Feasibility and efficacy of a pharmacist-led video consultation to identify drug interactions among patients initiating oral anti-cancer drugs.
Authors: Lichtenstein Morgan RL , Campbell Peter , Accordino Melissa Kate , Spivack John , Nguyen Michelle K. , Abramova Rachel , Patel Khilna , Harden Erik , Kelly Paige , Collins Nicole , Faheem Khadija , Crew Katherine D. , Beauchemin Melissa P , Elkin Elena B. , Wright Jason Dennis , Hershman Dawn L. 
Published: October 2023

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Background: The past decade has seen a dramatic increase in the number oral anti-cancer drug (OACD) approvals in the U.S. Though polypharmacy and drug-drug interactions (DDIs) likely contribute to OACD toxicity, the prevalence of these features in patients on OACDs remains largely unknown. We aimed to assess the feasibility and preliminary efficacy of a one-time 30-minute pharmacist-led video consultation among cancer patients initiating OACDs. Methods: We conducted a single-arm, prospective telehealth intervention study among patients initiating OACDs to assess the feasibility and preliminary efficacy of a one-time 30-minute pharmacist-led video consultation. The video visit focused on identifying potential DDIs, and pharmacists then communicated recommendations to the oncologist. Feasibility was defined as ≥ 60% completion of the pharmacist-led video visit among enrolled patients. We also estimated the prevalence, characteristics (QTc prolongation, absorption interactions, etc.), and severity of OACD-related potential DDIs. Lexicomp was used to assess potential DDIs and measure severity on a standardized scale where A signifies no interaction, B no action needed, C monitor therapy, D modify regimen, and X, avoid combination. In addition, we assessed the prevalence of medication list inaccuracies, polypharmacy, patient satisfaction, and patient perception of acceptability, appropriateness, and feasibility of the intervention. Results: Forty-three of the 58 eligible enrolled patients (74%) completed a pharmacist-led video visit, exceeding our feasibility definition. Among those 58 patients, mean age was 71 years (SD 12.3), and 26 patients (60%) were male. Twenty-two patients were non-Hispanic white (51%). Thirty-four patients (63%) were insured by Medicare, Medicaid, or both. The median number of standing prescriptions per patient was 9 (range: 4 – 21), and 98% of patients had at least 5 listed. The median number of medication list errors was 2 (range: 0 – 16), with at least 1 error for 76% and >1 error for 52% of patients. Pharmacists identified potential DDIs in 20 cases (47%). These included change in drug metabolism (9), QTc prolongation (1), elimination (1), and absorption (3). Interactions were classified as either category C (15) or D (5), requiring close monitoring or a change in treatment, respectively. All patients were somewhat or very satisfied with the visit, and agreed or completely agreed that the intervention was acceptable, appropriate, and feasible. Conclusions: Polypharmacy, medication list errors, and potential DDIs are prevalent among patients initiating OACDs. Our study suggests that a one-time remote 30-minute pharmacist-led video consultation is feasible and can effectively identify and address potential OACD-related DDIs, which may decrease medication complexity and improve adherence in this population.