Oral oncolytic regimens have many benefits; however, patients can encounter barriers (e.g., institutional, socioeconomic, treatment) that can hinder their ability to take their medication as prescribed. Patients with metastatic colorectal cancer (mCRC) face complex dosing schedules that challenge adherence. When patients take oral therapies at home, healthcare professionals (HCPs) can use tools to empower their patients to ensure they are taking the right dosages at the right time. HCPs—particularly oncology nurses and pharmacists—have an opportunity to embrace the roles of educators and advocates, to support and encourage patients with mCRC to overcome adherence barriers to achieve their treatment goals.
NCODA’s View: This is a excellent whitepaper by ONS detailing many of the challenges patients encounter in taking oral therapy. While the whitepaper is specific to metastatic colorectal cancer, the challenges and recommendations can be applied to all patients taking oral therapy. The Pharmacist, OCN Nurse, Pharmacy Technician dispensing staffing model advocated by NCODA dovetails nicely with the recommendations in this whitepaper.
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Approximately 40% of patients treated with anthracyclines are still not receiving National Comprehensive Cancer Network (NCCN) guideline–adherent prophylaxis for chemotherapy-induced vomiting. In most cases, guideline nonadherence was secondary to the lack of a neurokinin 1 (NK1) antagonist.
Patients on highly emetogenic chemotherapy should receive prophylaxis in the form of a 5-HT3 antagonist in combination with steroids and an NK1 antagonist, according to Mariana Chavez-MacGregor, MD. The addition of an NK1 antagonist was incorporated into the NCCN and American Society of Clinical Oncology guidelines in 2006.
“Patients receiving highly emetogenic chemotherapy, and also selected moderately emetogenic regimens commonly used in the treatment of breast cancer, should receive this prophylaxis to relieve their nausea and vomiting, starting with the first dose of the first cycle of chemotherapy,” said Chavez MacGregor, assistant professor in the division of cancer prevention at the University of Texas MD Anderson Cancer Center in Houston.
Chavez-MacGregor and her colleagues conducted a population-based study to evaluate adherence to antiemesis prophylaxis guidelines among breast cancer patients treated with anthracyclines and presented their findings at the 2015 Multinational Association of Supportive Care in Cancer/International Society of Oral Oncology International Symposium on Supportive Care in Cancer.
NCODA’s view: Advances in controlling nausea and vomiting have come a tremendously long way. This article points out that we may still have a ways to go. There are very few reasons why a patient should not be receiving the NCCN recommended antiemesis regimens. Standardizing anitemetic protocols within a practice’s EHR should be a priority for all oncology practices. No patient should needlessly suffer through chemotherapy-induced nausea and vomiting due to inadequate prophylaxis.
TON September 2015 Vol 8 No 5 – Side Effect Management Article by: Meg Barbor
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More Than 800 Medicines and Vaccines in Clinical Testing for Cancer Offer New Hope to Patients
In recent decades, tremendous – almost previously unthinkable – progress has been made in the fight against cancer. Advances in molecular and genomic research have revealed underlying complexities and provided insights into cancer, which we now know is actually more than 200 unique diseases. Continued research has expanded our knowledge of how the disease develops and how to target medicines for specific cancer types – resulting in more effective therapies for patients
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