Optimizing adherence to oral CLL therapies in community oncology centers: Key findings from a quality improvement initiative

Abstract

Abstract Background Oral therapies offer a convenient treatment option for patients with chronic lymphocytic leukemia (CLL), enabling at-home administration and reduced clinical burden. However, long-term adherence requires a multidisciplinary approach to provide evidence-based patient education, proactive adverse event (AE) management, and consistent follow-up. This quality improvement initiative aimed to identify patient and provider barriers to adherence and persistence with oral CLL therapies to inform the development and implementation of processes to optimize treatment continuity and patient health outcomes. Methods This initiative was conducted in a multi-state US community-based oncology network. The study comprised a baseline survey of 74 CLL care team members across the network, complemented by a nationwide survey of 129 patients with CLL conducted in partnership with the CLL Society. The baseline surveys aimed to identify alignments and discordances in perceptions regarding oral therapy adherence between patients and providers. Findings from the baseline survey assessment were shared back with the CLL care teams through a network-wide audit-feedback (AF) session in which a CLL expert oncologist guided teams in reviewing the data to assess and prioritize clinical care gaps and implement intentionally designed action plans to address their root causes. Results Demographics: The CLL care team, averaging a monthly caseload of 20 patients treated with oral therapy, included hematologists/oncologists (N=43) and other multidisciplinary providers (N=31), primarily nurse/nurse navigators (39%) and nurse practitioners (16%). Among the patients, 77% reported receiving treatment; 59% and 39% indicated treatment with a BTK inhibitor and BCL-2 inhibitor, respectively. Baseline assessment: For patients who have previously taken or are currently taking oral medication(s), 49% reported they never miss or skip a dose, with 85% and 73% reporting high/very high confidence in their ability to stick to their oral treatment plan at home and manage the side effects of their oral medication at home, respectively. Patients were more closely aligned with hematologists/oncologists than other multidisciplinary providers' perceptions on treatment topics discussed in detail, including side effects of treatment (49% patients vs. 42% hematologists/oncologists vs. 75% other providers; p = 0.015) and strategies to manage toxicities (39% vs. 35% vs. 69%; p = 0.007). AF Session: Providers reported providing education/resources on treatment adherence and/or treatment toxicity profiles as the biggest challenge to engaging CLL patients. Following the session, clinicians reported improved confidence in their ability to manage patients with suboptimal adherence to oral CLL therapies (51% vs. 84%; p < 0.001) and promptly recognize and manage AEs associated with oral CLL therapies (54% vs. 86%; p < 0.001), which translated to knowledge gains in associating atrial fibrillation with BTK inhibitors (34% vs. 66%; p < 0.001). Care teams set goals to better educate patients on their medication and utilize a standardized protocol for patient follow-up to promote adherence. Action plans to achieve these goals include developing a patient medication tip sheet, employing formal patient education and follow-up visits, measuring medication refill timing, and using lab results and AE trends to guide treatment adjustments and motivate patients via progress tracking. In 60-day follow-up surveys, 100% of clinic champions reported high/very high satisfaction in the quality and time their team now dedicates to engaging patients in education to support treatment adherence, with implementing patient education (56%) and processes to support routine AE monitoring and management (56%) as the most significant improvements. Conclusions Through this initiative, clinical teams identified barriers to engaging patients with CLL to support oral therapy adherence, creating and implementing process improvements including optimizing patient education and medication and AE tracking protocols to improve care. While meaningful gains were demonstrated, these data underscore practice gaps in patient education and oral therapy AE management to address in future initiatives to support oral CLL therapy persistence. Study Sponsor Statement The study reported in this abstract was funded by an educational grant from BeiGene USA, Inc., who had no role in the study design, execution, analysis, or reporting.