Collaborative Physician-Pharmacist Clinic Decreases Polypharmacy and Prevents Treatment Delays in Multiple Myeloma

To achieve optimal outcomes, patients with multiple myeloma (MM) require timely treatment, medication management, education, supportive care, and they must adhere to treatment, said Karen Sweiss, PharmD, of the University of Illinois Cancer Center and the Department of Pharmacy Practice at the University of Illinois at Chicago. She and her colleagues presented study findings at the annual ASH meeting showing that a collaborative multidisciplinary clinic engaging a physician and an oncology pharmacist can improve those aspects of care.

The group presented their model, in which an oncology pharmacist consulted with all patients in a specialist myeloma clinic. The pharmacist reviewed medications, provided medications lists, confirmed that physicians were adhering to supportive care guidelines, discussed treatment-related side effects, and assisted with access to oral specialty medications. The researchers compared results between (a) a group of patients seen in the new model and (b) a group of patients treated by the same physician the previous year who received ad hoc pharmacy consultation under the older clinic model.

The new model led to significant improvements in adherence to supportive medications (e.g., bisphosphonates, calcium and vitamin D, acyclovir, and Pneumocystis jirovecii pneumonia [PJP] prophylaxis). In addition, the collaborative clinic greatly shortened the time to initiation of bisphosphonates and PJP prophylaxis after autologous transplantation. Furthermore, the new model significantly reduced delays in immunomodulatory treatment.

Polypharmacy rates were high in both groups, but the clinic was successful in reducing both minor polypharmacy (five to nine medications) and major polypharmacy (10 or more medications), the authors said. The new group of patients took fewer medications on average; the median number of myeloma-related medications was higher, but the number of non-myeloma-related medications was lower.

The authors concluded that “incorporating another sub-specialized individual such as a clinical pharmacist into the care of multiple myeloma patients resulted in increased adherence to core supportive care measures and a reduction in delays in acquiring oral immunomodulatory drugs,” and adding that “although we illustrate a high incidence of polypharmacy among patients in both clinics, consultation by a pharmacist led to a significant reduction in the number of non-myeloma-related medications.”

The authors said their collaborative model may be applied to other other complex diseases and encouraged similar studies in other cancer clinics, in addition to examinations of the long-term impact of the model.