CN42 - A pharmacist-led interprofessional medication adherence program improved adherence to oral anticancer therapies: The OpTAT randomized controlled trial

Background

Protein kinase inhibitors (PKIs) are increasingly prescribed in cancer care. We aimed to evaluate the impact of a pharmacist-led interprofessional medication adherence program on patient implementation (dosing history), persistence (time until premature stop of the PKI) and adherence to 27 PKIs prescribed in different types of solid cancers.

Methods

Patients (n=118) were randomized 1:1 in two arms. All PKIs were delivered in electronic monitors (EM). In the intervention arm, pharmacists supported patient adherence through monthly electronic and motivational feedback including educational, behavioral, and affective intervention for 12 months. The control arm received standard care plus EM without intervention. Medication implementation and adherence were compared between groups using generalized estimating equation models, in which relevant covariables were included; persistence was compared with Kaplan-Meier curves. Oncologists prescribed regular treatment interruptions to help patients recover from side effects; this information was compiled in the analyses.

Results

PKI implementation was constantly higher in the intervention (n=58) than in control arm (n=60), 98.1% and 94.9% (Δ3.2%, 95% confidence interval (CI) 2.6%-3.7%) at 6 months. The probabilities of persistence and adherence were comparable between groups. The intervention benefited most to men (Δ5.4%, 95%CI 4.2-6.5), those who initiated PKI for more than 60 days (Δ4.6%, 95%CI 3.7-5.5), patients without a diagnosis of distant metastasis (Δ4.6%, 95%CI 3.4-5.7), those aged less than 60 years old (Δ4.1%, 95%CI 3.3-4.9) and those who had never used any adherence tools (Δ4.1%, 95%CI 3.4-4.7).

Conclusions

The interprofessional medication adherence program, led by pharmacists in the context of an interprofessional collaborative practice, supports implementation to PKIs in patients with solid cancers. In order to manage side effects, dose adaptations are often mandated, further supporting a proactive strategy aiming at supporting adherence. Longer-term medication adherence interventions, embedded in routine care, should provide results on the impact on progression-free survival.

Clinical trial identification

NCT04484064.

Editorial acknowledgement

Legal entity responsible for the study

Department of Oncology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland.

Funding

Swiss Cancer Research Foundation, grant HSR-4077-11-2016.

Disclosure

All authors have declared no conflicts of interest.