159 Background: Approval of new oral anticancer agents (OAA) continues to rise, accounting for 75% of new oncology drugs approved so far in 2015. OAA prescriptions generated at our institution demonstrate similar growth, as the prescription volume for OAA is approximately 200% greater than it was 8 years ago. Challenges of OAA, including safe prescribing, monitoring toxicities, and assessing adherence, continue to be an obstacle to providing quality care. In recognition of these challenges, our institution employed the electronic medical record (EMR) to develop tools to enhance safe prescribing, monitoring, and follow up for patients receiving OAA. Methods: Comprehensive, regimen-specific, OAA protocols were built in the EMR using the American Society of Clinical Oncology’s Quality Oncology Practice Initiative criteria as a guide. Protocols included OAA prescriptions, laboratory tests, monitoring communications, supportive care medications, plan for follow up, and a monitoring order. The monitoring order, dated 7 to 10 days after the start of each cycle, was utilized to identify patients for follow up, and as a documentation tool. During follow up calls, pharmacists provided education, addressed adherence and toxicities, and communicated findings to team members. The initial analysis focused on six of the most commonly prescribed OAA agents at our institution. Results: Cycle 1 follow up calls were placed for 115 new start OAA patients. Over half of the patients (56.5%) required an intervention (ex: symptom management, alerting the medical team, counseling). Eleven patients had barriers to adherence (ex: confusion, incorrect technique, cost, obtaining insurance coverage, and toxicity). Overall, 98% of patients verbalized appropriate adherence. There were 191 subsequent follow up efforts, after the cycle 1 follow up call, which resulted in 39 interventions (20%). Conclusions: OAA requires the same intensive monitoring and follow up as IV chemotherapy, but is more difficult to provide given the nature of administration of these medications. Utilizing the EMR to develop prescribing and monitoring tools can help address these challenges by providing a means for enhanced documentation and follow up.

77 Background: Utilization of oral anticancer agents (OAA) has drastically increased over the past decade, accounting for more than 70% of new oncology agents approved in 2013. There are many challenges associated with OAA, including monitoring of adverse drug reactions (ADR) and adherence. While few studies estimate adherence of OAA, it is known that a multidisciplinary approach with intensive pharmacist counseling may improve outcomes. Currently, the electronic medical record (EMR) at our institution has many limitations on tracking OAA. In 2007, 1,872 OAA prescriptions were written. The 2014 annualized OAA prescriptions will surpass 5,510, demonstrating a growth of 194%. The purpose of this project is to establish an OAA monitoring program to allow consistent documentation, closer monitoring, and timely management of ADR. Methods: American Society of Clinical Oncology’s Quality Oncology Practice Initiative criteria were utilized to develop a unique monitoring tool, specific for OAA, which was employed via EMR. The monitoring tool assesses the current regimen, ADR, labs, adherence, and drug interactions. The initial analysis focused on testing the tools on two of the most commonly prescribed OAA agents within our institution. New start patients were identified through utilization of an OAA pharmacist verification queue. The pharmacist provided education, intensive follow up, and communicated treatment complications to other healthcare team members. Results: Follow-up calls were placed for 24 capecitabine patients and four erlotinib patients. Over half of the patients required an intervention. For capecitabine, there were seven patients with barriers to adherence. There were two patients who were non-adherent and one patient who was lost to follow-up; therefore, overall adherence rate was 91%. For erlotinib, adherence rate was 100% with no barriers to adherence. Symptom management and education were provided to 16 patients with grade 1 toxicities, and four drug interactions were identified. Conclusions: Oral chemotherapy should be treated with the same intensive monitoring as IV chemotherapy. A multidisciplinary pharmacist driven OAA monitoring program may improve adherence and allow more timely management of ADR.

191 Background: Oral chemotherapy’s exponentially increasing role in the treatment of malignancies continues to pose unique challenges to oncology. The American Society of Clinical Oncology (ASCO) and Oncology Nursing Society (ONS) drafted measures in the Chemotherapy Administration Safety Standards that help address some of these issues concerning oral chemotherapy. There is a lack of data describing the prescribing process for oral chemotherapy. In a retrospective chart review, prescriptions at a hospital-based outpatient oncology center were evaluated for completeness of prescribing and follow up measures. Methods: A retrospective chart review of ten oral chemotherapy medications from May 2012 to July 2012 was conducted. The primary outcome measure was compliance with ASCO and ONS Chemotherapy Administration Safety Standards. A secondary outcome was frequency of pharmacist interventions on oral chemotherapy prescriptions. Results: 412 prescriptions were evaluated. Prescriptions were graded on a scale from 1 to 8. One point was given for inclusion of each of the following: prescribing physician, patient name, drug name, dose, dosing methodology, quantity, refills, and accurate directions. Of all the prescriptions, 23% contained all aspects of a complete prescription. The most common reasons for point deductions were contradictory or unclear directions and allowing refills for oral chemotherapy which should not be refillable. Four percent of prescriptions had a documented pharmacist intervention. Conclusions: This study revealed areas for improvement in the prescribing process of oral chemotherapy. Targeting directions and refill fields within prescription templates will improve compliance with ASCO and ONS standards. This can be accomplished by implementing customized oral chemotherapy prescription templates within treatment plans in the electronic medical record system. Unlike chemotherapy administered in the clinic setting, oral chemotherapy prescriptions are not generally reviewed by oncology trained pharmacists. With the collaboration of medical and nursing staff, a new work flow was implemented which includes pharmacist review of electronic oral chemotherapy prescriptions.

Purpose: The Health Information Technology for Economic and Clinical Health (HITECH) Act has placed an emphasis on electronic health information exchange (EHIE). Research on needs of patient, especially those touched by cancer, has been sparse. Here, we present data on preferences for EHIE among those touched by cancer compared with a nationally representative sample of American adults. Methods: Two surveys were used: an online survey designed by LIVESTRONG (the Lance Armstrong Foundation) and a dualframe, nationally representative sample of adults collected through the National Cancer Institute’s Health Information National Trends Survey (HINTS). Results: The LIVESTRONG EHIE survey yielded a sample of 8,411 respondents, including 433 currently receiving cancer treatment, 298 living with cancer as a chronic disease, 2,343 post-treatment survivors, and 5,337 with no history of cancer. The HINTS sample consisted of 7,674 respondents representative of the general adult population. Comparisons revealed a strong positive view of the value of EHIE within the cancer-relevant groups, especially among those living with cancer as a chronic disease. Only about half of the general population showed a similar degree of enthusiasm for EHIE. When asked about specific functions for EHRs, respondents valued privacy and security above all, followed by improving care coordination and data sharing between providers. Conclusion: These data suggest that the EHIE needs among those touched by cancer may be greater than in the general population. This is particularly important because people affected by cancer are among those who access our health care system most frequently and who have the most at stake.