publication date: Jun. 19, 2020

Trials & Tribulations

Mobile pharmacies—driving down rural cancer care disparities

Justin D. Floyd DO FACOI

Justin Floyd DO, FACOI

Cancer Care Specialists of Illinois

 

James Wade

James L. Wade III MD, FACP, FASCO

Cancer Care Specialists of Illinois

 

Allison_Braden_2

Allison Braden, PharmD

Cancer Care Specialists of Illinois

 

People living in rural communities are often located far away from the major cancer centers that offer a full spectrum of treatments, including clinical trials.

This distance barrier makes cancer patients vulnerable to disparities in care. Delivering cancer care to patients in or near the rural communities in which they reside reduces barriers and improves access.

Unaddressed, these barriers ultimately may prevent patients from pursuing cancer care or perhaps even more significantly, keep them from participating in cancer research trials.

One strategy to address this disparity is the implementation of central hubs housing personnel and resources that can radiate towards rural communities. In practice and principal, this has been demonstrated to be an effective tactic to deliver state of the art care to cancer patients in their home communities.

However, in order to improve efficiency and benefit for patients, this strategy must be continously evolving. A recent step in the evolution of this model of care has resulted in the development and implementation of a mobile, USP 800 compliant, compounding pharmaceutical vehicle… a “mobile pharmacy.”

Story 4 truck

 

Cancer Care Specialists of Illinois, a founding member of Heartland Cancer Research NCORP, has designed, developed, and launched a first of its kind mobile pharmacy. This vehicle resides in a rural hub where it is stocked and serviced daily by a ground crew, preparing it for daily travel to more remote rural clinics.

Upon arrival at a rural satellite clinic, the pharmacy allows a traveling oncologist to see patients and deliver anti-neoplastic agents to patients in their hometown, in real time.

Regulations around drug compounding continue to evolve to ensure safety to patients and health care providers. These new regulations are not easy to implement, are expensive, and may require special staff and equipment for compliance, none of which are necessarily readily available in rural communities.

Mobile pharmaceutical services allow these complex services to be rolled out in smaller communities without having to build infrastructure in a rural community that may only require such infrastructure one day a week.

Mobile pharmaceutical services reduce the waste of high cost medications. Wastage of such pharmaceutical agents results in a negative economic and environmental effect. Compounding high cost pharmaceutical products centrally and bringing the compounded product to the patient has proven to be effective.

However, issues including shelf life of the compounded product, patient compliance, and newly identified drug toxicity all add significant risk to a compounded agent being successfully delivered to the patient. Once compounded, if not administered, the cost of the drug must be paid without reimbursement. In addition, the environmental effects of the waste created will be realized without any benefit to the patient.

Mobile pharmaceutical services allow the drug to be delivered in the uncompounded state to the patient and compounded on-site once the patient has been evaluated and is deemed fit for therapy. This “real time” drug compounding is the process by which chemotherapy is typically compounded and administered in cancer centers.

Mobile pharmaceutical services assure that the same level of pharmacy care demanded by QOPI certification at the practice’s main hubs are now available to patients in rural clinics. The pharmacy ordering and verification process is run through the EPIC EHR system, just like in a centralized cancer center. Vial tracking, labeling, coding, and billing are also performed in EPIC, assuring patients are receiving and being billed for the correct treatment.

Finally, mobile pharmaceutical services increase patient access to therapeutic clinical trials since investigational drugs can be compounded on site in a USP 800 compliant pharmacy. Although many patients in rural communities receive standard of care therapeutic agents for cancer, they may be required to travel to a central site to participate in a therapeutic treatment trial.

Mobile pharmaceutical service providers, working closely with the Heartland NCORP, allow for compounding of investigational agents, by trained research study pharmaceutical staff on-site for real-time delivery of investigational agents close to home.

This assures that NCI, FDA, and science base pharmacy tracking requirements are met, while improving access to cancer research. The mobile pharmacy program is one additional step in closing the divide between cancer outcomes in rural vs urban patients (1).

Providing excellent cancer care to patients close to home continues to be an integral part of oncology care. Innovation has and will continue to advance this initiative. Keep an eye out­—you may see us roll into a community near you.


References

Unger, J, et al. JAMA Netw Open. 2018;1(4):e181235. doi:10.1001/jamanetworkopen.2018.1235

Copyright (c) 2020 The Cancer Letter Inc.