Developing A Standardized Protocol For The Prescription Of Oral Chemotherapy

120 Background: Over the last 10 years there has been a dramatic increase in the use of oral chemotherapy in the treatment of cancer. However, despite the route of administration, oral chemotherapies carry many of the same risks as intravenous agents and may have greater risks of drug-drug interactions due to variability in absorption and metabolism. Due to these risks, ASCO included oral chemotherapy as part of their updated chemotherapy safety standards in 2013. With this in mind, we sought to examine and improve the reliability and safety of the oral chemotherapy prescription process at the Abramson Cancer Center (ACC) of the University of Pennsylvania.A multi-disciplinary quality improvement team consisting of oncologists, nurse practitioners, and pharmacists was formed to analyze the current state of our oral chemotherapy practice. We identified an absence of signed informed consent and lack of pharmacist prescription review as areas for improvement. To address these deficiencies, we electronically routed our oral chemotherapy orders to an oncology specific pharmacist for review and implemented a policy change requiring that oral chemotherapy have signed informed consent. These changes were applied to the melanoma group of the ACC.Over a 3 month time period, 33 orders for oral chemotherapy were placed for 18 individual patients. Signed informed consent was obtained in 9 of 18 patients (50%). Of the 33 orders, all were reviewed by ACC pharmacists, and as a result, 11 interventions were made by these providers (33%). Types of interventions included dose adjustment (9%), modification of an interacting drug (27%), and additional monitoring specific to the oral agent (64%).Despite its route of administration, oral chemotherapy should be prescribed and reviewed with the same oversight as intravenous chemotherapy. At our institution, involvement of an oncology specific pharmacist in the review of oral chemotherapy led to meaningful interventions in about 1/3 of orders, and with a policy change, signed informed consent was performed in 1/2 of patients. Given these findings, and the clinical implications of this pilot, we plan to continue to study and disseminate this intervention throughout our cancer center.