2020 ACCC Innovator Awards: Making Outpatient Chemo Possible

This blog is the eighth of an eight-part ACCCBuzz series highlighting the achievements of the 2020 ACCC Innovator Award Winners. You can learn more about the innovations being recognized this year and the people who pioneered them by joining us at the upcoming ACCC 37th [Virtual] National Oncology Conference, September 14-18.

Largely due to the necessity of being able to respond quickly to potential toxicities, chemotherapy is typically administered in the acute care setting. But making chemotherapy infusion an inpatient service can be costly to cancer programs, hospitals, and patients. To improve patient care and reduce overall costs, the University of Arizona Cancer Center at Banner University Medical Center in Tucson has transitioned the delivery of select chemotherapies to its ambulatory clinics. 

Patients receiving chemotherapy in the hospital setting must often take time off work for the duration of their treatment, and they aren’t guaranteed access to patient assistance programs to help with the high costs of cancer drugs. “In many cases, patients would still have to pay for these drugs,” explains Ali McBride, PharmD, MS, BCOP, immediate past president of the Association of Community Cancer Centers and clinical coordinator of hematology/oncology at the University of Arizona Cancer Center. “But in the outpatient setting, we can provide better access to care for patients, potentially reducing copays and enabling patients to obtain free drugs from manufacturers.” 

When building chemotherapy orders into Banner University Medical Center’s new electronic health record in 2013, Dr. McBride and his team began to assess which chemotherapies could be safely administered in the outpatient setting. A large multidisciplinary team was key to helping identify these chemotherapies. “Our financial team as well as our nurses, nurse coordinators, nurse practitioners, physicians, advanced practitioners, and pharmacists worked together to develop our processes,” says Dr. McBride. Treatments the team identified as appropriate for outpatient administration include rituximab after inpatient chemotherapy, acute leukemia chemotherapy regimens, and lymphoma regimens. 

The transition to outpatient chemotherapy administration required the team to develop workflows for each chemotherapy to be administered in the ambulatory clinic. Since chemotherapy regimens and patients’ personal preferences for treatment administration vary, staff in the outpatient infusion suite had to be educated about the relevant chemotherapies and their potential side effects and toxicities. Staff also required detailed information on appropriate monitoring to ensure safe drug administration. “The delivery workflow is very important,” explains Dr. McBride. “Once we worked with our staff and infusion pharmacy team, we educated our clinical pharmacy team to ensure they can safely implement these chemotherapies in the outpatient setting.” 

Identifying chemotherapies appropriate for delivery in the University of Arizona Cancer Center’s ambulatory clinic took the team approximately one year. By mid-2014, the cancer center fully transitioned select chemotherapy administration to its ambulatory clinics. “This is manual work—the actual building of the chemotherapy order sets,” says Dr. McBride. "Once the implementation was done and the literature reviewed, we addressed supportive care measures, side effect profiles, and enhanced patient care.” 

The cancer center set benchmark goals to guide its transition from inpatient to outpatient chemotherapy treatment, and during the next five years, Dr. McBride says those goals were consistently surpassed. For example, while the cancer center set a benchmark goal of 90 percent of rituximab chemotherapy administered in the outpatient setting, it achieved 94 percent. 

By transitioning select chemotherapy administration to the outpatient setting, Dr. McBride says the University of Arizona Cancer Center has reduced costs for patients, the cancer program, and the hospital. Providing chemotherapy in its ambulatory clinics has allowed Banner University Medical Center to reserve beds for the patients who most need them, decrease overnight stays, and lower overall costs to the health system. Dr. McBride says that whether a cancer program is in a small community-based center or a large academic facility, the right team members can learn how to safely administer select chemotherapies in the outpatient setting. 

Dr. McBride will deliver an in-depth presentation on how his team developed processes to safely administer select chemotherapies in the outpatient setting at the ACCC 37th [Virtual] National Oncology Conference, September 14-18. To discover how much this process is driving down costs at the University of Arizona Cancer Center, register for the session, “Shifting Chemo Administration from Inpatient to Outpatient Setting Improves Care and Reduces Cost.” 

Attend the ACCC 37th [Virtual] National Oncology Conference to learn about the accomplishments of the other 2020 ACCC Innovator Award winners on topics ranging from the creation of a 3D educational tool that reduces patient distress to how to onboard experienced non-oncology nurses to address staffing shortages.