Dang, et al.: Role of Pharmacist in Counselling among Breast Cancer PatientsThe understanding of adult patients receiving cancer chemotherapy of their regimen is important for better control of chemotherapy-related side effects. Often, patients forget, misunderstand or unsatisfied with the information received. The purpose of this study is to investigate the effectiveness of pharmacist-led pre-chemotherapy counselling on the knowledge of chemotherapy treated breast cancer patients. It is a randomized and prospective study where patients were randomly distributed into intervention group who received pharmacist-led pre-chemotherapy counselling and control group who did not receive pharmacistled pre-chemotherapy counselling. Knowledge assessments and perception of the patients were carried out after pharmacist-led pre-chemotherapy counselling in both intervention and control group using a structured validated questionnaire. Overall, 38 out of 40 patients completed the study with a 97% response rate. Significant improvement in the understanding of chemotherapy regimen and its side-effects was observed in the intervention group as compared to the control group. Besides, patients counselled by pharmacists were able to recall back the information even at the sixth cycle of the chemotherapy regimen compared to the control group. Majority of the breast cancer patients agreed that pharmacist-led pre-chemotherapy counselling was effective. This study suggests that pharmacist-led pre-chemotherapy counselling improves patient knowledge and understanding of the chemotherapy regimen received.

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Introduction: Acute promyelocytic leukemia is an oncologic emergency. The limited cases reported in the literature have led to poor understanding of the safety of management of acute promyelocytic leukemia during pregnancy. Case report: Herein is an acute promyelocytic leukemia case of a 22-year-old young pregnant woman who had various social problems. The patient was diagnosed with acute promyelocytic leukemia in her the second trimester of her first pregnancy. Management and outcome: She was treated with all-trans-retinoic acid with idarubicin and successfully delivered a healthy baby. She completed induction with idarubicin but defaulted her all-trans-retinoic acid, 6-mercaptopurine and methotrexate maintenance. She relapsed after one year and was salvaged with all-trans-retinoic acid high dose cytarabine and arsenic trioxide. She went into remission and had autologous stem cells collected and was planned for an autologous stem cell transplant but she defaulted. She relapsed when she was pregnant with her second baby during her third trimester (29þweeks) 10 months later. Salvage chemotherapy with arsenic trioxide, all-trans-retinoic acid and idarubicin was given. Patient underwent an emergency lower segment caesarian section at 31 weeks of pregnancy due to abnormal fetal cardiotocography. A healthy baby was delivered. Discussion: This drug regimen is controversial during pregnancy owing to the teratogenic effects and fatal retinoic acid syndrome especially in early gestation. In this case, patient was started the induction therapy of all-trans-retinoic acid treatment at her second trimester during her first pregnancy. Conclusion: Our lady demonstrated the possibility of using all-trans-retinoic acid and arsenic trioxide and chemotherapy during second and third trimester with successful pregnancy outcomes.