Duke Team Addresses Barriers to Oral Chemo


A streamlined nursing protocol reduced delays related to treatment with oral formulations of chemotherapy and immunotherapy, and increased patient satisfaction.

At the 43rd ONS Congress in Washington, DC, a team of nurses from the Duke Raleigh Wake-Cary Cancer Center in North Carolina will be presenting their poster, “Identifying Barriers to Oral Chemotherapy: A Nurse Qualitative Review Process to Improve Initiating Therapy, Patient Adherence, and Nurse Satisfaction.  The study authors are Katherine A. Becker, MSN, RN, OCN; Coveny Greco, BSN, RN; Ramona Basnight, MSN, RN, OCN; and Deborah H. Allen, PhD, RN, CNS, FNP-BC, AOCNP.

They will present information describing a systematic, streamlined nursing process they developed to improve the way that healthcare providers order and patients receive oral formulations of chemotherapy and immunotherapy. Their innovative protocol arose from an essential need: patients should start their treatment-especially combination therapy-in a timely manner. However, oncology nurses face multiple challenges in ensuring prompt initiation of treatment, and identification of potential procedural problems that could improve the situation falls largely on nurses’ shoulders.

As lead presenter Katherine Becker told Cancer Network, certain barriers “are delaying when patients can start their oral chemotherapy, which adds to their anxiety. For many, oral agents are their best hope for remission, and delaying the start of treatment may mean disease progression.”

The most common barrier affecting treatment includes the need for insurance preauthorization. Other obstacles include pharmacy changes and e-prescribing; financial constraints such as high copays and lack of prescription coverage; and insurance coverage denials, which can necessitate an appeals process.

Since the back-end procedures that are a prerequisite for rapid implementation of cancer treatment are handled for the most part by nursing staff, Becker and her coinvestigators set a goal of developing protocols that would increase nurses’ satisfaction and reduce their workload. This was achieved “by designating a point person [to whom] questions can be directed,” Becker explained.

The streamlined process for initiating oral chemotherapy involves a clinic nurse initiating a tailored patient-education plan upon receiving the prescription from the provider, and a triage nurse then coordinating the patient’s insurance, prescription, and medication information with a specialty pharmacy. Communication from the triage nurse back to the clinic nurse closes the loop, with detailed education calls once the medications are received, and at regular intervals during cycles of chemotherapy. Patient compliance is assessed at a scheduled clinic visit.  Becker and colleagues found that this plan reduced treatment delays and increased patient satisfaction levels.

Becker and her team emphasize in their poster that while their new SOPs did not completely eliminate the barriers that delay patients from receiving their oral therapy, they did succeed in creating “a standardized process for obtaining the medication that has led to less staff frustration, [reduced] workload, and better tracking of [patient] status for each case.”

The investigators’ future goals include an improved method of alerting nursing staff to patient medication receipt, improved patient education regarding specific treatments, implementation of a full-time dedicated oral chemotherapy nurse to manage this role, and “improved follow-up with patients once they receive their oral medication,” Becker said.

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