As reported to Chris Pirschel by Kristine B. LeFebvre, MSN, RN, AOCN®
To ensure that patients and providers are equipped with the latest, most up-to-date knowledge and resources, ONS routinely works with patient advocacy groups, subject matter experts, and other provider organizations to develop and refine critical information for clinical practice. Following safety standards and meeting patient education requirements are critical to successful oral chemotherapy practice.
In 2013, oral chemotherapies were given their own designation in the Association for Clinical Oncology (ASCO)/ONS Chemotherapy Administration Safety Standards. However, after examining the literature and practice information available, ONS and ASCO determined that separating oral therapies from their IV counterparts was unnecessary because safety issues, a drug’s efficacy, and its administration should all be treated with the same level of caution and concern.
To address a potential education gap for patients, the 2016 updated Chemotherapy Administration Safety Standards included oral therapies in its recommendations for practice. For treatment planning, patient consent, and education, oncology professionals are required to inform patients about potential “symptoms and adverse events that would require discontinuation of oral or other self-administered treatments” (Neuss et al., 2017). Patient education should mimic that for patients receiving IV treatment, including teaching about when to contact healthcare professionals for symptom management and treatment side effects.
Any chemotherapy dosing modifications should be recorded in a patient’s medical record, including changes to agents (Neuss et al., 2017). Because many patients receiving oral therapy won’t have frequent clinic appointments, keeping information as up to date as possible in the medical record can help eliminate confusion in the future. Moreover, if patients report symptoms or side effects after a dosage adjustment, the information will be readily available for the care team. Oncology nurses can consider implementing proactive telephone triage to keep an open line of communication with their patients and easily communicate changes and modifications.
ONS chemotherapy standards also dictate that the healthcare team needs to include patient name, a second identifier, full generic drug name, date of order, dose, route of administration, quantity, schedule, duration, and number of refills on the oral chemotherapy medication to provide easily readable information for patients.
With oral treatment adherence rates as low as 50%, oncology nurses are in a unique position to supply their patients with education, proactive support, and follow-up care. ONS continually refines and updates its oral therapy resources, including the Oral Adherence Toolkit. Outlined in the toolkit are patient education tips to improve adherence, including discussing with patients how their drugs will be obtained, the potential side effects, how to safely handle and store medications, disposal of unused drugs, food and drug interactions, and more. A clear, standardized checklist for patient education points will help keep providers consistent with messaging and keep important information from slipping between the cracks.
Other ONS oral therapy resources include the Oral Chemotherapy Education Sheets, which break down oral agent information by drug name and provide details about usage, storage, dosage, potential side effects, and more. For effective oral education and reference, consider using the education sheets prior to patient visits or calls to ensure the relevant drug information is readily available should it be needed. Oncology nurses can also direct patients to ONS’s Oral Chemo Guide, a patient-facing website with videos and information about oral therapies.
By addressing patient education issues, ensuring standards are followed, and opening lines of communication, nurses can work to ensure successful outcomes for their patients. ONS remains committed to supporting oncology nurses as they care for patients navigating the complexities of oral chemotherapy agents.