Pharmacotherapeutic follow-up in oncology

Abstract

Background Morbidity and mortality associated with the use of medicines is a great problem of public health. The pharmacist has a key role in detection, preventing and resolving drug-related problems (DRP). This is even more important in the case of cancer patients, where the high number of treatment protocols and the extensive supportive therapy increases the number of drugs used. This particular setting is a challenge to the clinical pharmacist. Purpose Analysis and characterisation of pharmacotherapeutic follow-up and pharmacist interventions in oncology patients. Materials and methods Retrospective study of pharmacotherapeutic follow-up from January to September of 2011, in a central hospital. Results Between January to September of 2011 the team of oncology pharmacists monitored 56 patients (29 males and 26 females) with mean age of 69 years (min.: 33; max.: 93). Colorectal cancer was the most prevalent cancer in the study population, followed by breast and pulmonary cancers. The team monitored 316 drugs (a mean of 5.64 drugs per patient). The follow-up detected 43 DRPs, resulted in 43 pharmaceutical interventions (0.77/patient). The majority of interventions were related to the need to adjust dosages (53.5%), followed by the need to substitute one or more medicines (11.6%) and those related to adverse effects (11.6%), such as emesis protocol optimisation and other supportive treatment. The physicians accepted approximately 79% of pharmacist interventions. Conclusions The results show that cancer patients are one of the groups most at risk of DRPs. The analysis, characterisation and quantification of pharmaceutical interventions performed on the oncology unit are an important step in documenting the activities of hospital pharmacists in this area, enabling them to be measured. The pharmacist interventions stand out as individual contributions throughout the patient's cancer treatment, highlighting the role of the pharmacist as part of the multidisciplinary team.

Drug-related problems with targeted/immunotherapies at an oncology outpatient clinic

“…26 Previous studies show that patients with chronic disease experience at least one DRP during drug treatment, and this can vary between 0.58 and 0.87 in patients with cancer. [27][28][29] The results of this study are consistent with previous published studies in many Table 3. Targeted and/or immunotherapy related DRPs according to the PCNE v.7.…”

Exploring troublesome symptom and problems experienced by cancer patients undergoing chemotherapy

“…Interactions with other medications can cause small changes in the pharmacokinetics or pharmacodynamics of a chemotherapy agent that could significantly alter its efficacy or toxicity. 16,17 In our study we observed 1.85% drug interaction to the total number of DRPs. While the exact incidence of Drug-drug interactions (DDI) is unknown in cancer patients, it has been estimated that about one-third of cancer outpatients are at risk of developing a DDI.…”

“…13 But a higher number of DRPs was detected in this study when compared with another retrospective study done in Portugal that detected 43 DRP in 56 patients. 14 This variation indicates that as such comparisons are hampered by different settings, measurement methods and classification systems. In this current study, nausea and vomiting occurred in 155 patients of which about 140 patients needed additional medication as an antiemetic when they subjected to highly emetic chemotherapy like platins and commonly prescribed antiemetics were Ondansetron (8-16 mg), Dexamethasone (20 mg) and Aprepitant (125 mg).…”

“…15 A similar study in Portugal also showed that the majority of interventions were related to the need to adjust dosages (53.5%) which is much higher than this study. 16 Drug interactions in oncology are of particular importance owing to the narrow therapeutic index and the inherent toxicity of anticancer agents. Interactions with other medications can cause small changes in the pharmacokinetics or pharmacodynamics of a chemotherapy agent that could significantly alter its efficacy or toxicity.…”

Clinical oncology pharmacist: Effective contribution to patient safety

“…8 Several studies address prescription errors in oncology services and emphasize the role of the pharmacist even showing economy for health services. [9][10][11] However, there is little information on the classification of the pharmaceutical interventions (PIs) performed in this field.…”