The Clinical Oncological Society of Australia (COSA) guidelines for the safe prescribing, dispensing and administration of cancer chemotherapy

Abstract

The issue of medication safety is highly significant when anti-cancer therapy is used as a treatment modality due to the high potential for harm from these agents and the disease context in which they are being used. These guidelines provide recommendations on the safe prescribing, dispensing and administration of chemotherapy and related agents used in the treatment of cancer. The guidelines represent a multidisciplinary collaboration to standardise the complex process of providing chemotherapy for cancer and to enhance patient safety. These are consensus guidelines based on the best available evidence and expert opinion of professionals working in cancer care. The aim of these guidelines is to assist in the prevention of medication errors and to improve patient safety with respect to the treatment of cancer. This guidance is intended for a multi-disciplinary audience and will have most relevance for medical, nursing and pharmacy staff involved in the complex processes of delivering chemotherapy and associated treatment. The scope of the guidelines includes; all patients and age groups receiving chemotherapy and targeted therapy for the treatment of cancer and cancer therapy administered by any route in both the hospital and home setting. These guidelines should be seen as point of reference for practitioners providing cancer chemotherapy services.

Safe use of oral cytotoxic medicines

“…• the generic drug name, number of tablets to be taken 7 and frequency and duration of therapy (written in full)…”

“…7 For cancer chemotherapy the pharmacist should have access to the treatment plan, the chemotherapy protocol and relevant patient parameters including height and weight and recent laboratory results. 10 The pharmacist should ensure that the relevant supportive medicine has been prescribed or is available to the patient.…”

“…Patients should be given verbal and written information that includes dose instructions (when the medicine should be taken and if it is required to be taken before or after food), adverse effects and safe storage instructions. 7,12 Some oral cytotoxic medicines need to be stored securely in a refrigerator, for example chlorambucil and melphalan.…”

“…This is completed by the specialist who initiates the treatment 7 and should be given to the patient and all the healthcare professionals involved in their treatment. It is important that the patient has the plan with them if they see a different doctor, for instance in an emergency.…”

Safe Handling of Oral Chemotherapeutic Agents in Clinical Practice: Recommendations From an International Pharmacy Panel

“…Some of the existing recommendations to ensure the safe storage, prescribing, dispensing, administration, and disposal of cytotoxic oral chemotherapy drugs are listed in the Appendix (online only). 2,7,12,[15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31] However, the recommendations have not been universally accepted or incorporated into practice. Recent surveys of health care practitioners as well as patients found that the perception of oral chemotherapy being safer than intravenous chemotherapy was prevalent.…”