Making an Impact: Research Highlights from Recipients of the First Annual Certificate of Recognition for Exemplary Research on Quality of Care in Oncology

Nan Limvorasak, PharmD BCOP
Pharmacy Program Coordinator
Cedars-Sinai Medical Center
Los Angeles, CA

Amy H. Seung, PharmD BCOP FHOPA
Senior Medical Director
Pharmacy Times Continuing Education
Ellicott City, MD

The Quality Oversight Committee of the Hematology/Oncology Pharmacy Association (HOPA) would like to congratulate the recipients of the first annual Certificate of Recognition for Exemplary Research on Quality of Care in Oncology. A work group of the committee developed an evaluation process and reviewed each of the completed research and trainee research abstracts. Criteria for evaluating the submitted abstracts included the focus of the research on quality and value metrics in the care of patients with cancer using a nationally recognized oncology or pharmacy quality metric and the potential impact of the results on current practice.

Four certificates were awarded for abstracts presented at the HOPA Ahead 2020 conference in Tampa, FL: one was for completed research by Rachel McDevitt, PharmD BCOP (University of Michigan Rogel Cancer Center); and three were for trainee research by Jacqueline Majeski, PharmD (Maine Medical Center); Bianka Patel, PharmD (University of North Carolina Medical Center); and Michelle Azar, PharmD candidate (Michigan Oncology Quality Consortium and University of Michigan).

Evaluation of an Oncology Transitions of Care Pilot Program, presented by Rachel McDevitt, PharmD BCOP

Transition-of-care coordination led by pharmacists has been associated with a decrease in patient readmissions and an improvement in quality of care; however, implementation has been a nationwide challenge, and oncology patients are often excluded from these programs. To further study the feasibility of implementing such a program for patients with cancer, McDevitt and colleagues conducted a 3-month pilot program to investigate the effectiveness of an oncology pharmacist-led transition-of-care program on clinical outcomes at hospital transitions.¹ Of the 29 patients enrolled, 15 patients received outpatient pharmacist follow-up, and 14 patients did not. A total of 42 interventions were observed in a group of 15 patients with gastrointestinal cancers enrolled in the intervention cohort. The most common action items were related to symptom management, antibiotics, oncologic treatment, issues related to other comorbidities (e.g., diabetes), diet, anticoagulation, and medication reconciliation. In this prospective study, the 30-day readmission rate was reduced by 50% for patients who received outpatient pharmacist follow-up compared to patients who did not receive follow-up. Given the successful establishment of the program at the current institution, expansion to other oncology specialties is planned.

Impact of a Pharmacist Managing Outpatient Oral Oncolytics, presented by Jacqueline Majeski, PharmD

Oncology pharmacists have been instrumental in providing high-quality care to patients with cancer. In multidisciplinary teams, their role has expanded from providing patient education to leading clinically meaningful interventions measured by various quality metrics including symptom improvement, clinical outcomes, and patient satisfaction.² Now greater opportunities exist for pharmacists to enhance care through interprofessional collaboration.

Majeski and colleagues evaluated the impact of having a pharmacist managing outpatient oral oncolytics. They reported that pharmacists’ involvement in managing oral cancer therapy had a positive impact on the quality of patient care, as shown in a retrospective chart review.³ Their primary objective was to assess adherence to the 2016 American Society of Clinical Oncology (ASCO)/Oncology Nursing Society Chemotherapy Administration Safety Standards for oral oncolytics in a pharmacist-led oral oncolytic management program. A total of 193 interventions were made on 96 oral prescriptions, of which 45% involved dosing recommendations. The most common interventions involved medication procurement assistance. The results showed greater opportunities related to preventing prescribing errors and promoting patient safety and further highlighted the impactful interventions of oncology pharmacists.

Characterization of Testing for Targeted Therapy in Advanced Non–Small Cell Lung Cancer (NSCLC), presented by Bianka Patel, PharmD

Oncology pharmacists are increasingly being integrated into precision medicine programs to identify actionable mutations and apply specific targeted therapies to treat cancer.⁴ The service that they provide in this area demonstrates the important role of pharmacists in personalized medicine and opportunities for their integration. The completion of molecular testing and testing turnaround time (TAT) for patients with stage IV NSCLC with adenocarcinoma histology are included as metrics in ASCO’s Quality Oncology Practice Initiative (QOPI) recommendations.

To assess TAT for molecular testing, Patel retrospectively reviewed patients with stage 4 NSCLC with adenocarcinoma histology and identified 66 patients.⁵ Testing was completed in most patients (89.4%). The median time from diagnosis to receipt of sample at the vendor was 13 days, and the median time from vendor’s receipt of sample to testing results was 13 days, which exceeded ASCO QOPI recommendations that test results be available within 10 working days. The most common reasons for prolonged TAT were delays in samples being sent to the vendor and insufficient tissue samples. Results from this study identified specific opportunities for process improvement to be consistent with published guidelines. The authors made several recommendations for improvement of TAT, including the use of reflex molecular testing at the time of diagnosis and measures to ensure adequate sample quality.

Statewide Quality Improvement Addressing Overutilization of Neurokinin-1 (NK-1) Receptor Antagonists, presented by Michelle Azar, PharmD candidate

QOPI became available to ASCO members and their practices in 2006, with the goal to assess practice performance for a series of evidence- and consensus-based process measures.⁶ Practices that participated in QOPI demonstrated improved performance in self-reported process measures, with the greatest improvement demonstrated in initially low-performing practices.⁷ Symptom management, including the appropriate use of antiemetic therapy, is one of the medication-related QOPI measures. The use of NK-1 receptor antagonists or olanzapine administered for low or moderate emetic risk is classified as one of the top five test measures in QOPI. To evaluate this metric, Azar and colleagues conducted a statewide quality improvement evaluation addressing overutilization of NK-1 receptor antagonists.⁸ Following development of a framework for assessing the lack of concordance with guidance recommendations, a survey was developed to gain an understanding of the patterns of usage. Education on chemotherapy-induced nausea and vomiting was provided to participating practices, with the goal of decreasing inappropriate NK-1 receptor antagonist usage to less than 30%. The state average in fall 2018 was 34% and decreased to 19% in spring 2019, compared to the national average of approximately 29%. Reassessment of practice performance is planned following program completion. This study further demonstrated an opportunity for improvement through the use of prepopulated antiemetic order sets and evidence-based education led by oncology pharmacists.

The four recipients of the inaugural certificate of recognition addressed quality in cancer care using validated quality metrics, and their research further supports the roles of oncology pharmacists. 

References

1. McDevitt R, et al. Evaluation of an Oncology Transitions of Care Pilot Program. HOPA 2020 annual conference, Tampa, FL. Abstract PM10.
2. Mackler E, Segal EM, Muluneh B, et al. 2018 Hematology/Oncology Pharmacist Association best practices for management of oral oncolytic therapy: pharmacy practice standard. J Oncol Pract. 2019;15: e346-e355.
3. Majeski J , et al. Impact of a Pharmacist Managing Outpatient Oral Oncolytics. HOPA 2020 annual conference, Tampa, FL. Abstract TR147.
4. Walko C, Kiel PJ, Kolesar J. Precision medicine in oncology: new practice models and roles for oncology pharmacists. Am J Health Syst Pharm. 2016;73:1935-1942.
5. Patel B. Characterization of Testing for Targeted Therapy in Advanced Non-Small Cell Lung Cancer. HOPA 2020 annual conference, Tampa, FL. Abstract TR174.
6. Jacobson JO, Neuss MN, McNiff KK, et al. Improvement in oncology practice performance through voluntary participation in the Quality Oncology Practice Initiative. J Clin Oncol. 2008;26:1893-1898.
7. Neuss MN, Malin JL, Chan S, et al. Measuring the improving quality of outpatient care in medical oncology practices in the United States. J Clin Oncol. 2013;31:1471-1477.
8. Azar M, et al. Statewide Quality Improvement Addressing Overutilization of Neurokinin-1 Receptor Antagonists. HOPA 2020 annual conference, Tampa, FL. Abstract TR187.