JL1007C: Care Coordination Strategies for Patients Receiving Combination IV and Oral Anticancer Therapy: Findings for Advanced Practitioners From a National Mixed-Methods Study

BACKGROUND
When combination medical therapy incorporates both IV and oral anti-cancer agents, patients may experience compound side effects and face greater challenges with treatment adherence. To assess how advanced practitioners and other healthcare professionals (HCPs) working in community cancer settings may improve care coordination for patients receiving combination IV/oral systemic therapy, the Association of Community Cancer Centers (ACCC) conducted a national mixed-methods study.

METHODS
This study followed a sequential quantitative-qualitative design to answer questions around the barriers or challenges associated with the delivery of combination IV/oral therapy. The quantitative phase included an online survey of HCPs. In the qualitative phase, the HCP survey results were further contextualized through focus groups and individual interviews.

RESULTS
The survey was completed by 157 HCPs. For this analysis, we reviewed the responses provided by NPs/PAs (n=21) and pharmacists (n=27).

Biggest Challenges: APs identified the following topics as the “top challenges” associated with treating patients with combination IV/oral therapy (respondents selected up to 3):
1) Cost of care to the patient (51%)
2) Treatment coordination (45%)
3) Health insurance (43%)
4) Adherence and/or pill burden (23%)
5) Treatment-related side effects (17%)

Effective Strategies: APs identified the following as “top strategies” for improving care coordination for these patients (respondents selected up to 3):
1) Coordination and follow-up by in-house clinicians (57%)
2) Adherence education and discussions (36%)
3) Use of external assistance programs (33%)
4) Frequent communication with specialty pharmacies to ensure timely delivery of oral medications (27%)
5) Use of medically integrated dispensing (20%)

Adherence to oral therapy: APs identified the following as useful tactics to ensure adherence to oral therapy (respondents selected up to 3):
1) In-person assessment during office visits (53%)
2) Calendars and dairy sheets (54%)
3) Telehealth visits (38%)
4) Phone call reminders (26%)
5) Pill reminders (15%)

Patient concerns: APs identified the following as the biggest concerns among these patients (respondents selected up to 3):
1) Financial worry: (56%)
2) Anxiety (34%)
3) Fatigue (31%)
4) Inability or decreased ability to work (30%)
5) Patient’s perception of goal of treatment (25%)

In focus groups, APs discussed the importance of prioritizing efforts to prevent and mitigate financial toxicity, especially for patients receiving oral therapies. They also explained some of the challenges with coordinating care (eg, medication dispensing, tracking medication delivery, documenting start dates) as patients may receive oral agents from different specialty pharmacies.

CONCLUSIONS
This study identifies ways for APs to improve care coordination as patients with cancer are treated with combination IV/oral therapy. These findings may inform the creation and dissemination of effective practices and quality improvement projects. These results may also help APs coordinate resources and take proactive steps to address some of the key challenges patients may face during combination IV/oral anti-cancer therapy.