Transcript No Slide Title

FACET - European Journal of Cancer Care
September 2006
Oral anti-cancer therapies
Oakley, C.1, Bloomfield, J.2, Plant, H.3
Slide One
Oral anti-cancer
therapies – past,
present, future
What are the issues facing patients
prescribed oral chemotherapy, their
families and healthcare professionals
caring for them?
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FACET - European Journal of Cancer Care
September 2006
Oral anti-cancer therapies (continued)
The conference
Presentations:
Slide Two
• Drug developments in recent
years
• Commissioning issues
• Establishing oral chemotherapy
services from the points of view
of pharmacy and nursing
• Research exploring patient
experiences of oral
chemotherapy
Three workshops
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FACET - European Journal of Cancer Care
September 2006
Oral anti-cancer therapies (continued)
Who should attend a
workshop on oral
chemotherapy?
Slide Three
• Clinical nurse specialists
• Pharmacists
10
8
• Community nurses
• General practitioner
6
1
• Hospital based consultants
• Nurses/others
• Others/managers
• Patients/users
Total
3
5
20
5
58
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FACET - European Journal of Cancer Care
September 2006
Oral anti-cancer therapies (continued)
Slide Four
Why use the oral route?
It is the normal way!
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FACET - European Journal of Cancer Care
September 2006
Oral anti-cancer therapies (continued)
Development of oral
anti-cancer treatments
– the past
Slide Five
• Early anti-cancer drugs were
cytotoxics
• Oral hormonal agents were
used to treat hormone
dependent cancers as soon as
they became available
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FACET - European Journal of Cancer Care
September 2006
Oral anti-cancer therapies (continued)
Slide Six
Development of oral
anti-cancer treatments –
Capecitabine
• 5-FU can not be absorbed from
the gut so is administered as
continuous IV infusion to achieve
maximum cell kill
• Capecitabine is absorbed from the
GI tract and converts to 5-FU at
the liver, tumour site and other
tissues
• Capecitabine is licensed for
metastatic breast and colon cancer
and as adjuvant colorectal cancer
treatment
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FACET - European Journal of Cancer Care
September 2006
Oral anti-cancer therapies (continued)
Slide Seven
Development of oral
anti-cancer treatments –
the future
• Tyrosine Kinase Inhibitors (TKI)
• Hormones
• Vinorelbine
• Drugs under development
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FACET - European Journal of Cancer Care
September 2006
Oral anti-cancer therapies (continued)
The pharmacy model
Slide Eight
British Oncology Pharmacy Association
(BOPA) statement (2004)
•
Principles of safe practice
•
Prescribing
•
Dispensing and labelling
•
Patient education and information
•
Patients access to advice and
support when at home
•
General risk management
•
Audit
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FACET - European Journal of Cancer Care
September 2006
Oral anti-cancer therapies (continued)
Slide Nine
The pharmacy model –
implementing BOPA
recommendations
•
Established oral chemotherapy
working party
•
Purpose
•
Achievements
•
Future plans
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FACET - European Journal of Cancer Care
September 2006
Oral anti-cancer therapies (continued)
The nursing model –
nurse supported
capecitabine clinic
Slide Ten
• Pathway and role of the nurse
• Patient education and support
is of vital importance
• Can be a stressful experience.
• More responsibility placed on
patients to adhere to
treatment regimens and
recognise the onset of side
effects.
• Supporting documentation
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FACET - European Journal of Cancer Care
September 2006
Oral anti-cancer therapies (continued)
The patient’s
experience
Slide Eleven
Audit: Looking at the experience of
oral chemotherapy through audit
Hilary Plant & Jacqueline Bloomfield
Research: “It is a lot easier to cope
with” – An exploration of cancer
patients’ experience of oral
chemotherapy
Catherine Oakley
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FACET - European Journal of Cancer Care
September 2006
Oral anti-cancer therapies (continued)
Looking at the experience
of oral chemotherapy
through audit
Slide Twelve
Aims of the audit
• To gain awareness of issues
experienced by those taking oral
anti cancer treatment
• Identify needs – information,
practical, social and emotional
• To identify ways in which health
professionals can support these
needs
Plant & Bloomfield (2005)
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FACET - European Journal of Cancer Care
September 2006
Oral anti-cancer therapies (continued)
Findings: Information
Slide Thirteen
Additional information needs before
commencing treatment:
“How and when to take. How to store/
manage, handle.What to do if I missed a
dose. How the medication works,
expectation of outcome of medication”
(Female respondent aged 37, taking etoposide
for several months)
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FACET - European Journal of Cancer Care
September 2006
Oral anti-cancer therapies (continued)
Slide Fourteen
Findings: Side-effects
and support
• 86% of respondents reported sideeffects as a result of taking oral
chemotherapy treatment
• 90% indicated that they knew who
to seek help from to manage these
(nurse, hospital doctor, GP)
• 23% did not seek help or support
“Because I have been through it before I
have not sought help – I just get on with it”
(Female respondent, retired, taking oral
chemotherapy for 7 weeks)
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FACET - European Journal of Cancer Care
September 2006
Oral anti-cancer therapies (continued)
Findings: Perceptions and
experiences (1)
Slide Fifteen
“I much prefer taking oral drugs, side effects are
no worse than other treatments and oral drugs
give me the control which is very important”
(Female aged 40 taking treatment for 5 months)
“I did initially feel apprehensive about the
responsibility of taking the drugs myself. I didn’t
feel safe taking such powerful medicine & worried
about getting the dose right even though it was
clearly explained on the box. I preferred it when
the medicine was given intravenously. But I’m just
about to start my 3rd cycle & feel ok about it
now”
(Female aged 38 taking capecitabine for 3 months)
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FACET - European Journal of Cancer Care
September 2006
Oral anti-cancer therapies (continued)
Slide Sixteen
Findings: Perceptions and
experiences (2)
“I have found this type of oral chemo very easy to
use and with the least side-effects. My only worry is,
is it doing the job of shrinking the tumour and how
good the end result would be. Only time will tell. For
people with poor or collapsed veins it is a real
blessing”.
(Female aged 65)
“Oral chemotherapy relies on the diligence and
efficiency of the patient. Taking 8 tablets a day is
demanding particularly if the side effects, as in my
case, were severe”
(Female aged 46 taking capecitabine)
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FACET - European Journal of Cancer Care
September 2006
Oral anti-cancer therapies (continued)
Slide Seventeen
“It is a lot easier to cope
with” – An exploration of
cancer patients’ experience
of oral chemotherapy
Day 1
OUTPATIENT
ATTENDANCE

Participant
observation

Informal interviews

Involvement of
patients and
professionals
Day 15
HOME VISIT
Formal interview with
patient at home
Field notes collected
Reflective diary maintained
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FACET - European Journal of Cancer Care
September 2006
Oral anti-cancer therapies (continued)
Main findings
• Oral therapy is the preferred option
Slide Eighteen
• Healthcare professionals anxiety
– Probable drivers are experience
of patients not taking medicine
correctly or reporting symptoms
• Information rushed/repeated with
little time to check understanding
• Patients/caregivers
anxious/overwhelmed
• Patients/caregivers assumed
responsibility which they appeared to
find stressful
• Elderly patients stayed with caregivers
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FACET - European Journal of Cancer Care
September 2006
Oral anti-cancer therapies (continued)
Slide Nineteen
Main findings (2)
Patients may not comply by ringing in if
unwell. They:
– denied side effects would occur
– didn’t know when to call in
– viewed oral chemotherapy as
milder
“I’ve got to accept it and take it… I try to
think myself well. I’m not going to take too
much notice of side effects cause I don’t
want to let them get to me. I don’t want to
get that imagination where you’re feeling
bad.”
Patient
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FACET - European Journal of Cancer Care
September 2006
Oral anti-cancer therapies (continued)
What helps?
• Confidence in the service /24 hour
contact
• Practical advice
Slide Twenty
• Speaking to experienced patients
• Caregivers helped establish routine
“I come down and have me breakfast and then
(name of caregiver) used to get the bag that is
kept on top of the fridge out there and I‘d sit and
she’d watch me have me tablets….. we made a
list so she ticks it off when I’ve had them
(laughs)….”
Patient
“I just kept to 7, 7, 7, 7, 7, 7 .. I even put me
alarm on to 7 o’clock so if I should forget it, it
would give me a reminder……”
Patient
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FACET - European Journal of Cancer Care
September 2006
Oral anti-cancer therapies (continued)
Slide Twenty One
Implications for
practice/research of audit
and research project
• Preferred option
• Clear patient pathway
• Assessment and support
• Listen and respond
• Information
• Contact details
• Monitoring
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FACET - European Journal of Cancer Care
September 2006
Oral anti-cancer therapies (continued)
Slide Twenty Two
Chemotherapy alert card
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FACET - European Journal of Cancer Care
September 2006
Oral anti-cancer therapies (continued)
Workshop outcomes
Transforming delivery – identified
Slide Twenty Three
• barriers
• key issues
• potential resources
Who, where, when
• Pathway mapping
Information/documentation
• Problem areas
• Solutions
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FACET - European Journal of Cancer Care
September 2006
Oral anti-cancer therapies (continued)
Emerging themes
Slide Twenty Four
• Responsibility
• Support
• Service structure
• Community nurses
• Existing models of care
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FACET - European Journal of Cancer Care
September 2006
Oral anti-cancer therapies (continued)
The next steps
• Pathway mapping
Slide Twenty Five
• Model of care- research
• Hand held diary
• Repeating the conference
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September 2006
Oral anti-cancer therapies (continued)
Slide Twenty Six
References and further
reading
• Bedell C.H. (2003) A changing paradigm for cancer
treatment: the advent of new oral chemotherapy
agents. Clinical Journal of Oncology Nursing 7 (6 suppl), 59.
• Borner M.M., Schoffski P., de Wit, R., Caponigro F.,
Comella G., Sulkes A., Greim G., Peters G.J., van der
Born K., Wanders J., Boer R.F., Martin C., Fumoleau P.
(2002). Patient preference and pharmacokinetics of
oral modulated UFT versus intravenous fluorouracil
and lecovorin: a randomised crossover trial in
advanced colorectal cancer. European Journal of Cancer
38, 349-358.
• British Oncology Pharmacists Association (BOPA)
(2004) Position Statement on Safe Practice and the
Pharmaceutical Care of Patients Receiving Oral Anticancer
Chemotherapy. January 2004. BOPA, UK.
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FACET - European Journal of Cancer Care
September 2006
Oral anti-cancer therapies (continued)
References and further reading
Slide Twenty Seven
(continued)
• Cassidy J., Scheithauer W., McKendrick J., Kroning H.,
Nowacki M.P., Seitz J.F., Twelves C., Van Hazel G., Wong
A., Diaz-Rubio E., On Behalf of X-act Study
Investigators. (2004). Capecitabine (X) vs. bolus 5FU/leucovorin (LV) as adjuvant therapy for colon
cancer (the X-ACT study): efficacy results of a phase iii
trial. Proceedings of the American Society of Clinical
Oncology vol. 23, 2084-2091.
• Faithfull S., & Deery P. (2004). Implementation of
capecitabine (XELODA) into a cancer centre: UK
experience, European Journal of Oncology Nursing 8, S54S62.
• Harrold K. (2002). Development of a nurse-led service
for patients receiving oral capecitabine. Cancer Nursing
Practice 1(8):19-24.
• Hartigan K. (2002). Patient education: The cornerstone
of successful oral chemotherapy treatment, Clinical
Journal of Oncology Nursing supplement 7(6):21-24.
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FACET - European Journal of Cancer Care
September 2006
Oral anti-cancer therapies (continued)
References and further reading
Slide Twenty Eight
(continued)
• James R., Bianco C., Farina C. (2003). Savings in staff
time as a result of switching from De Gramont to oral
capecitabine for patients with advanced colorectal
cancer. European Journal of Cancer, Supplements 1(5),
S83 (abstract 271).
• Liu G., Franssen E., Fitch M.I., Warner E. (1997). Patient
preferences for oral versus intravenous palliative
chemotherapy. Journal of Clinical Oncology 15(1),110115.
• Lokich J. (2004). Capecitabine: fixed daily dose and
continuous (non cyclic) dosing schedule. Cancer
Investigation 22(5), 713-717.
• Mayor S. (2003). UK introduces measures to reduce
errors with methotrexate. British Medical Journal 372,
70.
• Mills M., E., and Sullivan K. (1999). The importance of
information giving for patients newly diagnosed with
cancer: a review of the literature. Journal of Clinical
Nursing 8(6) 631-642.
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FACET - European Journal of Cancer Care
September 2006
Oral anti-cancer therapies (continued)
References and further reading
(continued)
Slide Twenty Nine
• Oakley C. (2005) It’s a lot easier to cope with, an
exploration of cancer patients’ experience of oral
chemotherapy. Unpublished dissertation, Kings College
London, London, UK.
• Partridge A.H., Avon J., Wang P.S., Winer E.P. (2002).
Adherence to therapy with oral antineoplastic agents,
Journal of the National Cancer Institute, 94(9), 652-661.
• Plant H. & Bloomfield J. (2005) Looking at the
experience of oral chemotherapy through audit.
Unpublished audit, Guy’s and St Thomas’ NHS
Foundation Trust and Kings College London, London,
UK.
• Sanio C., Erickson E. (2003). Keeping cancer patients
informed; a challenge for nursing. European Journal of
Oncology Nursing 7(1), 39-49.
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FACET - European Journal of Cancer Care
September 2006
Oral anti-cancer therapies (continued)
References and further reading
Slide Thirty
(continued)
• Twelves C., Boyer M., Findlay M., Cassidy J., Weitzel C.,
Barker C., Osterwalder B., Jamieson C., Hieke K. on
behalf of the Xeloda colorectal cancer study group
(2001). Capecitibine (Xeloda) improves medical resource
use compared with 5-fluorouracil plus leucovorin in a
phase III trial conducted in patients with advanced
colorectal carcinoma. European Journal of Cancer 37, 597604.
• Twelves C. Gollins S., Grieve R., Samuel L. (2006). A
randomized cross over trial comparing patient
preference for oral capecitabine and 5fluorouracilleucovorin regimens in patients with
advanced colorectal cancer. Annals of Oncology 17, 239245.
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