Advancing Oral Oncolytic Care: HOPA and ASCO Partner to Standardize Quality Improvement in Oral Anticancer Agent Programs

The increasing shift toward oral anticancer agents (OAAs) has transformed cancer care, providing patients autonomy but introducing new complexities in medication safety, adherence, monitoring, and coordination. Recognizing the need for a unified quality framework, the Hematology Oncology Pharmacist Association (HOPA) established the Oral Chemotherapy Collaborative (OCC) in 2020.

Building on this foundation, the HOPA Oral Chemotherapy Collaborative Quality subgroup partnered with the Quality Oversight Committee to launch the first HOPA-ASCO 6-month Quality Training Program (QTP) centered on OAAs to develop and pilot a set of practice-based tools to enhance the management of patients on OAAs. Details on the design, implementations, and early outcomes of this initiative were published in JCO Oncology Practice in 2025.¹

The rise in OAA prescribing has expanded pharmacists’ responsibilities from education and adherence monitoring to coordination across multiple healthcare settings.² Yet, practices have lacked consistent methods to evaluate OAA program quality or measure patient outcomes. The HOPA OCC identified this gap as a top priority. Although national bodies like ASCO and the Oncology Nursing Society (ONS) have published chemotherapy administration standards, no unified model existed to measure or benchmark OAA program effectiveness.^3,4 This project directly addressed that void and aimed to create standardized, adaptable tools for OAA program and patient management designed for real-world practice.

OAA Tool Development

The collaborative developed three core instruments, each tackling a critical aspect of OAA program quality:

1. Baseline OAA Program Assessment Tool

Adapted from the Michigan Oncology Quality Consortium (MOQC) model, the baseline assessment enables practices to evaluate their OAA programs across six domains:

• Prescribing
• Patient education
• Dispensing/distribution
• Monitoring and follow-up
• Practice management
• Alignment with optimal state recommendations^5,6

With 62 structured questions rated as always, sometimes, or never, the assessment helps teams identify gaps in care and set priorities for targeted QI interventions. Initial pilot testing refined the tool’s clarity and usability before implementation in participating HOPA-ASCO QTP teams.

1. Clinical OAA Adherence Tool

Given the absence of validated adherence measures for OAAs, HOPA’s subgroup reviewed existing tools and identified three practical, patient-centered options:

• A single-item self-rating of adherence ability
• A questionnaire identifying reasons for nonadherence
• A three-item scale quantifying missed doses and perceived adherence success

Practices were encouraged to use combinations (e.g., tools 1 and 2, or 2 and 3) for a more comprehensive adherence assessment. Importantly, a detailed user guide accompanied the tool, offering guidance on interpretation and recommended clinical actions.

1. OAA Dashboard

To facilitate ongoing monitoring, HOPA developed a standardized dashboard to track key administrative and clinical metrics associated with OAAs. Administrative measures include prescription volume, fill capture rate, and financial assistance utilization. Clinical quality metrics include:

• Time from prescription to start of therapy
• Adherence rates
• Unplanned healthcare utilization
• Number of pharmacist interventions
• Patient-reported outcomes (PROs)

The dashboard was designed to help practices demonstrate value, benchmark performance, and align with national quality initiatives.

Implementation Through the HOPA-ASCO Quality Training Program

From September 2022 to April 2023, nine interdisciplinary teams participated in the HOPA–ASCO OAA Thematic QTP. These teams representing diverse geographic regions and institutional types (academic centers, community practices, and health systems) received the HOPA OCC tools and integrated them into their 6-month OAA-focused QI projects. Each team was led by a HOPA pharmacist and included multidisciplinary team members including physicians, nurses, and pharmacy technicians. Teams supplemented their OAA QI project with the three developed tools to assess baseline performance, identify gaps, implement changes, and evaluate outcomes.

Key Findings and Barriers

Baseline Results

Among 105 QTP participants completing the OAA program baseline assessment:

• Prescribing standards showed strong adherence. Most sites consistently documented essential OAA information including drug name, dose, duration, and refills.
• Monitoring (symptoms and adherence), follow-up, and care coordination showed significant variability, with many respondents selecting sometimes or never.
• The most common gaps relating to OAAs included patient satisfaction tracking, social determinants of health screening, and use of collaborative practice agreements.

These findings reveal a continued need for structured pharmacist involvement and consistent monitoring processes for OAAs across care sites.

Survey Insights

Post-program surveys revealed strong endorsement of the tools’ value:

• 71% found the baseline assessment useful and easy to use.
• 86% planned to implement one of the adherence questionnaires.
• 57% intended to use the dashboard, though IT and resource barriers limited adoption.

Overall barriers to tool implementation spanned across personnel shortages, competing institutional priorities, and inadequate health information technology integration, reflecting systemic challenges many oncology pharmacies face today.

Implications for Oncology Pharmacists

This initiative represents the first structured integration of pharmacist-driven OAA tools within a nationally recognized QI training program. Its success highlights the power of interorganizational collaboration between HOPA and ASCO to accelerate learning across oncology practices.

As oral therapies continue to dominate the oncology pipeline, ensuring that patients receive, understand, and adhere to their treatment safely is a priority. The HOPA OCC tools empower oncology pharmacists with the structure and resources needed to evaluate and strengthen institutional OAA programs, establish consistent adherence monitoring, and track outcomes that reflect both clinical excellence and financial value.

These tools, developed by oncology pharmacists, represent a framework for continuous quality improvement rooted in pharmacy practice. Oncology pharmacists serve as educators, adherence advocates, and system-level change agents who bring a unique, outcomes-focused perspective to the oncology team. By adopting and sustaining these tools, oncology pharmacists can lead the standardization and evolution of OAA care from reactive to proactive. In doing so, they not only elevate the quality of OAA management but also inspire a culture of pharmacist involvement in continuous improvement across disciplines, positioning us as an essential, data-driven partner in the future of oncology care.