Drug-related problems in head and neck cancer patients identified by repeated medication reviews on consecutive therapy cycles

Abstract

Background Head and neck cancer (HNC) patients are particularly vulnerable to drug-related problems (DRPs) given the toxicity of concomitant chemoradiotherapy (CCRT). Objective To investigate the number and type of potential DRPs (pDRPs) in HNC outpatients undergoing five consecutive cycles of CCRT. Methods A single-centre, non-randomized, non-interventional, observational study was conducted at the Oncological Outpatient Clinic of the Center for Integrated Oncology at the University Hospital Bonn, Germany. Clinical pharmacists took a comprehensive medication history, documented laboratory data, assessed patients’ symptom burden, and retrospectively performed medication reviews at study entry and on the first day of each therapy cycle without any clinical intervention. Results In 26 patients, the mean number of pDRPs continuously increased during therapy course, from 4.8 (SD 2.7, range 2–12) at cycle 1 to 6.9 (SD 2.6, range 2–12) at cycle 5, with drug-drug interactions, adverse drug reactions, inappropriate durations of use, and inappropriate dosage intervals being the most common. Considering only new and recurrent pDRPs, the mean number was 4.3 (SD 2.3, range 2–9) at cycle 1 and lower in the further therapy course with an average of 1.3 (SD 1.7, range 0–7) at cycle 2 and 1.9 (SD 1.5, range 0–5) at cycle 5. The number of pDRPs was found to be associated with medication regimen complexity and health-related quality of life assessed in the first therapy cycle. Conclusion pDRPs frequently occurred in HNC outpatients demonstrating the need for pharmaceutical care. A methodological framework for repeated medication reviews was established, facilitating implementation into routine healthcare practice.

Medication Risks and Their Association with Patient-Reported Outcomes in Inpatients with Cancer

“…This number was lower, compared to a retrospective study by Vucur et al on head and neck cancer outpatients. DRPs per patient ranged from 4.8 (first therapy cycle) to 6.9 (fifth therapy cycle) [ 19 ]. However, our findings correspond to the studies of Nightingale et al and Tan et al, with three DRPs per patient, and Edwards et al, showing 3.7 DRPs per patient [ 6 , 18 , 20 ].…”

“…Nevertheless, every administered drug can cause a DRP. The number of drugs per patient corresponds to the findings of most comparable studies [6,18,19], which is also true for the number of patients with polymedication. In contrast, the number of patients with hyperpolymedication is slightly higher in this study [3,6,7].…”

“…A DRP is defined as an event during pharmacotherapy which interferes with a desired health outcome [ 17 ]. The number of reported DRPs in cancer patients ranges between three and five per patient [ 6 , 18 , 19 , 20 ]. DRPs can lead to increased morbidity, unnecessary hospital admissions, and mortality [ 15 , 21 ].…”

Medication errors in cancer therapy: Reports from German hospital pharmacists between 2008 and 2019

“…Pharmacists’ positive contribution to multidisciplinary collaboration in oncology has been confirmed by numerous studies, which have demonstrated the benefits of pharmaceutical consultation in both outpatient and inpatient settings for various tumor entities. 32–37…”

“…Pharmacists' positive contribution to multidisciplinary collaboration in oncology has been confirmed by numerous studies, which have demonstrated the benefits of pharmaceutical consultation in both outpatient and inpatient settings for various tumor entities. [32][33][34][35][36][37] Especially in high-risk processes, not only the four-eyes principle is widely established: with the introduction of different checkpoints at different points of the process by different staff members, potential errors are detected at an early stage so that they do not reach the patient in the first place. These safety barriers do not necessarily have to be ensured by employees but can also relate to standardized processes or materials used.…”