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Montefiore in the News

May 19, 2010

Bronx, NY (May 19, 2010) - A new program at the Montefiore-Einstein Center for Cancer Care (MECCC) is helping to reduce the negative consequences of "polypharmacy", the use of multiple dissimilar drugs, frequently prescribed by different doctors, by a patient who may have more than one serious health problem.

Developed by the Department of Medical Oncology at Montefiore, the Medication Therapy Management program helps patients with cancer safely take their oral chemotherapy as well as prescription medications they need for other serious conditions such as heart disease and diabetes. The program was developed by Una Hopkins, BSN, MSN, FNP-BC, nurse practitioner, and Pragna Patel, PharmD, R.Ph, Oncology Investigational Pharmacy Manager, both in medical oncology, to help patients avoid what could be life-threatening errors in taking, using and storing their medications. It is believed to be the first hospital-based program of its kind in the New York-metropolitan area.

"Many of our patients were already living with other health issues when they were diagnosed with cancer, so their daily treatment regimens have become much more complicated," Hopkins said. "Our program is a partnership that involves the patient, the practitioner and the pharmacist, who together review the patient's medical history and devise a personalized plan that supports the safe and effective use of all their medications."

"The use of oral anticancer drugs has grown tremendously and is expected to become the main form of cancer therapy in the not-so-distant future. As a result, this pioneering program will become an essential component of any medical oncology treatment unit. Many of our patients have already benefited from it," said Roman Perez-Soler, MD, Chairman, Medical Oncology.

Each year, medication errors in the U.S. cause physical harm to patients and exact a serious financial toll on the healthcare system. According to the Institute of Medicine, adverse drug reactions and noncompliance are responsible for 28 percent of hospital admissions and 23 percent of nursing home admissions, and medication errors result in over $200 billion in direct health costs.

At the MECCC, patients considered to be at highest risk for errors include those who take more than five medications simultaneously, those with multiple co-morbid conditions, those taking oral chemotherapeutics, and those taking long-term (5 years) hormonal therapy. "Cancer commonly occurs in the setting of other chronic and acute diseases such as hypertension and diabetes. Our patients are often on multiple medications that are important to their well being. This program is a critical component to our paradigm of putting the patient first to ensure that they receive the best possible care and the best possible outcomes," said Steven K. Libutti, M.D., FACS, Director, MECCC, and Vice Chairman of Surgery.

"Our goal is to help patients get a clear understanding of their medications, both prescribed and over-the-counter, as well as any vitamins or herbal supplements they take," Patel said.

Patients are referred to the Medication Therapy Management program by the physicians and nurses at the MECCC. During a session, the clinical team discusses with the patient any possible side effects, allergies or adverse reactions he or she may experience, and possible drug-drug, drug-food interactions. The team then creates a "medication action plan" that clearly identifies any important concerns the patient should be aware of, and the signs of symptoms that may require emergency care. The patient is given a copy of the action plan to take home and share with his or her family, and their other various specialty health care providers including their local pharmacist.

"As our patients have more concurrent diseases, programs like Medication Therapy Management will have increasing importance, as this type of counseling cannot often be performed during routine office visits," said Richard V. Smith, MD, Vice Chairman, Department of Otorhinolaryngology-Head and Neck Surgery, and Chairman of the Cancer Committee at Montefiore. "The benefit to these patients is tremendous, as inappropriate use of the medications can affect the outcomes of the cancer treatment."

Since the Medication Therapy Management program's inception, the team has identified and corrected patients' problems such as non-cancer drugs' interactions with oral chemotherapy, non-adherence with chemotherapy and prescribed regimens for other conditions, outdated immunizations and cost/insurance challenges in obtaining prescription medications. During these interactions, the patient and family are given the opportunity to ask questions such as, "Can I take my pills with grapefruit juice?" The program's education component empowers patients to become active participants in their care, and the collaboration between specialties is rewarding for clinicians. Sessions can last up to 30-45 minutes and include a brief assessment of the patient, review of the current labs and all medications.

"Our goal is to personalize patient care and increase patient safety through this collaborative model," Hopkins said. "By helping patients understand and organize all of their medications, we're putting them in the best position to adhere to their prescribed regimens and stay as healthy as possible."