Rising Improvements in Oral Chemotherapy

The program’s goal is to measure performance, investigate quality and safety issues and implement change within the cancer center. Oncology Clinical Pharmacist, Cara Harshberger, believes being involved with this six-month program will be beneficial by providing a ​“great opportunity for the cancer team to learn how to improve our processes to give our patients the best possible care that we can.” 

This allows Ivinson to fulfill its promise of offering world-class healthcare to patients. Ivinson’s team members involved in the six-month improvement program included: Cara Harshberger, clinical pharmacist, Paula Eskam, performance improvement coach and Cancer Center Registered Nurses Cheryl Rodgers, Hannah Wilson and Erin Davis.

What is Oral Chemotherapy?

Oral Chemotherapy is a cancer fighting drug that is distributed by tablet, capsule or liquid form. Ivinson offers this treatment to patients that are prescribed this drug by a doctor, nurse practitioner or physician assistant. Oral chemotherapy can be beneficial to patients that have limited time to come into the hospital for chemotherapy infusions (IV) and instead can be taken in the comfort of their own home. 

Although oral chemotherapy saves patients from hospital visits, it’s not available for all stages of cancer. This treatment course is associated with being hard to manage because oral chemotherapy drugs need to be taken on a precise schedule and are often expensive. Both chemotherapy infusion and oral chemotherapy have side effects, but taking oral chemotherapy drugs can be challenging to manage side effects without hospital visits. 

“Oral chemotherapy is a challenge across the country,” Cara says. ​“There is no better way to learn than being part of a program that allows us to learn from other institutes that are having the same issues.”

How Do We Improve?

Gathering baseline data is part of participating in the HOPA and ASCO QTP six-month program in order to evaluate the process from start to finish. This allows the cancer team to recognize and pinpoint a specific area their team wants to improve. 

“Part of the program is really looking at the quality piece of it and how you complete the oral chemotherapy process over and over. This allows our cancer center team to pick an improvement project based on our institution, what we are struggling with and be able to use the tools and development to make our process better,” Cara said about the program.

“For this program, they recommend taking on a small scope first, because it is a short program. The idea is to utilize this process to identify and to fix other problems after the program,” states Cara. This allows the cancer team to identify issues in the oral chemotherapy process that is established by the baseline data research they conduct from start to finish and continue to implement the process improvement with each issue that arises. 

Based on the data collected, the cancer center is first focusing on improvement of treatment compliance, ensuring patients take therapy drugs correctly and respond appropriately to missed doses. 

“We’re focused on assessment of adherence and toxicity to their treatment, identifying missed dosage with patients, and being able to effectively document the information on the appropriate flow sheet” Cara said of the group’s main areas for improvement. 

Cara believes that focusing on this scope of improvement will address issues with oral chemotherapy patients early on, which will increase efficiency in side effect management and patient adherence issues. This allows the cancer center team to effectively provide an intervention to those oral chemotherapy patients in order to keep their treatment efficacious and cost efficient. 

The Results

The first session of the HOPA and ASCO program started in September of 2022 in Washington D.C. to help train the cancer team representative members. The cancer center team was also given a coach to meet over the course of six-months as a resource to help with their process improvement program. 

The HOPA and ASCO QTP final session took place in Phoenix, Arizona where the cancer center team presented their findings. In the earlier months of the HOPA and ASCO program, the cancer center team was able to identify adherence and toxicity monitoring as an area they wanted to improve. This focus was identified through data research of the oral chemotherapy process before and after the new implementation process. 

Before the program, the data showed less than 15% of patients on oral chemotherapy had adherence and toxicity documented within the oral chemotherapy adherence flowsheet. 

The process implemented to increase the percentage included:

1. Schedule oral chemotherapy patients with ​“nurse of the day” (NOD).
2. Provide patients a handout prior to NOD visit.
3. Include an appointment note with generic drug prescription, as a trigger for the front desk to give them a handout.
4. Pharmacist reviews the next data NOD schedule to identify the oral chemotherapy patients to be given a handout.

“The data has shown that scheduling our oral chemo patients with the nurse of the day and providing the patient with a handout to be completed prior to their visit has made a significant difference in completing and monitoring our patient’s adherence and toxicity. ​“stated Cara in the final presentation.

With the data collected and the new processes implemented by the cancer center, patients being monitored correctly on their adherence and toxicity was increased up to 75%. 

cancer treatment at ivinson

The Meredith and Jeannie Ray Cancer Center at Ivinson is a comprehensive facility offering patients access to state-of-the-art cancer treatments in chemotherapy and hematology, as well as radiation. At Ivinson we utilize the most advanced and progressive treatments that can destroy or control the growth of cancer cells.