A randomised controlled trial of clinical pharmacy intervention versus standard care to improve medication adherence in outpatients with head and neck cancer receiving radiotherapy

Maleki, S; Glewis, S; Fua, T; Liu, C; Rischin, D; Alexander, M; Na, L; Lingaratnam, S

Author(s): Maleki, S; Glewis, S; Fua, T; Liu, C; Rischin, D; Alexander, M; Na, L; Lingaratnam, S;
Details: Publication Year 2022-05,Volume 30,Issue #5,Page 4243-4253
Journal Title: Supportive Care in Cancer
Publication Type: Research article
Abstract: PURPOSE: Patient understanding of medicines information and adherence to medication instructions are important variables for ensuring optimal cancer care. This randomised controlled trial (RCT) aimed to evaluate the impact of an outpatient clinical pharmacy service on medication adherence and symptom burden in cancer patients. METHODS: In this single-centre RCT, 115 patients were randomised 1:1 to a pharmacist-led pharmaceutical care program (intervention, n = 59) versus standard of care (control, n = 56) within an outpatient multidisciplinary radiotherapy clinic. The primary endpoint was medication adherence as assessed by Medication Understanding and Use Self-Efficacy (MUSE) scale and Teach-Back assessment. Secondary endpoints were patient-reported symptom burden assessed by the Edmonton Symptom Assessment Scale (ESAS). Patients were assessed at baseline (weeks 1-2) and at discharge from radiotherapy (weeks 5-7). RESULTS: Polypharmacy (use of five or more medications) was observed in 26% of patients at baseline compared to 97% at discharge. Patient self-efficacy and medication adherence was higher in the intervention arm compared to the control arm, with a mean MUSE score difference of 2.70 (95% CI 1.24, 4.17) after adjustment for baseline, and a higher proportion of patients with average Teach-Back score of four or more (86% vs 14%; odds ratio (OR) 46.09, 95% CI 14.49, 146.56). The mean (SD) scores for aggregate ESAS (0-100) at discharge were 26.2 (14.0) in the intervention arm and 32.0 (15.8) in the control arm demonstrating lower overall symptom burden associated with the intervention (mean score difference adjusted for baseline - 0.52; 95% CI - 1.03, - 0.01). CONCLUSION: A structured outpatient clinic pharmacy service significantly improved medication adherence and reduced overall symptom burden in patients receiving radiotherapy.
Keywords: *Head and Neck Neoplasms/drug therapy/radiotherapy; Humans; Medication Adherence; Outpatients; *Pharmacy; *Pharmacy Service, Hospital; Ambulatory care; Outpatient clinical pharmacy service; Pharmaceutical Care Program; Radiotherapy; Randomised controlled trial
Department(s): Pharmacy; Radiation Oncology; Medical Oncology; Biostatistics and Clinical Trials
PubMed ID: 35091845
Publisher's Version: https://doi.org/10.1007/s00520-021-06779-5
Terms of Use/Rights Notice: Refer to copyright notice on published article.

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