Objectives: Medical oncologists and pharmacists at our institution established an integrated support program aimed at preventing unnecessary treatment interruption or dose reduction during oral targeted therapy with lenvatinib. Here, we evaluated the benefits of this program in managing patients with thyroid cancer receiving lenvatinib. Methods: We retrospectively evaluated thyroid cancer patients who received lenvatinib between May 2015 and March 2017. This descriptive study collected records in which pharmacists contributed to changing doctors’ prescriptions and categorized the interventions. Results: During the study period, 24 thyroid cancer patients were treated with lenvatinib. Among patients, the incidence of temporary interruption and dose reduction of lenvatinib due to adverse drug reactions was 100% (n = 24) and 83.3% (n = 20), respectively. There were 193 temporary interruptions of lenvatinib due to adverse drug reactions. A total of 501 outpatient pharmacy services were conducted by pharmacists in collaboration with oncologists, of which 125 were interventions (24.9%). In addition, pharmacists conducted 156 telephone follow-up services; 18 (11.5%) of these were to consult an oncologist about a patient’s confirmed problems and resulted in the decision to continue observation with no medical intervention while 41 (26.2%) resulted in the oncologist deciding to temporarily interrupt lenvatinib treatment after the report of an adverse drug reaction from the pharmacist. Conclusion: Pharmacist interventions in collaboration with medical oncologists improved lenvatinib therapy. Interventions for outpatients were conducted not only in outpatient clinics but also by telephone follow-up, clarifying the importance of continuous management for patients at risk of adverse reactions and misuse of oral medicine.
Background Collaboration between pharmacists, doctors, and nurses in outpatient treatment is beneficial; however, such services are limited in Japan due to the lack of a healthcare reimbursement fee for outpatient pharmacy services at outpatient clinic. Objective We evaluated the impact of a service in which clinical pharmacists collaborated with an oncologist at an outpatient clinic in the treatment of adverse drug reactions in outpatient cancer chemotherapy. Methods We performed a retrospective cohort study using patients' medical records and treatment diaries. Subjects were patients who received outpatient chemotherapy via a clinical pharmacist collaboration service provided by six outpatient pharmacists and an oncologist at an outpatient clinic between June and August 2016. Results During the study period, the total number of outpatient services was 2508, with 2055 (81%) related to chemotherapy. The six outpatient pharmacists provided interventions to 498 of the 2055 cases (24%). Of the 498 interventions, 103 (20%), in addition to oncologist's prescription, were suggested treatments for adverse drug reactions due to cancer chemotherapy. Oncologists approved a total of 82 prescription suggestions from pharmacists (79%) to 63 patients. Fifty-seven percent ( n = 47) of the adverse drug reactions were improved following the pharmacists' suggested prescriptions. Conclusions This is the first study to clarify the benefits of outpatient pharmacy services in which pharmacists collaborate with oncologists at an outpatient clinic for the management of adverse drug reactions in cancer patients in Japan.
Background: Skin toxicity is a common adverse event during cetuximab (Cmab) treatment. However, few reports have investigated the correlation between skin toxicity and the efficacy of Cmab in patients with recurrent or metastatic squamous cell carcinoma of the head and neck (R/M SCCHN).Methods: We retrospectively reviewed 112 R/M SCCHN patients who received palliative chemotherapy with Cmab. Main eligibility criteria included primary disease in the oral cavity, hypopharynx, nasopharynx, oropharynx, or larynx; no prior history of EGFR-directed therapy; receipt of Cmab plus chemotherapy as first-line therapy for recurrent or metastatic disease; and follow-up for more than 90 days. We analyzed the time to first occurrence and time of maximum grade skin toxicity, and its predictive value with regard to treatment efficacy.Results: After a median follow-up of 393 days (range 109–1501 days), 105 (94%) and 20 (18%) patients had skin toxicity of any grade and grade 3, respectively. Among them, 8 patients with grade 3 acneiform rash, skin rash, or paronychia within 90 days after treatment initiation (“early skin toxicity”) had improved progression-free survival (PFS) (log-rank test, P = 0.045; 2-year PFS, 25.0 vs. 2.9%) and overall survival (OS) (log-rank test, P = 0.023, 2-year OS, 50.0 vs. 14.4%) compared with those with < grade 3 toxicity. A greater proportion of patients with early skin toxicity than patients without this toxicity could proceed with Cmab maintenance (88 vs. 44%, P = 0.021). Multivariate analysis identified early skin toxicity as an independent predictor of better PFS (hazard ratio [HR] = 0.363, 95% confidence interval [CI] 0.142–0.924, P = 0.034) and OS (HR = 0.187, 95% CI: 0.045–0.781, P = 0.022).Conclusion: Grade 3 Cmab-induced skin toxicity within 90 days was associated with better survival in R/M SCCHN. Effective rash management therefore seems necessary to realize the benefit of Cmab treatment.
Pulmonary hypertension syndrome (PHS), also known as ascites, in broiler chickens prevailed in the local area of Ibaraki prefecture, Japan, and was investigated epidemiologically, serologically, and pathologically. PHS developed in chickens older than 35 days of age when rapid increase of body weight started. Approximately 90% of affected birds were males, in which weight increase was greater than in females. Serologic test revealed that PHS broilers had an increase of hematocrit value. Pathologic studies indicated that the heart of affected birds had an obese-induced pressure and cold exposure triggered congestion in the right ventricle/cava and an increase in peritoneal fluid. These changes were consistent with the previous reports of PHS, so we designed the experiment of effects on cold-induced PHS birds in a temperature-controlled house. After the 10 PHS birds at 55 days were reared for 14 days in a temperature-controlled house at 20 +/- 5 C, ascites disappeared in eight birds and hematocrit values decreased to normal range in nine birds. Our finding indicated that temperature-controlled environment may be one solution to reduce mortality in PHS birds.
Objectives: This retrospective study was conducted to evaluate the impact of a service in which clinical pharmacists collaborated with oncologists at an outpatient clinic on chemotherapy order prescriptions and adverse drug reaction management in outpatient cancer chemotherapy. Methods: This was a single-center retrospective cohort study. Subjects were patients who received pharmacist services at an outpatient clinic in 6 treatment divisions at the National Cancer Center Hospital East from June to September 2016. Pharmacist interventions were categorized and assessed for impact by 2 pharmacists according to previously published methods. Results: The 6 pharmacists worked a total of 1396 hours, providing 1645 pharmacy interventions to 3419 patients. Of the 1645 interventions, 459 interventions (27.9%) involved chemotherapy order prescriptions. The 459 interventions for chemotherapy prescriptions were categorized according to the previously reported categories “drug therapy safety” (n = 330, 71.9%), “other” (n = 91, 19.8%), “drug therapy efficacy” (n = 28, 6.1%), and “drug therapy indication” (n = 10, 2.2%). Of the 91 interventions categorized as “other,” the 2 most frequent types of interventions were “confirmation from pharmacists to oncologists about laboratory test order” (n = 54, 11.7%) and “consultation from oncologists to pharmacists about chemotherapy regimen” (n = 23, 5.0%). Most interventions were identified as having “no error” (n = 369, 80.4%), while 8 interventions (1.8%) were identified as being “potentially lethal” or “serious.” Moreover, 92.8% of interventions were identified as being “extremely significant,” “very significant” or “significant.” Conclusions: This study clarified the benefits of outpatient pharmacy services in which pharmacists collaborate with oncologists at an outpatient clinic on outpatient chemotherapy prescription orders.
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