Chemotherapy Stewardship Programs Needed for Cutting Cancer Costs

Chemotherapy stewardship programs—particularly those involving pharmacists—may result in cost savings to both health systems and patients, according to a recent study.

Implementing chemotherapy stewardship processes can decrease the number of inappropriate inpatient anticancer regimen administrations along with inpatient resource use, Emily R. Hennes, PharmD, BCOP, clinical pharmacist in the Pharmaceutical Research Center at University of Wisconsin Health, in Madison, Wisconsin, and colleagues wrote in the study, published in the American Journal of Health-System Pharmacy.¹

Cancer care costs are increasing faster than those in other medical sectors, reaching $130 billion in spending on anticancer agents worldwide in 2017, the authors wrote.

The cost hikes are associated with many factors, including increasing complexity of cancer care due to screening recommendations and integration of precision medicine, as well as increasing drug prices and an aging population.

Many types of cancer care have shifted to the outpatient setting “due to toxicities, administration challenges, and certain patient-specific factors, inpatient chemotherapy administration remains necessary, and even desirable, in individual cases,” the authors wrote. Because of this, “it is essential that health systems implement novel programs to optimize the site of care for chemotherapy regimens,” they said.

According to the study, successful chemotherapy stewardship programs include these actions:

1. Assessing and establishing the site of care for institutional chemotherapy regimens during the initial evaluation process, which reduces unnecessary variation in administration location. Designation of site-of-care also allows for the development of downstream processes to evaluate patients who fall outside of standard-of-care practices or may not be candidates for ambulatory administration due to patient-specific risk factors.
2. Evaluating previous in-patient resource utilization practices to establish criteria for inpatient administration of chemotherapy and develop pathways to triage patients who do not meet those criteria.
3. Implementing continuous process improvement measures to further optimize inpatient administration criteria and to formally assess the institutional impact.

Successful chemotherapy stewardship processes rely on multidisciplinary health care personnel, including pharmacists, along with leadership collaboration to design and implement infrastructures that support standard-of-care therapies, they wrote.

Pharmacists play an integral role in establishing and maintaining chemotherapy stewardship programs through comprehensive analyses of chemotherapy regimens, review and implementation of clinical decision support tools within the electronic health record, collaboration with multidisciplinary teams to ensure safe administration of chemotherapy, and continuous review of new evidence and practice changes, according to the authors.

At the University of Wisconsin Carbone Cancer Center and UW Health, inpatient pharmacists were responsible for tracking inpatient chemotherapy administration via a tool built into the electronic medical record (EMR).

Then, the detailed information was analyzed by the oncology pharmacist team and used in conjunction with retrospective data from other reporting tools to make recommendations to the hematology/oncology division, disease-oriented teams, and oncology pharmacy service lines regarding the use of inpatient chemotherapy, flagging regimens for movement to the ambulatory setting, and narrowing or changing of current exclusion criteria within the chemotherapy stewardship process, the authors wrote.

“The concept of a chemotherapy stewardship process was well received across healthcare disciplines within our institution and offers a tool to standardize inpatient chemotherapy administration and simplify the process for the prescribing provider while implementing a pathway to pursue inpatient treatment for patients who fall outside of parameters outlined in the process,” they concluded.

References:

1. Hennes ER, Reed M, Mably M, et al. Implementation of a Chemotherapy Stewardship Process. American Journal of Health-System Pharmacy. July 4, 2020. Doi: https://doi.org/10.1093/ajhp/zxaa157