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This increase not only affects billing and reimbursement, but it also escalates the risk of patient non-compliance. In contrast with traditional infusions, which require patients to physically come into a cancer program, oral chemo places significant responsibility on patients when it comes to refills, dosage, and timing. There's a lot at stake for patients when you take into account that non-adherence to oral chemo regimens is associated with disease progression, lack of efficacy, and increased risk of toxicity.
Managing patients on oral chemo
Despite the rise of oral chemo, cancer programs struggle to find effective ways to manage and support patients on oral chemo. For instance, while 83% of cancer programs have staff dedicated to managing patients on oral cancer therapies, they lack consensus on which providers to involve in oral chemo management.
Today, oral chemo management relies largely on phone calls to ensure patients take their medication as prescribed and to assess any side effects or other concerns. This support can be useful, but it isn't a foolproof way to ensure patient adherence and doesn't provide real-time patient monitoring—which is where new technology such as digital pills and other efforts may add significant value.
The introduction of digital pills to oral chemotherapy
In September of 2018, Proteus Digital Health launched its "digital pill program" for seven patients, all of whom have Stage 3 or 4 colorectal cancer, at Fairview Health Services.[1] To create these digital pills, Proteus manufactures and embeds a digital sensor into a placebo pill that is then sent to a specialty pharmacy and combined with the active oral chemo in one larger capsule. When apatient takes the capsule, the sensor in the digital pill transmits data on the timing and dosing of the medication to a patch on the patient's torso. This information is then sent to an online portal. Patients have access to this portal and can opt to allow their care team access to the portal as well.
While the hope is that digital monitoring will help improve patient adherence, Proteus's partnership with Fairview is also an interesting example of outcomes-based payments in oncology: The health system pays only if cancer patients in the study adhere to their oral chemotherapy treatment as prescribed 80% of the time. And though the impact on patient adherence in the program is yet to be determined, Proteus aims to ramp up its trial of digital chemotherapy pills with eight trial sites and 750 patients enrolled in 2019.
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Managing oral cancer therapies at your organization
While the advent of digital pills is promising, cancer providers already know that patients can be non-adherent for many reasons, from cost to side effects to confusion about their treatment regimen—challenges that digital sensors may fail to address.
To improve oral chemotherapy management, your cancer program does not have to wait for digital pills. Here are three steps your cancer program can take to help patients stick to their treatment regimen once they leave your program:
- Help patients manage the high cost of cancer drugs by investing in financial navigation and exploring all available options for financial assistance.
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- Prepare patients for managing side effects with upfront education and ongoing support that makes it easy for patients to report their symptoms to providers.
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- Tap in to the expertise of your pharmacists to support patients in filling their prescriptions, answering questions about their treatment regimen, and remotely monitoring adherence.
[1] Robins, "A 'digital pill' for cancer patients is rolled out for the first time, in hopes of improving outcomes," STAT News