Updated ASCO-NCODA MIP Standards Emphasize Health Equity, Patient-Centered Care, and Integrated Workflows in Oral Oncolytic Management

In this Pharmacy Times interview, Gurjyot K. Doshi, MD, a medical oncologist and hematologist at Texas Oncology, discusses the key updates to the American Society of Clinical Oncology (ASCO)–Network for Collaborative Oncology Development and Advancement (NCODA) Medically Integrated Pharmacy (MIP) Standards, which reflect the evolving landscape of oral oncolytic therapy. With a sharp focus on patient-centered care, health equity, and interdisciplinary collaboration, the revised standards aim to address the growing complexities of managing oral anticancer medications. Doshi highlights how these updates incorporate structured patient education, integration of electronic health records, and proactive identification of social determinants of health to optimize treatment adherence and outcomes—particularly for underserved populations.

Pharmacy Times: What are the key updates in the revised ASCO-NCODA MIP Standards that specifically address the unique challenges of managing oral oncolytics?

Gurjyot K. Doshi, MD: Thanks for the update and the information and the ability to share the key updates with you all. You know, in the last 5 years, we've seen tremendous growth in the use of oral oncolytics, or oral anticancer medicine, and so these updated standards really focused on integrating patient-centered approaches and workflows. Additionally, we started to focus on health care inequities and how we can best support all of our patients taking oral anticancer medicines and how those workflows and access issues really are imperative to understand and provide support for patients so that we can optimize outcomes. For example, you know, in our updated standards we spoke about the importance of education prior to initiating therapy and to really put this into a structured process that includes cultural educational information and also linguistics, speaking in the patient's own native language and providing education in that format. We also talked about the integration of communication through integration in the electronic medical record, and how important that is for all members of the medically integrated dispensing team. We know that that helps to reduce delays to initiation of treatment, and this coordination between initiation of treatment and continuation of treatment are really important. Additionally, we focused on medication safety practices like dual identity checks and timely and early toxicity checks within the first week of starting on therapy and then continuing at a frequency to ensure that patients are actually well monitor on their therapies. So, all of these things represent some updates and additional information that is different from the previous standards.

Pharmacy Times: How do the updated ASCO-NCODA MIP Standards specifically address barriers related to health equity and social determinants of health in oral anticancer therapy management?

Doshi: So, at this time, the new standards, the updated standards, really use health equity as a foundational element. We know that so much goes into having the cancer diagnosis and then having to start on oral anticancer therapy. The burden, if you will, ends up falling on the patient and the patient's caregivers. So, we really laid a foundational support in these updated standards to screen our patients for social risks, including housing, transportation to and from clinic, and then really financial hardships, getting access to their medication. And then, additionally, health literacy, so the education of their therapy must be rooted in the patient's health literacy, and we must use our education materials as well as our nurse navigators and our pharmacists. Education must all be tailored to the specific patient with their cultural background needs, their social needs, as well as their linguistic needs. Once we screen patients and provide them education, we not only identify their needs, but then we have oncology nurse navigators and our pharmacy technician navigators that are identifying community resources and financial aid assistance programs so that we can provide the patient the help they need. All of this is with the intent to safely start patients on therapy and then also prevent that prescription abandonment that we see is really prevalent with high cost of care, or with patients who lack those resources. So, these patient navigation standards are really aligning with our initiatives to make sure that patients not only start on therapy, but then they stay on therapy.

Pharmacy Times: How can pharmacists within MIP teams effectively collaborate with providers and patients to optimize adherence to oral anticancer medications, particularly in underserved populations?

Doshi: Well, pharmacists play a key role in making sure that patients are starting on therapy and then continuing on therapy. And the largest impact that they have is really conducting that initial assessment of patients. It's actually even part of pharmacy accreditation, and it's a very integral role of this medically integrated pharmacy where our pharmacists are embedded in the care team. So, they play that prominent role of interacting with our patients first and foremost, and then they conduct follow up, education, and assessments, and these are regularly scheduled adherence checks, and they talk about side effects and really plug into management of side effects. The pharmacists, being part of the comprehensive medically integrated pharmacy care team, have the ability to enhance communication electronically through the same medical record, and then also by being in the clinic with the nurses and the physicians, so that we have seamless communication for our patient care to be seamless, effective, prompt, and continuous. And so, we've found that with this type of collaboration, we're able to make sure that patients are cared for in a timely way with multiple touch points, and then the literature has shown that that enhances adherence to anticancer medication.

Pharmacy Times: What are some key considerations or challenges for institutions that are looking to implement or adapt these updated MIP Standards into their pharmacy operations?

Doshi: Institutions must be applauded for taking the initiative to enhance and apply these standards into their practice. We really hope that they will look at the resource allocation that they would need to ensure that they have adequate staffing and then look to these standards and to the NCODA and ASCO websites to make sure that they are having the training modules that they need to meet these standards requirements. Additionally, being part of an integrated [electronic health record] system allows for communication amongst the team members of their medically integrated team. Of course, state by state, they have to navigate their state and federal regulations related to pharmacy operations and patient privacy. And then, being part of quality improvement processes and implementing regular mechanisms for assessment and refinement of these medical integrated pharmacy practices is an important part of any program.

Pharmacy Times: In your literature review, were there any surprising gaps or underexplored areas in MIP practices that you believe require further research or implementation guidance?

Doshi: So, as much as we've made progress, there's always areas of opportunity that we know that we need to address in the future, and a large area that needs more research is how oral anticancer medications are used in the pediatric and adolescent young adult cancer population. So, we have limited studies now, and I would like to see us focus on those populations to understand their unique needs. We also don't talk about this as much, and there's limited studies, but we would like to address the mental health needs of our patients undergoing cancer therapies. There's a really, really huge impact of cancer on the adult population and the pediatric and young adult population. We know that mental health and stressors related to cancer are interrelated, and we would like to do further studies as to the impact of mental health challenges in our patient population. Additionally, our rural population may have lack of resources or different resources and challenges that are caused by their geography, including access to patient care and support services. So, further data and analysis on the impact of rural populations with oral anticancer medication is an unmet need that needs to be studied further.