Summary

Oral anticancer agents – cancer treatment in tablet and/or capsule form – can improve independence and quality of life for people with cancer.1 2 However, treatment impact may be limited if people do not take these medicines in line with instructions agreed with their healthcare team (i.e. non-adherence).2-4 Pharmacists dispensing oral anticancer agents have an important role in reducing non-adherence.5 The European Society of Oncology Pharmacy launched the Empowering Pharmacists to Improve Healthcare for Oral Chemotherapy Patients (EPIC) project to establish a European best-practice model for pharmacists dispensing oral anticancer agents.5 The project developed a training programme and online cancer drug database for pharmacists in Slovenia and Estonia. These pilot initiatives improved pharmacists’ access to information on oral anticancer agents and confidence in counselling people with cancer.5 The EPIC project aims to expand these initiatives in future to include other countries in the European Union.

 

Challenge

Oral anticancer agents are cancer treatments that come in tablet and/or capsule form. People with cancer can take these medicines outside of hospital settings, such as at home, potentially improving independence and quality of life.1 2 However, some people with cancer may not take oral anticancer agents according to the instructions agreed with their healthcare team; this is known as non-adherence.2 3 For example, some people may forget to refill their prescriptions or struggle with the size and number of prescribed tablets.2 4 Others may stop taking their medicines due to side effects, such as nausea, or interactions between cancer treatment and certain foods and medicines.5 Non-adherence, regardless of the cause, limits the impact of treatment.2 3

Pharmacists dispensing oral anticancer agents have an important role in reducing non-adherence, as they may be the last point of contact a person has with the healthcare system before taking their medicines.5

Solution

The European Society of Oncology Pharmacy launched the Empowering Pharmacists to Improve Healthcare for Oral Chemotherapy Patients (EPIC) project to establish a European best-practice model for pharmacists dispensing oral anticancer agents.1 5 The project aims to improve medicines-related counselling led by pharmacists (pharmaceutical counselling) and consequently increase knowledge of oral anticancer agents among people with cancer.

 

What has it achieved?

Through an online survey of European pharmacists, the EPIC project established that pharmacists’ knowledge of oral anticancer agents and confidence in pharmaceutical counselling was low.5

The pharmacist training programme

The EPIC project developed a training programme for pharmacists in Slovenia and Estonia, based on knowledge gaps identified in the online survey and input from national working groups.5 The programme consists of three online modules and one full day of face-to-face training. Pharmacists receive more than 500 minutes of lectures and case report sessions and are tested on each module. The programme includes sessions on oncology and haematology, cancer pharmacotherapy, side effects and drug interactions, pharmaceutical counselling, herbal/alternative medicines and food supplements, and safe handling of medicines.5

The Oralia database

Based on an existing database in Germany, the EPIC project developed the Oralia database to support pharmacists dispensing oral anticancer agents in Slovenia and Estonia.5 The online database contains information on oral anticancer agents and treatment side effects, and stores patient data to support and track pharmaceutical counselling – for example, pharmacists can create personalised medication plans and information leaflets for people with cancer.5 The database is currently in use in 74 pharmacies in Slovenia and 33 pharmacies in Estonia.

Evaluation

The pharmacist training programme and Oralia database were evaluated using an online survey of 164 pharmacists in Slovenia and Estonia.5 Most respondents were satisfied with the information available on the Oralia database and the content and online delivery of the training programme. A few respondents reported a preference for face-to-face teaching, limited improvement in their confidence in counselling people with cancer and a desire for more information on drug interactions in the Oralia database.5

 

Next steps

The EPIC project plans to:

  • introduce the pharmacist training programme in other EU countries
  • adjust and expand the Oralia database to include other EU countries
  • involve other stakeholders, such as other healthcare professionals and people with cancer, to comment on their needs surrounding adherence and oral anticancer agents.1 5

Further information

  •  The European Society of Oncology Pharmacy website with EPIC project updates
  • The EPIC project webpage in the European Commission Health Programmes database

References:

  1. Meier K, Astier A, Bosnak AS, et al. 2019. The future of oncology pharmacy: European Conference of Oncology Pharmacy 2018. European Journal of Oncology Pharmacy 2(3): 10.1097/OP9.0000000000000020
  2. Muluneh B, Deal A, Alexander MD, et al. 2018. Patient perspectives on the barriers associated with medication adherence to oral chemotherapy. Journal of oncology pharmacy practice : official publication of the International Society of Oncology Pharmacy Practitioners 24(2): 98-109
  3. Nunes V, Neilson J, O'Flynn N, et al. 2009. Medicines adherence: involving patients in decisions about prescribed medicines and supporting adherence. London: National Institute for Health and Care Excellence
  4. Bryant AL, Chan Y-N, Richardson J, et al. 2019. Understanding barriers to oral medication adherence in adults with acute myeloid leukemia (AML). Journal of Clinical Oncology 37(31_suppl): 106
  5. European Society of Oncology Pharmacy. EPIC project. Available here: https://esop.li/activities-2/projects/epic-project/%20[Accessed%2016/02/20] [accessed: February 2020]