Overcoming Barriers to Treatment Adherence in MPN

Michael Reff, RPh, MBA, provides insight on adherence programs for MPNs and discusses why patients may not be adherent to therapies.

Bruce Feinberg, DO: Michael, I want to get back to you because I was looking at you, but Kathy got you off the hook. Do we have any data that there is a real adherence issue? Is it more of a general thought process, or is there something specific on why MPNs [myeloproliferative neoplasms] were early targets?

Michael Reff, RPh, MBA: There are a lot of elements that Kathy alluded to, that we can expand on. We can even go a little deeper on some of them regarding adherence. What she talked about was a systematic approach. Whether it is MPN, colorectal cancer, or breast cancer, practices will take a look at adherence as adherence. They may take a look at individual therapies or disease states and whittling away those, but it has to be a systematic approach. That is what Kathy was talking about embodying in her practice.

For taking adherence from a holistic approach right, we touched on how we can utilize some of the innovation in the technology and how practices need to do that to enhance their adherence programs. Adherence in oncology is no better and no worse than it is in hypertension, cholesterol, or what have you. Depending on what study you are looking at, and I have looked at several, they point to cost and adverse events. There is a whole list of reasons why patients are not adherent to their oral oncology products. We have touched on several of those, but there is another important point that I keep going back to.

Another important point that Kathy mentioned—and we talked a little about it earlier—is adherence. Part of the NCODA [National Community Oncology Dispensing Association] quality standards is that adherence needs to be looked at from a best-practice approach. That best-practice approach is patient specific and specific to the medicine or the therapeutic option. She mentioned certain patients’ lifestyle and workstyle and whether they will be available for either certain therapies or other options, so that means making a clinical decision on where their health care provider is going to take those treatment options should be dependent on that patient. Do they understand English? Are they a truck driver, as Kathy mentioned, and not available for certain aspects of their therapy? Can they swallow or not? These are some things that need to be dialed in. If we are speaking specifically about oral therapies, those need to be considered. There is a whole list of items that need to be considered before you start a patient on an oral therapy. We are then dovetailing or dialing in that specific therapy, so when you do adherence talks or interactions with patients, is a day 7 callback the most appropriate cadence for that patient and that product? What I can tell you is this: 1 size does not fit all.

When you look at patient-specific attributes and then look at product-specific attributes, a practice should not say, “On day 14, we always call back,” because day 14 may be too late. The diarrhea may have already started, or the peripheral neuropathy may have already started. Something may have occurred with that patient because of that product or the situation that they are in that does not allow the patient to optimize their oral therapy. That is the best practice that we promote, and Kathy has certainly embodied that at her practice.

It is not really necessarily done across the country yet, and it is something we are focusing on by taking a look at the patient-specific attributes and the product or the molecule and what the adherence touchbacks and cadences are, as well as the specifics around that. Those are important things to help increase adherence of oral therapies.

Transcript edited for clarity.

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