Follow-up of outpatients taking oral anticancer drugs in the multidisciplinary community hospital ONCORAL care plan.

Abstract

1507 Background: The increasing use of oral anticancer drugs (OADs) has shifted cancer care toward outpatient and home-based management, raising major challenges related to treatment adherence, drug-related problems (DRPs), and coordination between hospital and community healthcare professionals. ONCORAL is a structured multidisciplinary community-hospital care plan designed to secure OAD use through coordinated personalised pharmacist-nurse-oncologist follow-up, by face-to-face consultations and phone-calls. The present study aims to assess the impact of ONCORAL over the course of treatment. Methods: This prospective real-life cohort study included adult outpatients treated by OADs and followed within ONCORAL between October 2021 and April 2024 in a tertiary referral hospital within the Hospices Civils de Lyon (Lyon, France). The 6-months follow-up was structured in two sequential phases from initiation, with hospital-led consultations, to community monitoring. The primary outcome was the number and nature of nurse and pharmacist interventions (NPIs), classified between DRPs and coordination issues. The secondary outcome was relative dose intensity (RDI), defined as the ratio of prescribed to theoretically approved dose, assessed at months 1 (M1), 3 (M3), and 6 (M6). Based on the literature, a RDI target range of 80-85% is associated with OAD efficacy. Descriptive analyses were performed at both patient and treatment follow-up levels. Results: Five hundred and thirty-six patients were included: mean age 69 ± 13 years; M/F ratio 0.8; 52.4% women; 55.8% with solid tumours. Targeted therapies accounted for 55.2% of treatments. Overall, 71.3% of patients received OADs for ≥ 6 months. Mean RDI was above 80% throughout follow-up for 86.1% at M1, 84.3% at M3, 83.5% at M6. Four hundred and eighty-one patients (90.0%) had at least 1 NPI during follow-up, for a mean of 4.8 NPIs per patient. DRPs (88.5%) were identified in 426 patients (79.5%): patient-reported symptoms and adverse effects (37.5%), drug-drug interactions (DDIs) (30.1%), and adherence issues (20.4%). Clinically relevant DDIs were identified in almost more than 1 in 3 patients (n = 145; 27%), with respectively 26.2% and 43.4% of DDIs potentially reducing OAD efficacy or increasing toxicity. Most NPIs concerned information relay to community healthcare professionals (64.2% of patients), and pharmaceutical counselling on side-effects management and treatment schedules (58.4%). Conclusions: This longitudinal evaluation demonstrates that the ONCORAL multidisciplinary community-hospital program enables safe outpatient management of OADs, with sustained dose intensity and early detection of DRPs. Pharmacist-nurse collaboration plays a crucial role in securing treatment pathways and optimising the use of anticancer therapies in a real-world setting.