Community providers are becoming more comfortable managing the adverse-effect profiles of CDK4/6 inhibitors, shifting their primary concern to patient access and transportation, said Kimberly Podsada, BSN, RN, MSN, NP-C, a nurse practitioner at the University of California San Diego, after moderating a Case-Based Roundtable on CDK4/6 inhibitors in hormone receptor–positive metastatic breast cancer.
Podsada, who has moderated similar meetings, said attendees reported greater confidence in recognizing and managing drug-specific toxicities — from gastrointestinal symptoms to QTc prolongation and neutropenia — allowing care teams to focus on logistical barriers to treatment.
Frequent early monitoring, including interim blood draws and EKGs, can create a substantial burden for patients. Transportation challenges, lack of family support and the cost of taxis or rideshare services often complicate adherence to required visits and labs.
Many clinics now use nurse navigators or dedicated staff to coordinate care, check on medication tolerance, schedule follow-up labs, and consolidate appointments so patients can complete multiple tasks in a single visit. Some practices arrange home health visits for blood draws or provide limited taxi vouchers, although such assistance is constrained by clinic funding.
Clinics have adopted varied strategies to reduce patient burden, such as directing patients to closer laboratories or consolidating clinic visits, but logistical issues remain — particularly the need for blood work at two-week intervals after starting therapy.
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