Tag Archives: oral oncolytics

Staying the Course: The Role of Oral Oncology Nurse Navigators

By Virginia Vaitones, MSW, OSW-C

The development and use of oral agents in treatment for oncology and blood disorders has exploded over the last decade and half. Today, these agents bring many benefits to patients and cancer care staff, but along with those benefits come challenges.

Then . . . and Now
Thinking back to 2001, for example, when capecitabine, the first oral chemotherapy for the treatment of metastatic colorectal cancer was approved, Medicare covered 80% and the beneficiary’s co-insurance was 20%. A patient could simply take the prescription to the local pharmacy and get it filled. The relatively modest financial impact and the ease with which the patient could access the medication made me excited about the use of oral agents. And at the time, there was much discussion about oral agents being the treatment of choice in the future.

Nearly two decades later, we now have more than 50 U.S. Food and Drug Administration-approved oral anticancer agents.  Over that same time span, as we all know, our healthcare landscape has become increasingly complex, as have our anti-cancer therapeutic regimens. Currently, capecitabine is 1 out of only 5 oral chemotherapy that is covered by Medicare at 80%. Patients and providers today often face challenges in accessing and affording costly new oral agents. Patient understanding of and adherence to complex treatment regimens can also be a barrier to effective treatment. As a result, ensuring quality care for patients receiving oral agents often requires a coordinated effort by innovative and creative cancer practices and programs.

The September/October edition of Oncology Issues highlights two such programs. One program is a large physician practice in central New York with an in-house dispensary; the other is a large outpatient hospital network serving two states, Kentucky and Southern Indiana, also with an in-house dispensary. The first step for both was consulting with their stakeholders to identify how care needs to be delivered and monitored. In both instances, on-going patient support and education were identified as key in establishing trust and compliance with the patient and their caregivers. The answer for both programs? Creating an oral oncology nurse navigator program that ensures care coordination, provides a single point of contact for patients and providers, and has led to improved patient care and satisfaction.

As we engage in the complex delivery system of value-based, patient-centered care, the Association of Community Cancer Centers continues to develop tools and resources for cancer care providers seeking to implement or enhance their oral oncolytic programs. Explore peer-to-peer resources, including webinars, white paper, and patient education materials, available through the ACCC Education initiative Steps to Success: Implementing Oral Oncolytics.

Approximately 25-30 percent of the new cancer treatments in the pipeline are oral agents; cancer programs and physician practices will continue to need a well-coordinated team effort to ensure patient safety and satisfaction.


Virginia Vaitones, MSW, OSW-C, is a past president of the Association of Community Cancer Centers (ACCC)  and the Association of Oncology Social Work (AOSW). She is currently serving as chair of the ACCC Editorial Committee. 

The 34th ACCC National Oncology Conference, Oct. 18-20, offers the Oncology Pharmacy Education Network (OPEN) Pre-Conference, including a session on a comprehensive, collaborative, pharmacist-led oral chemotherapy program. Learn more here.  View the full conference agenda.

OPEN Pre-Conference Highlights

By Amanda Patton, ACCC Communications

New ACCC "Hub" in the Exhibit Hall, one-stop for resources, informatiion, and membership information

ACCC “Hub” in the Exhibit Hall welcomes conference attendees with a central source for resources and information on everything ACCC.

We’re in St. Louis for the ACCC 33rd National Oncology Conference this week. Events got underway on Wednesday, October 19, with dynamic pre-conference sessions focused on some of the most challenging and rapidly evolving areas in cancer care delivery. Read on for highlights from the Oncology Pharmacy Education Network (OPEN) pre-conference.

A morning panel discussion during the OPEN Pre-Conference focused on strategic planning for the oncology pharmacy. Zaven Norigian, PharmD, BCOP, Beth Israel Deaconess Medical Center, moderated a discussion with Steve D’Amato, BSPharm, New England Cancer Specialists, and Ali McBride, PharmD, MS, BCPS, BCOP, University of Arizona Cancer Center, that touched on some of the toughest challenges for oncology pharmacy today. Among these:

Cost of drugs. Pharmacy budgets continue to increase, the value of inventories in clinics is escalating, and if programs are not paid in a timely manner, cash flow problems will result. With the increase in immunotherapies and new oral agents, programs are wrestling with how to afford of these therapies and provide access to these for all of their patients. “The bank is going to break eventually,” said D’Amato.

Implementing genomic testing. Operationalizing this in the community setting is creating big challenges for the oncology pharmacy, panelists agreed. It requires a multidisciplinary approach providing integration and education for clinical pharmacists and nurses. There must be buy-in from everyone.

EHR and data issues. Programs need to be able to mine their data, understand their data, and reduce the staff time needed to collect and report data. Pharmacy is looking to technology to solve some of these important issues—without being “nickel and dimed to death” by their EHR vendors, panelists said.

USP 800. This is top-of-mind if you work in pharmacy, panelists agreed. Among the pressing challenges: How do you explain issues related to USP 800 compliance to the C-suite? Attendees were urged to act now—if they haven’t already—and at a minimum bring in a consultant to determine what it will cost to be compliant by 2018. “We know it’s going to be costly…it’s not something you can flip the switch one day and start it,” said Norigian.

Succeeding with Oral Oncolytics

An OPEN Pre-conference session tackling a critical current day challenge highlighted ACCC’s education initiative, Steps to Success: Implementing Oral Oncolytics. (The session was broadcast live, and will be available on the ACCC website on-demand soon.)

“One of the biggest challenges with oral oncolytics is that we put so much responsibility on the patient,” said presenter Niesha Griffith, RPh, MS, FASHP, West Virginia University Health System. Pharmacists need to be “on the frontlines” of taking care of oncology patients, she said.

Calling attention to the Steps to Success white paper developed as part of this ACCC initiative, Griffith focused on the project’s key programmatic recommendations for successful integration of oral oncolytics:

  • Take a multidisciplinary approach
  • Assign responsibilities; clearly identify who is responsible for what
  • Work collaboratively with specialty pharmacy (as needed)
  • Provide financial advocacy services
  • Develop a robust patient education program
  • Put in place effective processes for monitoring for adherence and toxicity
  • Maximize the use of technology

Griffith stressed the importance of developing robust case management platforms so that all providers can document information from patient visits. Where possible, develop methods to streamline processes. For example, devising a streamlined process for prior authorizations can help avoid pulling staff away from frontline care for this time-consuming task. Access more resources from ACCC on successful integration of oral oncolytics here.

Stay tuned for more from the ACCC 33rd National Oncology Conference from ACCCBuzz. Follow the conference highlights on Twitter #ACCCNOC.

Oral Parity: When Modern Medicine Outpaces Policy

By Leah Ralph, Director of Health Policy, ACCC

PillsACCC has been a longtime champion of oral parity, the legislative effort to equalize patient cost sharing for intravenous (IV) and oral chemotherapy drugs.

Oral oncolytics can offer a better quality of life for patients undergoing chemotherapy treatment, including less travel time, fewer work absences, often fewer side effects, and the convenience and comfort of at-home administration. For some cancer patients, an oral anti-cancer medication is the only option for treatment. Yet insurance coverage has not kept pace with medical innovation. Outdated insurance benefit designs continue to cover oral medications under the pharmacy benefit, which often means high, burdensome out-of-pocket costs for patients. (Traditional IV chemotherapy is covered under a plan’s medical benefit, resulting in minimal co-pays or no cost for patients.) This coverage disparity creates financial burdens for patients prescribed an oral anti-cancer medicine, leaving them less likely to adhere to treatment and often unable to fill their prescription. The number one reason a patient does not take his or her medication appropriately is cost. According to a 2011 study published in the Journal of Oncology Practice and the American Journal of Managed Care, 10 percent of cancer patients failed to fill their initial prescriptions for oral anticancer medications due to high out-of-pocket costs.

Progress at the State Level

We’ve come a long way in terms of state law. To date, 40 states plus the District of Columbia have passed oral parity legislation. These laws are not a mandate to cover oral chemotherapy, but rather require that if an insurance plan covers chemotherapy treatment, a patient’s out-of-pocket costs must be the same, regardless of how the therapy is administered. As a member of the State Patients Equal Access Coalition (SPEAC), ACCC has partnered with several state oncology societies—including Virginia, West Virginia, and Arizona in recent years—to pass oral parity laws, and this year we’re focusing our efforts on Tennessee and South Carolina. (If you are a provider in either of these states, and you’d like to be an advocate, email ACCC Director of Health Policy, Leah Ralph. ACCC participated in this new SPEAC video that helps to tell the oral parity story from the patient’s perspective.

Why Federal Legislation is Necessary

And even though a majority of states have now passed state-level oral parity legislation, federal legislation is still needed. A federal law would ensure that new cost-sharing restrictions are implemented consistently across the country, and that plans that fall outside state regulation, such as those covered under the federal ERISA law (usually large, multi-state health plans), must comply with the same equitable coverage requirements. In September, an ACCC member spoke at a Congressional briefing on the Cancer Drug Coverage Parity Act of 2015 (S.1566/H.R.2739), helping gain critical momentum to move the bill forward.

In a few weeks, at ACCC 2016 Capitol Hill Day on March 2, ACCC members will be walking the halls of Congress to talk with legislators about the importance of this bill to cancer patients and the providers who care for them.

ACCC encourages members to join our efforts, and continue to monitor opportunities to weigh in with your state and federal legislators. For more on this issue, look for an upcoming article to be published in the March/April Oncology Issues, “Exploring the Issue of Cancer Drug Parity.”