The Role of the Navigator in the Oral Chemotherapy Process: Ensuring Compliance and Patient Safety

Objectives: The management and monitoring of oral chemotherapy is complex. Components include documentation of the oral chemotherapy plan, education, adherence, and monitoring for toxicities. Bon Secours St. Francis Health System’s Cancer Center located in Greenville, SC, monitored the oral chemotherapy process using the American Society of Clinical Oncology’s Quality Oncology Practice Initiative (QOPI). Specific oral chemotherapy (defect-free) indicators include a documented plan for oral chemotherapy, education, and monitoring for toxicities. Data abstracted in 2014 demonstrated opportunity for improvement in all 3 categories. Our goal was to improve compliance with oral chemotherapy standards measured through QOPI.

Methods: A multidisciplinary team was convened to develop and implement an oral chemotherapy process. Once the healthcare team and patient agree on the treatment plan and the order is written, the navigator initiates and oversees the comprehensive process to manage and monitor oral chemotherapy. The navigator schedules the patient for chemotherapy education with the clinical pharmacist and with the financial counselor. The education process begins with navigation. The navigator provides basic drug education (ie, drug name, what it is designed to do, how it is given (meaning once a day/twice a day/every day/cycle information), and common side effects). The navigator contacts the patient 48 to 72 hours after initiating therapy to identify barriers related to toxicities and compliance. The navigator monitors and documents adherence and toxicities at each medical oncology visit.

Results: QOPI data abstraction was repeated in 2015. Improvement in all oral chemotherapy (defect-free) indicators was observed. Improvements in QOPI indicators were as follows: documented plan for oral chemotherapy increased from 37.90% in 2014 to 62.50% in 2015; oral chemotherapy education provided rose from 25% in 2014 to 75% in 2015; oral chemotherapy monitored rose from 41.67% in 2014 to 100% in 2015.

Conclusions: Improvement in compliance with QOPI oral chemotherapy indicators demonstrates the effectiveness of the navigation process to manage and monitor oral chemotherapy. The use of oral chemotherapy agents has grown tremendously. The navigation process is an important tool to ensure compliance and patient safety.