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Supportive Oncology Meeting Educational Needs and Enhancing Adherence of Patients Receiving Oral Cancer Agents Through Use of the MASCC Oral Agent Teaching Tool © Cynthia N Rittenberg President, Rittenberg Oncology Consulting, Metairie, Louisiana, US Abstract Just as new discoveries are changing the approach to ‘personalise’ cancer treatments, the medications to treat cancers have changed as well. Anticancer agents now include cytotoxics, thought of as traditional chemotherapy, and biologics, often referred to as targeted therapy, many of which are formulated as oral agents. This changing model has resulted in new challenges for oncology professionals to ensure that patients receive education in a comprehensive and consistent manner regarding oral agents. In response to published reports and studies citing the adherence and safety problems for people on these oral medications, along with the noted lack of systematic teaching strategies, the MASCC Oral Agent Teaching Tool © (MOATT), issued by the Multinational Association of Supportive Care in Cancer (MASCC), was designed by oncology nurses to meet the need for a complete and dependable approach to education. Keywords Oral chemotherapy agents, professional consistency, patient education, patient adherence, MASCC Oral Agent Teaching Tool © Disclosure: The author has no conflicts of interest to declare. Acknowledgements: The author would like to thank Judi Johnson for her review of the article. The Multinational Association of Supportive Care in Cancer (MASCC) has received grants from Eli Lilly, OSI Pharmaceuticals and Celgene for the development of the MASCC Oral Agent Teaching Tool © (MOATT). Permission has been received from the MASCC to quote the MOATT. Received: 9 February 2012 Accepted: 24 February 2012 Citation: European Oncology & Haematology, 2012;8(2):97–100 Correspondence: Cynthia N Rittenberg, Rittenberg Oncology Consulting, 500 Rue St. Ann, Suite 223, Metairie, LA 70005, US. E: cindyrit@bellsouth.net The challenge of patient education traditionally is a responsibility of nurses. The nursing process of assessing, planning, implementing and evaluating is never more appropriate than when teaching patients and families about cancer treatments. In the past, as patients prepared for traditional IV (intravenous) treatment, nurses had a ‘captured audience’ to teach and the opportunity to then reinforce repeated verbal instructions and written materials, slowly and thoroughly reviewing procedures and potential problems. Plus, nurses had ample opportunities to physically see and touch patients throughout the course of their treatments in order to assess for treatment side effects and disease symptoms. However, today, patients prescribed oral chemotherapy may never see a nurse. The physician may write a prescription, which is then filled by a pharmacist. 1 Thus, opportunities for nurses to give needed education are lost. The advent of increasing numbers of oral anticancer agents with new, different and challenging side effects has forced those working in patient education to reevaluate and redesign approaches to instruct cancer patients receiving oral therapy. The development of oral cancer agents has changed the paradigm not only of cancer treatment but also of patient education. From less than 5 % a decade ago, 2 the number of oral cancer therapies in use had increased to approximately 17 % by 2007, 3 and it is now estimated that at least 25 % of the 400 anticancer agents in the pipeline are planned as oral agents. 4,5 Oral agents have been in use for years, but the numbers were limited and often they were used in combination with IV agents concomitantly. An example is the cyclophosphamide, © TOUCH BRIEFINGS 2012 methotrexate and 5-fluorouracil (5-FU) (CMF) combination used for years for breast cancer treatment, with the cyclophosphamide taken orally for two weeks and the methotrexate and 5-FU given by vein on Days 1 and 8 of a four-week cycle. A regimen such as CMF, where patients were seen by nurses several times a month for their IV medications, gave nurses ample opportunities to teach and assess a patient’s knowledge of his or her oral medications. The movement towards the use of more oral agents, whether because of necessary formulation, ease of administration, promotion of patient autonomy and independence, saving of time and perhaps money, convenience, and/or avoidance of problems with IV administration, has in itself created other issues. Problems include: proper handling and disposal, prescribing errors, financial considerations, potential interactions with food and other medications, recognition and reporting of side effects and, certainly, ensuring patient adherence. Development of the MASCC Oral Agent Teaching Tool © (MOATT) Background – Assessing At the 2005 Multinational Association of Supportive Care in Cancer (MASCC) symposium, Sultan Kav, from the Department of Nursing at the Faculty of Health Sciences of Başkent University in Turkey, received the Best Young Investigator Award for her study ‘Nurses Attendance of Patient Education and Follow-up for Oral Chemotherapy Treatment in Turkey’ (which was reported the following year by Kav and Bostanci in the journal Supportive Care in Cancer 6 ). The goal of the 97