Background: The introduction of CDK4/6 inhibitors for advanced hormone receptor positive, HER2 negative, breast cancer patients has contributed to increased ambulatory patient visits for oncologists. Oncology clinical pharmacists have training and expertise in medication management and adherence. The aim of the Medication Assessment by Pharmacist (MAP) program is to evaluate the impact of clinical pharmacists performing medication assessment follow-up visits. Methods: Metastatic breast cancer patients on a CDK4/6 inhibitor (palbociclib or ribociclib) deemed suitable for pharmacist assessment were identified by medical oncologists at British Columbia (BC) Cancer Surrey. Oncologists can book the patient for a pharmacist medication assessment appointment at alternate cycles. The clinical pharmacist uses standardized medication assessment forms, provincial protocols and toxicity management guidelines. Results: Between April 2018 to December 2019, 82 patients were initiated on a CDK 4/6 inhibitor at BC Cancer Surrey. Of these, 12 patients (14.6%) were selected for the MAP program for a total of 17 pharmacist visits. This resulted in 340 minutes of clinic time savings for physicians. Patients who underwent the MAP program were more likely to follow provincial and regional protocols for scheduling clinic visits (99%) as compared to those who did not (96%). Rates of monitoring investigations adhering to provincial protocols were similar between those in the MAP program or not (97.6% versus 97.7%). There was a 100% physician and pharmacist survey response rate with a total of 9 physicians and 9 pharmacists participating. 100% of surveyed pharmacists agreed or strongly agreed when asked whether MAP increased job satisfaction. 100% of physicians indicated that MAP reduced physician workload. Physicians and pharmacists who participated in MAP all agreed or strongly agreed when asked if patients were receptive to meeting with a pharmacist. Only 33% of physicians routinely ask about medication adherence, newly started medications or natural health supplements at each visit, as compared with 100% of pharmacists. 100% of physicians reported that they wanted to see MAP expanded to include additional oncology drugs. Conclusions: This study demonstrates that expanding the role of clinical oncology pharmacists and their integration in a shared care model with oncologists can reduce ambulatory patient visits for oncologists without compromising clinical care. Additionally, leveraging pharmacist expertise helps to enhance care by evaluating medication adherence and concurrent drug therapies. Based on this program, MAP has expanded to include additional cancer centres and other oral cancer therapies. This shared care model in the ambulatory oncology setting may be a way to help alleviate projected shortages of oncology providers.
Citation Format: Angela Chan, Sylvie Labelle, Elaine Goh. Implementation and evaluation of a shared care model between oncologists and pharmacists for advanced breast cancer patients on cyclin-dependent kinase (CDK) 4/6 inhibitors [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P1-18-23.