANCER BUZZ: And who on the multidisciplinary team plays a role in supporting patients with this?

Sandra Cuellar, Pharm.D., BCOP, FHOPA, FASHP: So at our institution, the, the main driver with utilizing these tools that are available for assisting patients with medication adherence and persistence is primarily the pharmacist. We have pharmacy services here at our institution that recognize the value of a medication assistance and persistence. And again, we're also have accreditations, you know, URAC accreditation and all these accreditating bodies really want to make sure that we are, our patients are taking their medications and we have tools such as, you know, we refill reminders, you know, pill boxes if necessary phone calls to follow up with these patients. I would say is primarily at our institution pharmacy.

CANCER BUZZ: Dr. Lustberg, what are some broader system level processes and interventions that can help address issues around patient adherence to oral therapies?

Maryam Lustberg, MD, MPH:I think this, the healthcare system certainly plays a big role in supporting adherence and one significant way is making sure that patients have a relatively easy way of contacting their healthcare team within oncology. If they're having issues, the issues could be side effects, it could be financial issues, they don't have a refill and to, to be able to reach out without too much of a hassle, without too many calls to reach the right person.

So I think ease of access within the system is a really key ingredient that I believe we all need to continue to improve on.

CANCER BUZZ: Thank you Dr. Lustberg and Dr. Cuellar. This show is a resource of the Association of Cancer Care Centers developed to deliver the news and latest trends in cancer care right to cancer professionals. This episode was made possible through funding and support provided by Lilly Oncology. Stay tuned for more in our four-part series on Oral Therapies for HER+, HER2- Breast Cancer. On behalf of all of us here at CANCER BUZZ TV, thank you for watching. I'm Summer Johnson.