PQA’s Plan to Improve Oral Anticancer Medication Use Quality

Man with beard in dark suit with blue tiePQA, the Pharmacy Quality Alliance, is launching a national initiative to prioritize research and measurement strategies to improve the quality of care for individuals using oral anticancer medications (OAM). 

OAM includes oncolytics – the oral medications used to treat cancer, including targeted agents, antimetabolites, topoisomerase inhibitors, and biologics – as well as hormonal therapies that can treat or prevent the recurrence of cancer. Hormone therapies are used commonly in breast and prostate cancers. 

Our initial goal is to forge national consensus among oncology and quality experts on the most meaningful measurement concepts and the solutions needed for improving medication use and medication management services. 

There is growing desire from PQA members and oncology stakeholders for performance measures and tools to support quality programs and value-based arrangements involving OAM. 

Now Is the Time to Build Consensus and Create Momentum  

The desire reflects the growing importance of OAM over the last two decades. In 2018, 98 of the medications with approved indications for treating cancer were oral medications, up from 11 in 2000. Today, oral medications represent nearly 40% of all cancer medications.  

Optimizing the quality of OAM use is a priority for all health care system stakeholders working to advance value-based models of care. OAM use quality which includes patient access, adherence, maintenance and related medication management services impacts clinical care, care coordination, patient safety and outcomes including disparities in care, patient and caregiver experience, population health and prevention, and total health care costs. 

Now is the time to build consensus and create momentum for medication use quality improvement in this complex and rapidly evolving area of care.  

Advancing OAM Use Quality Faces Unique Challenges 

There is a gap between what stakeholders aspire to measure and what is possible today based on available data and the state of practice. That’s why our first step is finding consensus among national experts, which will allow us to focus resources on the most impactful and meaningful measure concepts.  

We are hopeful that our initiative will yield specific measure concepts that can advance quickly. But even these concepts face development challenges.  

In contrast to many chronic medications, where reliable methodologies for adherence and persistence have been established, OAMs are often discontinued or decreased due to toxicity. OAMs also have a highly complex evidence base that varies across specific regimens, which can introduce substantial complexity when appropriately assessing adherence when individuals switch among different regimens.  

PQA’s Ben Shirley and Flatiron Health’s Ann Schwemm addressed these issues in a HOPA News Q&A earlier this year. 

When we identify measure concepts with broad support from oncology stakeholders, pre-development analyses and research may be needed to inform measure development. This work provides us the best chance to identify and develop performance measures that are feasible, reliable and usable.  

There are no shortcuts to developing good measures, and the dearth of oncology measures today reflects these development challenges. 

PQA’s Process to Improve Quality 

PQA’s work to improve medication use quality is distinguished by its multi-stakeholder collaboration and consensus-driven processes.  

We’re ready to move forward on OAM, and PQA and its members have the expertise and a demonstrated track record of developing nationally recognized measures with broad implementation potential. 

In December, PQA will host the first in a series of three national, multi-stakeholder workshops. The series will bring more than two dozen national health care leaders and oncology experts around the table to address: 

  • Access and management of OAM 
  • Performance measurement in oncology 
  • Opportunities for clinicians and providers to improve OAM use quality 

The convened leaders will discuss medication access and adherence specific to oncology, including issues related to treatment recommendations, acceptance, initiation, persistence, and maintenance. 

The discussions around measurement will focus on measure use and attribution, existing measurement gaps and implementation opportunities, and data access and feasibility issues critical for low-burden measurement. 

Across all areas, we’ll consider the impact of health disparities, health inequities and social determinants of health on OAM use. 

The workshops will be informed by a robust environmental scan that is underway to ensure productive discussions and decisions that reflect the current state of research, clinical practice and quality improvement.  

The participants for this initiative will include:  

  • Clinical oncology practitioners, including physicians, nurses and pharmacists, 
  • Patients and patient advocacy organizations, 
  • Health plans, health systems and employers, 
  • Life sciences and biopharmaceutical organizations, 
  • Pharmacy benefit managers, 
  • Oncology researchers, and 
  • Health information technology and solutions providers. 

Following an in-person workshop in early 2023 and a third event that will be online, PQA will produce a public, consensus-based report with a prioritized list of research and measurement opportunities for improving OAM use quality that impacts care delivery, patient outcomes and health care costs. The report, to be published in May, will be a foundation for PQA quality improvement initiatives and a resource for all oncology stakeholders. 

We’re reaching out to PQA members and national stakeholders now about participating in and supporting this effort. 

I want to thank EMD Serono, Jazz Pharmaceuticals and HOPA for their early support of this work. Their leadership and commitment to improving the quality of OAM use helps make our work possible. We hope that our members and other oncology stakeholders will join them in supporting the development of a national, consensus strategies for research and measurement. 

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