COVID-19 Pandemic Has Surprisingly Little Impact on Oral Oncolytic Adherence

In an interview with Pharmacy Times at the American Society of Clinical Oncology (ASCO) Annual Meeting, Kelly McAuliff, PharmD, BCOP, CSP, spoke about research into the impacts of the COVID-19 pandemic on oral oncolytic adherence, particularly for patients with ovarian cancer, prostate cancer, or chronic myelogenous leukemia.

Q: Can you discuss how the COVID-19 pandemic impacted medication adherence overall?

Kelly McAuliff, PharmD, BCOP, CSP: Yeah, absolutely. So, just before I do answer that, just to provide some context, I want to clarify that the research that we did that we submitted to ASCO evaluated 3 cancer types, so ovarian cancer, prostate cancer, and then chronic myelogenous leukemia, or CML. And at the beginning of the pandemic, what we saw is a significant drop in cancer screenings, cancer management visits, and cancer related surgeries. We saw a care shift from in-person [care] to telehealth and that makes sense because of the concerns that cancer patients would naturally have, given that they are immune compromised, and they are at higher risk of contracting COVID-19. So, beyond that, what we anticipated was that patient adherence for oral oncolytics was likely going to be impacted. And so, the intent of our study that we published was to evaluate the impact of COVID-19 on adherence to oral oncolytics among adult patients in a large health plan who had one of those 3 diagnoses for ovarian, prostate cancer, or CML. We also looked at digital engagement and how that mediates the impact of adherence for patients who, again, had a cancer diagnosis during the COVID-19 pandemic timeframe.

Q: What role did oral oncolytics play during the pandemic, particularly as patients may not have been able or willing to go into medical facilities?

Kelly McAuliff, PharmD, BCOP, CSP: Yeah, absolutely. So, I think the use of oral oncolytics has become increasingly prevalent in cancer care. And we certainly hear from our patients that there tends to be a preference for oral administration as opposed to intravenous or intraductal therapies, given their advantages and the ease of administration. I think that preference certainly may have been amplified by the pandemic, but it's not an entirely new concept. In addition to looking at adherence, we also wanted to see if our patients were switching therapy during their respective follow-up timeframe. So, while I can't speak to all cancers, I will highlight some of the work that myself and my colleagues researching the impact COVID-19 had on multiple myeloma prescribing patterns. And so, this is an abstract that's available at ASCO online only and it's titled “COVID-19 Impact on Multiple Myeloma Prescribing Patterns.” So, for context, the standard of care for multiple myeloma patients typically involves a combination of intravenous and/or oral medications to treat that type of cancer. So, my colleagues and I sought to assess the impact that the pandemic had on those oral and IV prescribing patterns, both pre- and then during the pandemic amongst multiple myeloma patients. And what we found was pretty interesting. So, during COVID-19, the total number of new therapy starts decreased, and that was by 11%. And the number of newly diagnosed multiple myeloma patients likewise decreased pretty significantly by 22%, which resonates with some of the research that I've seen in the field and some of the abstracts that are being posted as well. When we looked at the new rates of therapy starts per newly diagnosed multiple myeloma patient, both IV and oral medication rates significantly increased. These increased rates may be explained by that remarkable 22% decrease in the number of newly diagnosed patients. So, your denominators shrink, which is why we think we saw that significant rate of medication start increase. So, what we decided is that we really need further research to understand how COVID-19 may impact IV versus oral utilization in the multiple myeloma space. But it certainly got us asking a lot of questions and doing a little bit more research than I think we initially anticipated.

Q: How did the pandemic impact adherence to these medications?

Kelly McAuliff, PharmD, BCOP, CSP: Our results demonstrated that overall, COVID-19 appears to have no to minimal impact on adherence to oral oncolytics. For patients with a diagnosis of ovarian prostate cancer or CML, adherence was actually high in both the pre-COVID as well in the post-COVID initiator groups. We did see a slight increase in optimal adherence in the post-COVID group, despite that MPR being relatively similar. Another interesting finding was that a smaller proportion of patients in the post-COVID initiator group switched therapy compared to their peers in the pre-COVID group. So, these patients, once they're starting on therapy, they're changing less frequently once they start on your oral oncolytic in that timeframe. So it’s pretty interesting stuff.