(130) Impact of a Pharmacist-Led Telehealth Toxicity Monitoring Initiative at an Academic Gastrointestinal Oncology Clinic

Poster Abstract:

Background: Patients undergoing intravenous and oral anticancer therapy may experience significant treatment-related toxicities that impact their quality of life and outcomes. Adverse effects vary and can be challenging to identify despite routine clinic follow-ups. Early identification of toxicities can improve symptom management which may lead to reduced side effects, treatment modifications, emergency department visits, and hospitalizations. Many studies highlight the benefits of pharmacist involvement in the care of patients through a wide variety of functions. A pilot program was launched at Harris Health System utilizing oncology pharmacists to assess patient safety outcomes in our gastrointestinal oncology clinic.

Objective: To evaluate the impact of a pharmacist-led telephone-based toxicity monitoring program on pharmacist interventions for safety outcomes to cancer treatment.

Methods: This is a single-center, retrospective review of adult cancer patients referred to oncology pharmacists at an academic gastrointestinal oncology clinic from September 2022 to December 2023. Patients were selected by a medical oncologist based on a high risk of developing toxicities after implementing changes in supportive care management, initiating a new intravenous or oral chemotherapy regimen, or modifications to chemotherapy dose. Patients were excluded if there were no phone encounters documented. Data collection included patient demographics, cancer diagnosis, chemotherapy regimen, patient-reported adverse effects, toxicity severity, and intervention type. Patients were contacted one to two weeks following the start of treatment changes to assess safety and tolerability. Pharmacy students and residents contributed during their rotation experience. The primary objective of this study is to evaluate the incidence of pharmacy interventions that led to improved patient safety outcomes. The secondary objective is to assess the number of patient education provided and incidence of accepted treatment recommendations by oncology pharmacists.

Results: Of the 46 patients enrolled in our program, 29 patients were evaluated, and 17 patients were excluded due to no phone encounters after two call attempts. Most patients were referred after initiating a new chemotherapy regimen (62%) consisting of fluorouracil, oxaliplatin, irinotecan, and capecitabine. Out of the 33 phone encounters, a total of 67 interventions were identified which included patient education (33%), supportive care management (13%), medication adherence assessment (16%), treatment modifications (10%), and other (28%).
Conclusion/discussion: We concluded that our pilot program improved patient care and safety outcomes with early toxicity detection, guidance to supportive care and therapy management, and access assistance to healthcare services. Implementing standardized processes to further integrate oncology pharmacists is recommended for optimizing cancer patient care and outcomes.

References (must also be included in final poster): 1. Mathur AD, Maiers TA, Andrick BJ. Impact of a pharmacist-led telehealth oral chemotherapy clinic. American Journal of Health-System Pharmacy. 2022;79(11): 896-903.
2. Darling JO, Raheem F, Carter KC, Ledbetter E, Lowe JF, Lowe C. Evaluation of a Pharmacist Led Oral Chemotherapy Clinic: A Pilot Program in the Gastrointestinal Oncology Clinic at an Academic Medical Center. Pharmacy (Basel). 2020;8(1):46.
3. Ajewole VB, Wong K, Nguyen M, Phillips A, Malik Z. Impact of a Pharmacist-led Oral Chemotherapy Medication Therapy Management (MTM) Program in a Large Academic Medical Center. TSHP Conference, September 2020.
4. Tamer, D. Impact of pharmacist-led oral chemotherapy telehealth clinic at a community cancer center using the tamer model. HOPA News Pharmacists Optimizing Cancer Care. 2021;18(1):3–5.