The use of oral anticancer treatments is widespread and vital to modern cancer treatment. Novel oral chemotherapy and targeted therapy treatments continue to receive US Food and Drug Administration approval every year, making knowledge of these agents a necessity for practitioners working in oncology. Many oral anticancer agents are prone to drug interactions that can contribute to adverse effects and decrease therapy efficacy. Potential drug-drug interactions include (1) interactions with CYP3A4 inhibitors and inducers, (2) interactions related to gastric acid suppression, (3) interactions related to prolongation of the cardiac QT interval, (4) interactions related to anticoagulant medications, and (5) drug-food and drug-herb interactions. Identifying potential drug interactions and appropriately managing them is key to preventing adverse effects and ensuring maximum efficacy while on oral anticancer therapy. Management of adverse effects increases patient compliance, ensures medication safety, and allows patients to remain on therapy. This article discusses the mechanisms of interactions and types of interacting medications. Specific recommendations are discussed.
Post-traumatic epilepsy is a complicated disease that remains challenging to treat even for patients who are able to access care regularly. People experiencing homelessness (PEH) represent a vulnerable demographic for neurologic disorders, especially due to gaps in care, limited resources, and low health literacy. This is a case of a 53-year-old male experiencing homelessness who was encountered by low-resource medical providers in an extra-clinical setting. His medical history was pertinent for a traumatic brain injury at a construction site a few years prior. He was diagnosed with post-traumatic epilepsy but was lost to follow-up due to being homeless and lacking health insurance. He also had a history of multiple hospitalizations secondary to seizures and did not consistently take his anti-epileptic medications. He was noted to have multiple facial wounds of unclear etiology. Upon further investigation, he complained of episodes of waking up on the sidewalk with facial injuries. The high-risk characteristics of his seizures prompted street medicine providers to quickly arrange an appointment with a primary care doctor. The process was further expedited by petitioning other local charitable organizations. He was later connected to a physician and represcribed levetiracetam 1000 mg twice daily for his post-traumatic epilepsy. After taking his medication regularly, his facial wounds were noted to have dramatic improvement. In this way, his medication adherence was measured as a function of his healing wounds since a lack of fresh wounds implied a lack of spontaneous seizures and subsequent reinjury. Low-resource medical providers caring for PEH in extraclinical settings may necessitate using unconventional indicators to assess disease status.
Topic Significance & Study Purpose/Background/Rationale: Blood and marrow transplantation (BMT) requires comprehensive follow-up care and knowledge about post-BMT complications to prevent adverse outcomes. Patients are referred to our comprehensive cancer center from oncologists worldwide , and are discharged to their community providers for follow-up care. Patients are eager to return home but need education about post-BMT precautions and their new health status. Post-BMT patients comprise a small percentage of most community oncology practices, but they have complex care needs. Oncology nurses play critical roles in this transition as educators and care coordinators. Methods, Intervention, & Analysis: Around day 80, postallogeneic BMT patients undergo a comprehensive evaluation in preparation for discharge. Patients and caregivers attend an RN-taught departure class covering infection prevention, possible transplant sequelae (sexuality, cognitive, emotional changes), screening for secondary cancers, chronic GVHD (cGVHD), and transition of care from the BMT team to the Long-Term Follow-up (LTFU) team. Patients receive survivorship resources, a tour of the LTFU website, and a refrigerator magnet with contact information for LTFU Telemedicine. This service is available to patients and providers for life. The LTFU RN takes baseline photographs of range of motion poses for future comparison in evaluating cGVHD. They provide a 1:1 teaching session and written instructions about signs and symptoms of cGVHD. The BMT nurse communicates to the community oncology RN regarding home infusion needs, cytomegalovirus monitoring requirements, and provides a hand-off summary. Community providers receive a discharge letter and verbal report from the BMT attending. They receive contact information for LTFU, access to the Long-Term Follow-Up after Hematopoietic Stem Cell Transplant General Guidelines for Referring Physicians, a personalized calendar to guide future monitoring, transfusion recommendations, and a patient-friendly medication list. Findings & Interpretation: A transition system should be based on best practices and be responsive to changing technology and evolving opportunities for improvement. Standardized processes and excellent communication involving patients, the transplant center, and community providers lead to a successful discharge. Discussion & Implications: A comprehensive process for discharging patients from BMT centers back to community providers is critical for effective long-term follow-up care. Future nursing research is needed to evaluate the process and make improvements that benefit patients and providers.
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