Written by: Joshua Nubla, PharmD, NCODA
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Description: This PQI will discuss management strategies for oncolytic medication induced diarrhea including combinations of fluid hydration therapies, antimotility agents such as loperamide, and dose modifications.

Background: A common side effect with many oncolytic therapies is medication induced diarrhea which can result from chemotherapy or targeted therapy regimens. Medication induced diarrhea will present with increasing frequency and consistency of bowel movements and drastic changes in hydration status and electrolyte levels. Oncolytic induced diarrhea can lead to life threatening dehydration and electrolyte imbalances.

PQI Process: Identify patients who are taking an oncolytic agent with a known diarrhea side effect.

Common oral oncolytic agents that cause diarrhea

  • Tyrosine Kinase Inhibitors (TKI)
  • Multi-kinase Inhibitors
  • Phosphatidylinositol-3-kinase (PI3K) Inhibitors
  • Capecitabine
  • Everolimus
  • Fluorouracil (5FU®)
  • Irinotecan

Upon receiving a prescription of any agents that commonly cause diarrhea:

  • Counsel patient on importance of diarrhea management and risks of dehydration
  • Provide loperamide and dosing instruction (see supplemental information)
  • Counsel patient on appropriate diet (see supplemental information)
  • Schedule follow up phone call within first few days or weeks of starting therapy to asses if patient is experiencing diarrhea
    • If not controlled with loperamide change in therapy may be needed
    • If severe, may need to provide IV fluid and electrolyte replacement

Patient Centered Activities:

  • Provide Oral Chemotherapy Education (OCE) Supplemental Sheet
  • Adhere to suggested dosing and diet strategies
  • Start taking loperamide at the first onset of diarrhea
    • If taking antidiarrheal and without relief for 48 hours, then contact clinic
  • Drink plenty of fluids: 6-8 large glasses of water, clear liquids, soup per day
  • If on immunotherapy contact your clinic immediately at the first onset of diarrhea

References:

  1. Micromedex Drug Database
  2. Up To Date

Supplemental Information:

Diet

  • Avoid greasy, spicy, or fried food
  • Avoid milk, caffeine, alcohol
  • Avoid high fiber vegetables
  • Eat small meals
  • Follow B-R-A-T diet
    • Bananas, rice, apple sauce, toast/tea (decaffeinated)

Medication Therapy

  • Loperamide (OTC)
    • Mild-Moderate – Take two caplets (4 mg) by mouth at the onset of diarrhea, followed by one caplet (2 mg) every hour hours or after each loose stool
    • Persistent (12-24 hrs) – Take two caplets (4 mg) by mouth at the onset of diarrhea, followed by one caplet (2 mg) every two hours until no diarrhea for 12 hours
    • During the night, take 2 caplets (4 mg) by mouth at bed time and continue every four hours during the night until morning
    • Stop taking loperamide only after there is no sign of diarrhea for 12 hours
    • Max 16 mg per day (up to 24 mg per day for chemotherapy induced diarrhea under medical supervision)
  • Diphenoxalate/Atropine (Rx)
    • Take two tablets (5 mg) by mouth three to four times daily
    • Max 40 mg per day
    • Atropinism (dryness of the skin and mucous membranes, tachycardia, urinary retention, and hyperthemia) has been reported
    • Respiratory depression has been reported
  • Octreotide (Rx)
    • Inject 100-150 mcg subcutaneously three time daily
      • Rapidly escalate to 500 mcg subcutaneously three times daily if lower doses are not effective
    • Tincture of Opium (Rx)
      • Take 10-15 drops in water every three to four hours
    • Budesonide (Rx)
      • Take 9 mg by mouth once daily (off label)

Important notice: NCODA has developed this Positive Quality Intervention platform. This platform represents a brief summary of medication uses and therapy options derived from information provided by the drug manufacturer and other resources. This platform is intended as an educational aid and does not provide individual medical advice and does not substitute for the advice of a qualified healthcare professional. This platform does not cover all existing information related to the possible uses, directions, doses, precautions, warning, interactions, adverse effects, or risks associated with the medication discussed in the platform and is not intended as a substitute for the advice of a qualified healthcare professional. The materials contained in this platform are for informational purposes only and do not constitute or imply endorsement, recommendation, or favoring of this medication by NCODA, which assumes no liability for and does not ensure the accuracy of the information presented. NCODA does not make any representations with respect to the medications whatsoever, and any and all decisions, with respect to such medications, are at the sole risk of the individual consuming the medication. All decisions related to taking this medication should be made with the guidance and under the direction of a qualified healthcare professional.

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Written by: Brady Quinn, PharmD and Britny Rogala, PharmD, BCOP – University of Rhode Island College of Pharmacy
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Description of PQI: Discuss prevention and management strategies for treatment related constipation.

 

Background: The utilization of proper diet, over-the-counter medications, and alternative prescriptions can be helpful for patients suffering from multisource drug induced constipation. Preventing this type of constipation requires less interventions than treating the symptoms once they occur.1 Many chemotherapeutic medications, antiemetics, and pain regimens can commonly cause constipation (see supplemental information). Drug-induced constipation, often characterized by infrequent, hard, or difficult to pass bowel movements, can significantly impair quality of life or cause severe pain, rectal fissures, or bowel obstruction.1-3

PQI Process: Upon receipt of an oral chemotherapy agent with known constipation side effect

  • Counsel patient on constipation management
  • Provide information on foods to eat to prevent the onset of constipation
  • Provide stool softener and stimulant laxative to patient if patient reports signs of constipation (see supplemental information)
  • Keep stool softener and stimulant laxative well stocked if patient experiences intermittent constipation
  • Consider scheduling a follow up phone call with patient within one week after initiation of therapy to assess if patient is experiencing constipation
    • Assess the cause of constipation (chemotherapy/antiemetic/opioid)
    • If opioid therapy is the cause of the constipation and significant effort to alleviate constipation has been made with no relief, consider prescription therapy (ex. methylnaltrexone, naloxegol)
    • If antiemetic therapy is the cause of constipation provide a prescription for a different type of antiemetic for chemotherapy induced nausea/vomiting (ex. prochlorperazine, metoclopramide)

 Patient Centered Activities:

  • Provide Oral Chemotherapy Education (OCE) Supplemental Sheet
  • Educate patients on different forms of laxatives (bulk forming, polyethylene glycol), if bowl movements do not become regular continue on OTC agents and advise patient to:
    • Try to find a diet and regimen that helps to keep bowel movements regular
    • Attempt to treat to regular bowel movement schedule
    • Keep track of how many bowel movements are made in a week
    • Drink plenty of fluids while taking laxative and stool softening medications
    • Contact clinic if there have been no bowel movement in 2 or more days
    • Have patient notify provider OTC medications have been taken continuously for 7 days

References:

  1. McQuade RM, Stojnovska V, Abalo R, Bomstein JC, Nurgali K. Chemotherapy-Induced Constipation and Diarrhea: Pathophysiology, Current and Emerging Treatments. Front Pharmacol. 2016;7:414.
  2. Andrews CN, Storr M. The pathophysiology of chronic constipation. Can J Gastroenterol. 2011;25:16B-21B.
  3. Kumar L, Barker C, Emmanuel A. Opioid-Induced Constipation: Pathophysiology, Clinical Consequences, and Management. Gastroenterology Research and Practice. 2014; https://doi.org/10.1155/2014/141737.

 

Supplemental Information:

Oral chemotherapy agents that commonly cause constipation (>30%): alectinib, crizotinib, ponatinib, ixazomib, lenalidomide, niraparib, pomalidomide, rucaparib temozolomide, and thalidomide

Anti-emetics that commonly cause constipation: 5-HT3 antagonists (ex. ondansetron)

Diet/Exercise:

  • Increase fiber intake; patients prone to small bowel obstruction (ex. abdominal surgery) should avoid additional fiber intake
    • Whole grains, brown rice, raw fruits and vegetables, etc.
  • Drink plenty of fluids
    • 8-10 glasses of water, fruit/vegetable juices, decaffeinated teas
  • Encourage physical activity

Drug Therapy

Osmotic Laxative

  • Polyethylene Glycol (OTC/Rx)
    • Take 1 capful/packet/heaping tablespoon (17 g) of powder dissolved in 4-8 ounces of any beverage daily
    • Onset of action:12-72 hours

Stool softener

  • Docusate Sodium (OTC)
    • Take 1 softgel (100 mg) up to 3 times per day in divided doses
    • Onset of action: 12-72 hours
    • Can take with in combination with a stimulant laxative for best results

Stimulant laxatives

  • Senna (OTC)
    • Take 2 tablets (17.2 mg) as one dose once daily to start. If needed can take up to 4 tablets (34.4 mg) twice daily
    • Onset of action: 6-12 hours
  • Bisacodyl (OTC)
    • Take 1 tablet (5 mg) once daily to start. If needed can take up to 3 tablets (15 mg) once daily
    • Onset of action: 6-12 hours


Prescription Options

  • Methylnaltrexone (Relistor®) (Rx)
    • Used to treat opioid-induced constipation
    • Rule out GI obstruction (contraindicated)
    • Inject 1 prefilled syringe (dose may vary) subcutaneously up to every other day as needed
    • Rotate injection site between abdomen, thighs, and upper arms
    • Discontinue methylnaltrexone immediately if severe/persistent diarrhea/abdominal pain occurs
  • Naloxegol (Movantik®) (Rx)
    • Used to treat opioid-induced constipation
    • Rule out GI obstruction (contraindicated)
    • Usual dose: take 1 tablet (25 mg) daily at least 1 hour before the first meal of the day (dose may differ due to tolerability)
    • Concomitant use with strong CYP3A4 inhibitors is not recommended
  • Lubiprostone (Amitiza®) (Rx)
    • Used to treat opioid-induced constipation
    • Rule out GI obstruction (contraindicated)
    • Usual dose: take 24 mcg by mouth twice daily

 

Important notice: NCODA has developed this Positive Quality Intervention platform. This platform represents a brief summary of medication uses and therapy options derived from information provided by the drug manufacturer and other resources. This platform is intended as an educational aid and does not provide individual medical advice and does not substitute for the advice of a qualified healthcare professional. This platform does not cover all existing information related to the possible uses, directions, doses, precautions, warning, interactions, adverse effects, or risks associated with the medication discussed in the platform and is not intended as a substitute for the advice of a qualified healthcare professional. The materials contained in this platform are for informational purposes only and do not constitute or imply endorsement, recommendation, or favoring of this medication by NCODA, which assumes no liability for and does not ensure the accuracy of the information presented. NCODA does not make any representations with respect to the medications whatsoever, and any and all decisions, with respect to such medications, are at the sole risk of the individual consuming the medication. All decisions related to taking this medication should be made with the guidance and under the direction of a qualified healthcare professional.
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Written by: Neal Dave, PharmD and Julianne Orr, PharmD
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Description of PQI:  Discuss the prevention and management of opioid induced constipation.

Background: Constipation is a major side effect of opioid administration and should be assessed and managed by the healthcare team. In cancer patients receiving chronic opioid therapy, the prevalence of constipation can be as high as 60 to 90 %. Constipation is the most common manifestation of opioid induced bowel dysfunction (OBD) and typically occurs through activation of both peripheral and central opioid receptors. Opioid induced constipation (OIC) has the potential to effect patients’ quality of life or lead to complications such as bowel obstruction or anorexia. 

PQI Process: Once a prescription for an opioid is obtained:

  • Assess the medications patients are currently on
    • Look for causative medications in addition to opioids
    • If patient is already on an agent that is notorious for causing diarrhea, there may be no need for prevention of OIC
  • Educate patient on opioid induced constipation
    • Symptoms of constipation
      • Straining
      • Lumpy or hard stools
      • Sensation of incomplete evacuation
    • Consider adding preventative agents:
      • Docusate/Senna: Two tablets (17.2 mg sennosides plus 100 mg docusate) by mouth once daily
        • Max dose of senna: 68.8 mg by mouth twice daily
      • Polyethylene Glycol: 17 g orally 4-8 oz of water daily
      • Lactulose: 30 mL by mouth daily (avoid in patients who are lactose intolerant)
    • Pharmacologic options once preventative measures are ineffective, consider use with discretion as clinical efficacy varies:
      • Magnesium citrate: 195 – 300 mL by mouth given once or in divided doses
        • Consider milk of magnesia if citrate is unavailable
      • Methylnaltrexone (Relistor®): Dosing is according to body weight; Administer one dose subcutaneously once every other day as needed (Max: 1 dose/24 hours)
        • <38 kg: 0.15 mg/kg rounded to the nearest 0.1 mL
        • 38 to <62 kg: 8 mg
        • 62 to 114 kg: 12 mg
        • >114 kg: 0.15 mg/kg rounded to the nearest 0.1 mL
      • Naloxegol (Movantik®): 25 mg by mouth once daily
        • Can decrease to 12.5 mg if 25 mg not tolerated
      • Lubiprostone (Amitiza®): 24 mcg by mouth twice daily

Patient Centered Activities:

  • Provide Oral Chemotherapy Education (OCE) Supplemental Sheet
  • Non-pharmacologic counseling
    • Increase fluids
      • Common recommendation for water consumption is eight 8-ounce glasses, which is about 2 liters (or a half gallon) per day
      • Caffeine can contribute to dehydration
    • Increase fiber
      • USDA fiber intake recommendation is between 25-38 g per day
    • Modifying diet
      • Eat several small meals throughout the day, rather than a few large ones
      • Avoid fatty, processed meats, and fast foods
      • Consuming natural laxatives:
        • Prunes, apple cider, bran cereals, watermelon, rhubarb, etc
      • Increase activity
        • Exercise can increase circulation, which can naturally accelerate movement of stool
      • Consider offering diet counseling books (ex. “Eating Well Through Cancer”)
      • Taking preventative agents daily
    • Patient Medication Education
      • Review maximum daily doses of any agent the patient starts
      • Relistor® – make sure the patient is aware that an instant bowel movement is possible after they receive their injection

References:

  1. Poulsen et al. Therap Adv Gastroenterol. 2015 Nov;8(6):360-72.
  2. Dhingra et al. Palliative Medicine. 2012 June;27(5):447-457.
Important notice: NCODA has developed this Positive Quality Intervention platform. This platform represents a brief summary of medication uses and therapy options derived from information provided by the drug manufacturer and other resources. This platform is intended as an educational aid and does not provide individual medical advice and does not substitute for the advice of a qualified healthcare professional. This platform does not cover all existing information related to the possible uses, directions, doses, precautions, warning, interactions, adverse effects, or risks associated with the medication discussed in the platform and is not intended as a substitute for the advice of a qualified healthcare professional. The materials contained in this platform are for informational purposes only and do not constitute or imply endorsement, recommendation, or favoring of this medication by NCODA, which assumes no liability for and does not ensure the accuracy of the information presented. NCODA does not make any representations with respect to the medications whatsoever, and any and all decisions, with respect to such medications, are at the sole risk of the individual consuming the medication. All decisions related to taking this medication should be made with the guidance and under the direction of a qualified healthcare professional.
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Written By: Natasha Olson, PharmD, NCODA
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Description: The purpose of this PQI is to provide proper identification and management of patients who may benefit from the use of non-hormonal contraception using lactic acid/citric acid/potassium bitartrate (Phexxi), a novel non-hormonal, vaginal pH modulator.

Background: Lactic acid/citric acid/potassium bitartrate is indicated for the prevention of pregnancy in females of reproductive potential for use as an on-demand method of contraception.1 In a single arm, multicenter, open label, phase 3 study, Lactic acid/citric acid/potassium bitartrate was evaluated for cumulative pregnancy prevention in  women ages 18 – 35 years old and considered at risk for pregnancy.2 Women enrolled in this study recorded use of the medication, coital frequency, symptoms experienced, and overall satisfaction with the product. The study found 86.3% contraceptive effectiveness with typical use and 93% contraceptive effectiveness when used as directed, with minimal side effects, and high satisfaction (up to 90%).2 For decades we have known that hormones play an active role in cancer.3 For women specifically, endometrial, breast, and ovarian cancers can be highly dependent on hormone driven oncogenesis. Although studies differ on the risk associated with the use of oral contraceptives and a woman’s overall risk of cancer development, it is evident that women who used oral contraceptives have an increased risk of breast cancer and cervical cancer. 4, 5 For this reason, alternative non-hormonal contraceptive methods may be warranted during and after treatment of cancer.

PQI Process:

  • Identify patients that may need non-hormonal contraception
    • Women of child bearing potential
      • Breast or cervical cancer patients
        • Other cancer patients may be considered as well
      • Female partners of cancer patients
    • Screen for precautions and contraindications
      • Should not be used with vaginal ring
      • Cystitis
      • Pyelonephritis
      • Chronic UTI infections

Patient Centered Activities:

  • Discuss the pros and cons of lactic acid/citric acid/potassium bitartrate
    • Non-hormonal
      • Works by maintaining acidic vaginal pH in presence of semen and reduces sperm motility
      • Safe to use in cancer treatment
      • No systemic absorption
    • On demand usage/administration
      • Only used when needed as opposed to daily dosing with traditional oral contraceptives
  • Must be used before every act of intercourse – not effective if used after
  • Due to the thickness of the product, there will be limited vaginal discharged
  • Provide counseling on potential side effects
    • Burning sensation of vulva (18%)1
    • Pruritus of genital organs (14.5%)1
    • Vulvovaginal infections
      • Mycotic infection (9.1%)
      • Bacterial vaginosis (8.4%)
    • Urinary tract infections (9.0%)
  • Counsel the patient on the intravaginal administration and the timing of administration
    • Immediately before each act of vaginal intercourse
    • Up to 1 hour before each act of vaginal intercourse
    • Repeat before each vaginal intercourse act takes place 

Supplemental Information

How to write prescription

  • Medication – Phexxi Vaginal Gel 5g applicator
  • Directions – Administer 1 application intravaginally immediately before or up to 1 hour before EACH act of vaginal intercourse as needed
  • Quantity/refills – 12 applicators/11 refills

Copay Card (for commercially insured patients)

References:

  1. Phexxi® (lactic acid, citric acid, and potassium bitartrate) [prescribing information]. San Diego, CA; Evofem Biosciences, INC: 2020.
  2. Michael A. Thomas, B. Todd Chappell, Bassem Maximos, Kelly R. Culwell, Clint Dart, Brandon Howard. A novel vaginal pH regulator: results from the phase 3 AMPOWER contraception clinical trial. Contraception X, Elsevier, 2020.
  3. Key, T. (1995, December). Hormones and cancer in humans. Retrieved March 02, 2021, from https://www.sciencedirect.com/science/article/abs/pii/0027510795001328?via%3Dihub.
  4. Collaborative Group on Hormonal Factors in Breast Cancer. Breast cancer and hormonal contraceptives: collaborative reanalysis of individual data on 53,297 women with breast cancer and 100,239 women without breast cancer from 54 epidemiological studies. Lancet1996; 347(9017):1713–1727.
  5. Smith JS, Green J, Berrington de Gonzalez A, et al. Cervical cancer and use of hormonal contraceptives: a systematic review. Lancet2003; 361(9364):1159-1167.
  6. (2017, April 07). Retrieved March 02, 2021, from https://www.cdc.gov/biomonitoring/glossary.html.
Important notice: National Community Oncology Dispensing Association, Inc. (NCODA), has developed this Positive Quality Intervention platform. This platform represents a brief summary of medication uses and therapy options derived from information provided by the drug manufacturer and other resources. This platform is intended as an educational aid and does not provide individual medical advice and does not substitute for the advice of a qualified healthcare professional.  This platform does not cover all existing information related to the possible uses, directions, doses, precautions, warning, interactions, adverse effects, or risks associated with the medication discussed in the platform and is not intended as a substitute for the advice of a qualified healthcare professional. The materials contained in this platform are for informational purposes only and do not constitute or imply endorsement, recommendation, or favoring of this medication by NCODA, which assumes no liability for and does not ensure the accuracy of the information presented.  NCODA does not make any representations with respect to the medications whatsoever, and any and all decisions, with respect to such medications, are at the sole risk of the individual consuming the medication. All decisions related to taking this medication should be made with the guidance and under the direction of a qualified healthcare professional.

 

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Written by: Kristyn DiSogra, PharmD, BCOP and Justin Arnall, PharmD, BCOP, Atrium Health
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Description: The purpose of this PQI is to highlight implementation of telehealth symptom and risk survey completion by pharmacists or other healthcare providers for myelofibrosis (MF) patients. The goal is to improve provider clinical care pathway adherence and treatment optimization in MF patients.

Background: Patients diagnosed with MF may have a symptom burden that compromises patient quality of life. Myelofibrosis is one of the classical Philadelphia chromosome negative myeloproliferative neoplasms (MPNs). The only curative treatment option is allogeneic hematopoietic stem cell transplantation, which is associated with significant risks and can only be administered to a minority of patients based on disease risk category and age. Other treatment options have been historically focused on alleviation of the symptoms that are present for each individual patient but do not alter the course of the disease itself.1-2

Multiple studies have led to the development and validation of a patient MPN-related symptom burden questionnaire that can be used for serial assessments of response to therapy. The Myeloproliferative Neoplasm Symptom Assessment Form total symptom score (MPN-SAF TSS) was calculated as the mean score for 10 items from two previously validated scoring systems with questions to assess symptoms of fatigue, concentration, early satiety, inactivity, night sweats, itching, bone pain, abdominal discomfort, weight loss, and fevers. Scoring is from 0 (symptom absent) to 10 (worst imaginable) for each symptom assessed. The final score is the summation of all of the 10 symptom scores on a 0 to 100 scale.2  In addition to symptom assessment utilizing the MPN-SAF TSS, a risk scoring system, the Dynamic International Prognostic Scoring System (DIPSS-Plus) has been developed to be a dynamic risk assessment tool that can be used at diagnosis and anytime during the course of therapy to attempt to predict survival.3 The DIPSS-Plus risk score is a prognostic tool evaluating age, blood counts, peripheral blood blast percentage, karyotype, transfusion dependency, and presence of constitutional symptoms to tabulate a combined score to assign low, intermediate-1, intermediate-2, and high-risk categories to MPN patients.3

Guidelines recommend evaluation of patients’ symptom burden and prognostic risk scores prior to initiation of therapy and at a regular intervals during the course of therapy, typically every 3 to 6 months during clinical encounters. Symptom response defined by the International Working Group-Myeloproliferative Neoplasms Research and Treatment and the European LeukemiaNet consensus report requires a greater than or equal to 50% reduction in the MPN-SAF TSS sustained for at least 12 weeks.4 Providers utilize both the MPN-SAF TSS and DIPSS-Plus as tools upon diagnosis and throughout therapy to guide treatment, to assess when changes in therapy are needed, and occasionally to assess the optimal timing of allogeneic hematopoietic stem cell transplantation. However, the traditional approach to obtaining these assessments, during clinic visits, may be burdensome for many patients and providers given limited time and other resources as well as patient needs for these visits. A recent analysis has additionally demonstrated that risk prognostication is often done incorrectly so there may be a need to identify mechanisms to perform these assessments in a correct, standardized, and uniform manner.5

Performing the MPN-SAF TSS and DIPSS-Plus assessments prior to clinic appointments offers enhanced efficiency of clinic time and allows MF providers to create therapy plans prior to patients’ clinic appointments. A pharmacist-driven telehealth consult program at Atrium Health was developed to an increase adherence to internal care pathways/national guideline recommendations and led to care optimization for MF patients. This consult service represents an opportunity for the outpatient and specialty pharmacy services to be incorporated into the care pathways for MF patients as an element of standard of care and demonstrates a shift towards a pharmacy practice-based model. By implementing this service, pharmacists have had an active and leading role in virtual care which has become more relevant as a result of the COVID-19 pandemic.6

PQI Process:

  • Upon diagnosis or clinical review of a MF patient, the patient should be flagged by the provider for symptom and risk assessments to be completed at baseline and a predefined interval with corresponding physician visits
  • A pharmacy consult service can be established to utilize multidisciplinary approach for long-term patient follow-up and assessment completion
    • MPN-SAF TSS symptom and DIPSS-Plus risk assessments for MF can be completed in person or via telephone for patients prior to their provider appointments (in-person or virtual) and then uploaded via the electronic medical record for the provider to review prior to the upcoming appointment
  • If a pharmacy consult is established, the following workflow can be mimicked or translated into best practice for your institution:

  • Providers identify patients and initiate a consult through a consult order
    • The consult triggers an order to be sent to the pharmacy queue or triggers an email to be sent to the pharmacy team
    • The patient is notified of enrollment by the provider prior to pharmacist contact
  • A system should be developed to track the patients in two manners
    • The number of times patient has been contacted to complete the assessments
    • The date of the previous assessments to make sure the patient is contacted at the correct interval
  • Once consulted, the pharmacist attempts to complete both the MPN-SAF TSS and DIPSS-Plus risk score assessments
    • MPN-SAF TSS questions are completed with patient consent via telephone
      • Three phone call attempts are completed by the pharmacist
    • Once the MPN-SAF TSS is completed and the confirmation of presence or absence of constitutional symptoms is confirmed, the DIPSS-Plus risk assessment can be completed using the most recent laboratory values and karyotype information
  • Completed assessments via the pharmacy consult service are scanned into the EMR prior to the patient’s next clinic appointment
  • Provider is notified via the EMR of the importation and assessment location of the assessment
    • If the patient was not reached, pharmacists should notify the provider which then prompts the provider to complete the assessments during the clinic appointment, thereby reinforcing adherence to the guideline recommendations via a multidisciplinary approach
  • Patients are contacted at 3-month, 6-month, or 12-month intervals corresponding with their planned follow-up schedule with the physician based on disease stability to adhere to guideline recommendations

Patient Centered Activities:

  • With the establishment of a telehealth consult for the MPN-SAF TSS and DIPSS-Plus assessments, patients are provided with the opportunity to streamline their discussion with their provider at upcoming clinic appointments
  • Patients to receive Oral Chemotherapy Education (OCE) for applicable medications that may be prescribed for their MF
  • Patient medication adherence can be assessed with completion of the MPN-SAF TSS assessment
  • Medication issues (ex. drug-drug interactions, non-adherence, etc.) can be identified by the pharmacist and relayed to the provider with additional patient interaction through completion of the MF assessments

References:

  1. Cervantes F. How I treat myelofibrosis. 2014;124(17):2635-42.
  2. Emanuel RM, Dueck AC, Geyer HL, et al. Myeloproliferative neoplasm (MPN) symptom assessment form total symptom score: prospective international assessment of an abbreviated symptom burden scoring system among patients with MPNs. J Clin Oncol. 2012;30(33):4098-103.
  3. Passamonti F, Cervantes F, Vannucchi AM, et al. A dynamic prognostic model to predict survival in primary myelofibrosis: a study by the IWG-MRT (International Working Group for Myeloproliferative Neoplasms Research and Treatment). Blood. 2010;115(9):1703-8.
  4. National Comprehensive Cancer Network. Myeloproliferative Neoplasms (Version 1.2021). https://www.nccn.org/professionals/physician_gls/pdf/mpn.pdf. Accessed April 16, 2021.
  5. Verstovsek S, Yu J, Kish JK, et al. Real-world risk assessment and treatment initiation among patients with myelofibrosis at community oncology practices in the United States. Ann Hematol. 2020; 99(11):2555-2564.
  6. Yemm KE, Arnall JR, Cowgill NA. Necessity of Pharmacist-driven non-prescription telehealth consult services in the era of COVID-19. Am J Health Syst Pharm. 2020; 77(15): 1188. Doi: 10.1093/ajhp/zxaa162.
Important notice: NCODA has developed this Positive Quality Intervention platform. This platform represents a brief summary of medication uses and therapy options derived from information provided by the drug manufacturer and other resources. This platform is intended as an educational aid and does not provide individual medical advice and does not substitute for the advice of a qualified healthcare professional. This platform does not cover all existing information related to the possible uses, directions, doses, precautions, warning, interactions, adverse effects, or risks associated with the medication discussed in the platform and is not intended as a substitute for the advice of a qualified healthcare professional. The materials contained in this platform are for informational purposes only and do not constitute or imply endorsement, recommendation, or favoring of this medication by NCODA, which assumes no liability for and does not ensure the accuracy of the information presented. NCODA does not make any representations with respect to the medications whatsoever, and any and all decisions, with respect to such medications, are at the sole risk of the individual consuming the medication. All decisions related to taking this medication should be made with the guidance and under the direction of a qualified healthcare professional.
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