Training Targets Oral Adherence

Ken Geans, Sherry Yarbrough, Jeremy KlossTrainers included members from the Gila River Health Center, located in Sacaton, Ariz. From left: Ken Geans, social worker; Sherry Yarbrough, nurse; and Jeremy Kloss, pharmacist.

As a clinical oncology social worker, Harold Dean has watched the evolution of chemotherapy delivery from a mostly intravenous form to today’s more accommodating oral method.

“This shift, although sometimes more efficient for the patient, has brought many challenges to the issue of compliance. Oral chemo regimens can be complicated and confusing for patients,” he said.

In an effort to improve cancer medication adherence, Dean was part of a group of health care professionals who attended the Oral Chemotherapy Adherence Train-the-Trainer Conference at NASW’s national office.

The session was hosted by NASW, the Association of Oncology Social Work, the Oncology Nursing Society and the National Coalition for Cancer Survivorship over the summer.

The conference included 10 teams representing social workers, nurses and pharmacists across the U.S. Attendees gained insight into the benefits of utilizing interdisciplinary approaches to improve outcomes of oral chemotherapy delivery.

“This training occurred at an opportune time, as my institution is currently developing a model for a supportive care clinic where treatment-related issues including compliance can be addressed,” said Dean, who was a team leader at the event. He works at the Winthrop P. Rockefeller Cancer Institute at the University of Arkansas for Medical Sciences.

“It is anticipated that most new and emerging cancer therapies will be in oral form,” Dean said. “As a social worker, I am pleased to see (the four sponsoring organizations) are at the forefront of recognizing this issue and developing strategies to address it.”

Another team leader for the training was Susan Glaser, clinical social worker at the University of Southern California Norris Cancer Hospital. She noted that the conference offered unique insight on the topic from a variety of professionals across the country.

“Persons receiving a cancer diagnosis and undergoing treatment are overwhelmed mentally, physically and emotionally,” Glaser said, adding that adherence can be a challenge because many factors — such as a patient’s and/or family’s values and beliefs, financial resources and home care settings — can affect its success.

From the psychosocial standpoint, “assessment of communication skills, coping skills, support system, learning styles and strengths, family dynamics, culture and language and the patient’s expectation and wishes with regard to treatment is an integral part of the ascertaining what approach will be most successful with a patient,” she said.

She pointed out that there are efforts under way at the hospital to exchange information to not only other clinical social workers, nurses, nurse practitioners, pharmacists and clinical dieticians, but also to students at USC.

“We will subsequently reach out to local hospitals, pharmacies and oncology group practices,” Glaser said.

Stacy Collins, NASW senior practice associate, coordinated the conference. She said the number of cancer survivors has grown significantly in recent years to 12 million in the U.S.

“Simultaneously, the use of oral agents to treat cancer has increased,” Collins said. “There are now 50 cancer oral medications approved for use in the U.S. and that number is likely to increase.”

Besides learning about the latest scientific advances in oral chemo and medication adherence research, attendees discussed case studies from an interdisciplinary perspective.

“They also did role-playing on motivational interviewing, which is an important tool for working with patients to improve medication adherence,” Collins said.

The training teams will host their own local and regional trainings through June 2012, she said.