The patient is provided with a pillbox and encouraged to track any missed doses. The oncology nurse then reschedules the patient for the next appointment at the clinic no more than 14 days later. Some treatments require more frequent monitoring and therefore are only dispensed 7 days at a time.
First Follow-up Visit (7-14 days)
At the first follow-up visit, the oncology nurse reviews adherence and toxicity with the patients. If any toxicity is identified, the oncology nurse contacts the oncology physician for additional assessment and orders. If the patient demonstrates adherence and tolerability, an additional 7- to 14-day supply is dispensed and the next appointment is scheduled 7 to 14 days later.
Subsequent Follow-up Visits
The patient continues to follow up at least every 28 days after cycle 1. The oncology nurse practices veterancentered care when trying to determine the appropriate follow-up for each patient. Continuous monitoring of toxicity and adherence occurs at each visit. If toxicity develops, monitoring may be increased at the discretion of the oncology nurse or physician.
Conclusions
Patients at VAPHS have been very receptive to the oral anticancer therapy protocol. Few patients have refused the initial biweekly visits, and many patients appreciate the special attention being focused on their treatment. The facility hopes to be able to expand its oral anticancer monitoring protocol to a telehealth clinic to help reduce the travel time of many patients. Additionally, as the program continues to expand, it is hoped it will be able to support a full-time outpatient oncology clinical pharmacist with a scope of practice to help manage toxicity and continue to improve adherence rates.
Author disclosures
The authors report no actual or potential conflicts of interest with regard to this article.
Disclaimer
The opinions expressed herein are those of the authors and do not necessarily reflect those of Federal Practitioner, Frontline Medical Communications Inc., the U.S. Government, or any of its agencies. This article may discuss unlabeled or investigational use of certain drugs. Please review the complete prescribing information for specific drugs or drug combinations—including indications, contraindications, warnings, and adverse effects—before administering pharmacologic therapy to patients.