Effectiveness of pharmacist-managed oncology ambulatory care for patients with non-small cell lung cancer in Taiwan

Non-small cell lung cancer (NSCLC) is commonly treated with tyrosine kinase inhibitors (TKIs). However, adverse events from such treatment can lead to treatment discontinuation and additional medical expenditures. Ambulatory care from oncology pharmacists in patient education and symptom management can benefit patients with NSCLC. In this study, we evaluated the effectiveness of an oncology pharmacy service at a medical center in Taiwan. We retrospectively enrolled 137 patients with NSCLC who initiated treatment with afatinib, gefitinib, or erlotinib between January 2017 and December 2021; 40 of them utilized the oncology pharmacy service (intervention group), and the remaining 97 did not (nonintervention group). To determine the effectiveness of the oncology pharmacy service, we analyzed the following outcomes: adverse event rates, number of hospital visits (unexpected outpatient department visits, emergency department visits, and hospitalization), and medical expenditure. The intervention group had significantly more skin-related adverse events (acneiform rash: 75% vs. 49%; mucositis: 40% vs. 21%; dermatitis: 30% vs. 9%; and paronychia: 85% vs. 28%) but significantly fewer monthly emergency department visits (0.04 vs. 0.17) and unexpected outpatient department visits (0.15 vs. 0.34). The intervention group also had significantly lower expenditure for emergency department visits (NT$166.4 vs. NT$734.8) and nonsignificantly lower expenditure for outpatient department visits. Our findings indicate the value of pharmacist-managed ambulatory oncology care. Although this service did not reduce the incidence rates of adverse events, it reduced the number of unplanned outpatient and emergency department visits and reduced the emergency department expenditure of patients with NSCLC receiving TKIs.