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Report on Take-Home Cancer Medications

Recognizing the challenge and opportunity of take-home cancer medications, Cancer Care Ontario hosted a policy planning and consultation session in May 2014 with partners and stakeholders from across the healthcare spectrum.

Our objective: To explore, in an open and collaborative manner, how to enhance Ontario’s delivery model for take-home cancer medication by examining the following areas (or dimensions) for change:

  • Reimbursement and distribution
  • Information management and
  • information technology

Take-home cancer medications, such as oral chemotherapy, are emerging as a standard treatment option for many cancers. Highly effective, yet potentially toxic, these treatments are challenging healthcare providers an patients to find new ways to maximize benefit while minimizing risk. Current delivery models, designed primarily around hospital- administered injectable therapies (e.g., intravenous (IV) chemotherapy), must adapt to ensure appropriate prescribing, dispensing, handling and monitoring of these therapies. Open communication, whether between patients and healthcare providers, or between the different health-network databases that monitor use, is essential.

While the increased use of take-home cancer medications may partially mitigate the growing burden on cancer centres, it has also introduced issues of safety, accessibility, equity and responsiveness, all of which affect the overall quality of patient care and effectiveness of the cancer system.

Through panel discussions and facilitated small group discussions, the morning sessions allowed participants to gain a detailed understanding of the way Ontario delivers these therapies to patients, and the limitations of existing approaches.

Participants gained an understanding of how other provinces approach take-home therapies. Speakers emphasized the need for equivalent standards for hospital-administered and take-home cancer medication. They also noted the need to restrict access to specialized cancer experience to provide these treatments in safe, effective ways.

Following the morning sessions, participants collaborated to generate ideas on how to bolster the current Ontario model.

Upon collectively considering all participant feedback, four primary themes emerged. Patients, healthcare providers and administrators want:

  • A more integrated system — one that simplifies access to benefits, coordinates care across delivery location and ensures that all providers have access to relevant patient information.
  • A more responsive system — one that delivers services efficiently, minimizing treatment delays.
  • A system that is simpler and more comprehensive, delivering take-home therapies in a model with the same quality standards as hospital-administered treatment.
  • A person-centred system to oversee access and quality of care, regardless of the site of care delivery. A single administrator should monitor access, safety and quality.

Suggested enhancements

For each dimension analyzed, participants suggested ideas to enhance the current Ontario delivery model for take-home cancer medications.

DIMENSION ANALYZED SUMMARY OF KEY IDEAS
Quality and Safety
  • Provide comprehensive, multidisciplinary, standardized patient education
  • Use an electronic method of prescribing with a standardized template
  • Establish guidelines for safely prescribing, dispensing and handling take-home cancer medications
  • Develop patient and provider tools to monitor adherence
  • Create an infrastructure for patient support and side-effect
  • Utilize an integrated error reporting system
  • Provide specialized education, training and support to cancer healthcare providers
Reimbursement and Distribution
  • Resolve inequitable cancer drug funding
  • Simplify complex reimbursement processes to support ease of access to timely, integrated quality care
  • Identify best practices for value-based reimbursement
  • Determine the best drug distribution chain for Ontario patients
Information Management and Information Technology
  • IM and IT solutions should support continuity of care
  • Simplify the system and reduce its administrative burden
  • Create a system for robust data collection at all points of care

The growing importance of take-home medications for cancer treatment has introduced new opportunities and challenges to cancer systems worldwide to ensure safe, high-quality cancer care. Our think tank was the first consultation to examine Ontario’s current delivery model and consider opportunities for both incremental and transformative change.

While participants raised diverse perspectives, there was also clear consensus around a small set of priorities: Ontario’s cancer system should be more integrated. It should be more responsive for patients and healthcare providers. By making it more comprehensive, the system can be simpler. And all cancer therapies, whether they are hospital-administered or take-home medications, should be delivered within a single, person-centred system. Think tank participants made a compelling case that the benefits to patients and to healthcare providers from system transformation deserve careful consideration.