Adherence to Oral Anticancer Medications After Implementation of an Ambulatory Adherence Program at a Large Urban Academic Hospital

PURPOSE: Oral anticancer medications (OAMs) offer convenient administration, reducing the burden of cancer treatment, but create challenges for patients and practitioners. Using data from the Quality Oncology Practice Initiative analysis, a baseline adherence rate of 30% was identified at a large public, academic hospital. To improve OAM adherence, a quality improvement initiative was conducted. METHODS: The aim was to increase OAM patient adherence by 30 percentage points. Through cause-and-effect analysis, adherence barriers were identified, leading to the development of 2 strategies: low-cost adherence tools and a pharmacist-led adherence program. Prescription refill data were collected before and after the intervention, using prescription-fill data and specialty pharmacy records. Adherence was defined as the patient having the drug available at least 80% to less than 120% of the days evaluated for 4 treatment cycles. Other indicators collected included the number of interventions, OAM-related toxicity, emergency room visits, and hospitalizations. RESULTS: OAM adherence increased from 37% to 85% (n = 20 of 54 v 44 of 52 patients; P < .0001) in 1 year. During the study, 655 interventions were documented by the pharmacist (adherence related, n = 331; treatment related, n = 324). The number of oncology-related emergency room referrals leading to hospitalization increased from 52% (n = 13 of 25) to 62% (n = 23 of 37) during the study period. CONCLUSION: A pharmacist-led adherence program, combined with low-cost adherence tools, exceeded the goal for the adherence initiative, suggesting that a multidisciplinary collaborative approach to OAM adherence can have a significant impact on outcomes.