Oral chemotherapy practices at Ontario cancer centres

Purpose: The use of oral chemotherapy agents in cancer treatment is increasing. To better understand issues affecting the optimal use of these agents, Cancer Care Ontario conducted an environmental scan of current practices in Ontario related to prescribing, dispensing, patient education, and supporting regimen adherence.

Methods: A series of semi-structured interviews were conducted either by phone (11 regions) or via email (two regions) with Ontario's Regional Cancer Centres over a 3-month period in 2012. A questionnaire was pre-circulated to the regions to guide the discussions.

Results: Responses were received from 13 of 14 regions. Considerable variation in practice was found. Of 13 responding regions, 12 (92%) lacked formal procedures or processes for the prescription of oral chemotherapy. Ten regions (77%) reported using either handwritten prescriptions or a mixture of methods with only three regions routinely using computerized order entry systems for oral chemotherapy prescribing. Oral chemotherapy was reported to be labeled as "chemotherapy" in 46% of the regions. Twenty-three percent indicated that they provide extensive patient education through a multi-disciplinary approach. A number of tools were used to encourage patient adherence in different regions. Patient education was identified as an area where more work could be done.

Conclusion: Results indicate a lack of formal policies and variable practices across all aspects of oral chemotherapy in many regions. However, some regions have developed and implemented successful initiatives. The results from this review are informing provincial priorities and being shared between regions to support collaborative learning.