Abstract A065: Prospective cohort study of a pharmacist-driven medication management program to improve oral cancer therapy adherence in an underserved, diverse urban setting
Authors: Smith Claire E.P. , Hughes David , Gould Scott , Buck Anne , Ko Naomi Y. 
Published: January 2023

Abstract
Introduction: Patient adherence is critical to the efficacy of oral cancer chemotherapy. At a major safety net hospital, we sought to define the adherence to oral cancer therapy amongst our diverse and socioeconomically disadvantaged patient population. We designed a high-touch, pharmacist driven program called Boston Medical Center’s Specialty Pharmacy Adherence Program (B-SPAP), to see if this intervention could improve adherence to oral cancer treatment. Methods: We conducted a prospective intervention study of adult patients undergoing treatment with an oral oncology agent for advanced cancer or hematologic malignancy. The intervention incorporated the Multinational Association of Supportive Care in Cancer Oral Agent Teaching Tool by a clinical pharmacist for 30-60 minutes at initial, 3, 6, and 12 month study visits. Patients completed Patient Activation Measure (PAM) and Trust in Physician (TIP) surveys during visits. The primary endpoints were adherence (medication adherence ratio (MAR) (= sum of days’ supply for all fills in period/number of days in period) x100), and persistence (presence or absence of a &gt;/= 45 day treatment gap). We utilized a 2:1 matched historical control design on type of chemotherapy agent. Linear regression models examined differences in adherence and persistence between intervention and controls. Data: There were 218 patients, 74 intervention and 144 historical controls. 54% of patients identified as Black, 28% Caucasian, 7% Asian, 6% other, 17% as Hispanic/Latino. 37% do not use English as their preferred language. 24% reported finishing high school. 30% are on Medicaid, 42% on Medicare, 10% had commercial insurance. The MAR in the intervention group was 92 (SD 14.6) compared with 93 (SD 10.8) in the historical control group (p=0.4). 78% of patients in the intervention group were persistent compared with 80% of historical controls (p=0.9). Non-English speaking patients had higher MAR=94.5 than English speaking patients, MAR=91 (β 3.5, SE 1.7, p=0.04). There were no differences in MAR in relation to age, marital status, or charlson comorbidity index. For the intervention patients, the average TIP Score was 48 (max of 55). TIP score did not differ by race (white=47, non-white 49, p=0.4) or language (English=49, non-English=47, p=0.3). The average PAM score was 43 (max of 52). Conclusions: Adherence to oral cancer therapies amongst our diverse patient population is high, over 90 adherent days in a 100 day period. Our high-touch, pharmacist driven intervention did not improve adherence or persistence between controls and intervention due to high rates in the control population. Interestingly we found that non-English speaking patients were more likely to be adherent than English speaking patients. Our findings suggest that equal access among a diverse patient population at a safety net institution can result in high adherence and positive outcomes despite socio-demographic factors that often lead to disparities in cancer care.
Citation Format: Claire E.P. Smith, David Hughes, Scott Gould, Anne Buck, Naomi Y. Ko. Prospective cohort study of a pharmacist-driven medication management program to improve oral cancer therapy adherence in an underserved, diverse urban setting [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr A065.