Patient Support Programs and Managing Time Toxicity with Oral HMAs in MDS/CMML

This segment explores the critical role of patient support programs, insurance navigation, and balancing the convenience of oral HMAs with ongoing clinical oversight. NP Granato describes how her team supports patients in navigating oral chemotherapy, including assistance with insurance forms and coverage. NP Granato highlights that managing these therapies requires a coordinated, multi-disciplinary approach involving managed care teams, specialty pharmacies, and regional pharmacists who interact directly with patients to facilitate copay assistance, foundation support, and medication access.

Dr. Fazal adds that initiating treatment with intravenous therapy while insurance approval for oral therapy is in process is a practical strategy, ensuring patients can start treatment without delays. He also emphasizes that oral therapies reduce “time toxicity”, defined as the significant burden of frequent clinic visits for blood draws, infusions, and monitoring, allowing patients to maintain their daily routines and quality of life.

The discussion then shifts to setting expectations for patients regarding oral chemotherapy. Speakers emphasize adherence, the delayed hypermethylation effect (requiring multiple cycles for maximal efficacy), and normalizing expected side effects such as cytopenias. NP Granato and Dr. Fazal underscore patient education as essential: patients must understand when to seek care for fevers or infections and how dose adjustments are handled. They also highlight the importance of normalizing lab fluctuations and reframing them as expected treatment effects rather than signs of treatment failure.

Overall, this segment illustrates the integration of logistical support, patient education, and careful clinical guidance to optimize outcomes with oral HMAs while minimizing disruptions to patients’ daily lives. It emphasizes the collaborative effort required across the care team to ensure both adherence and safety in oral chemotherapy.