BackgroundChemotherapy prescriptions validation by the oncology pharmacist often require interventions to optimise some aspects of the treatment, usually related to the safety and effectiveness of antineoplastic agents.PurposeOur pharmacy department has developed an initiative to register these interventions, in order to characterise possible areas of improvement in the prescription validation process.Material and methodsDuring a period of 2 months, we created a database collecting data from the interventions made, which included the following information: date of intervention, medical record number, drug involved, reason/type of intervention and result of the intervention (accepted/not accepted). Sociodemographic, clinical and laboratory data were obtained from medical records. Statistical analysis of the results was performed using Microsoft Excel.Results44 interventions (43 accepted) were recorded. The department in which more interventions were recorded was medical oncology (64%), followed by haematology (29%), paediatrics (4.8%) and radiotherapy oncology (2.4%). Median age of the patients included in the database was 58.5 years (2–87), and 72% of patients were women. The most common reasons for intervention were due to ‘prescribing errors’ (47.7%), ‘pharmacotherapeutic recommendations’ (22.7%), ‘consultations/requests for information’ (15.9%), ‘adverse events’ (6.8%) and some minor reasons grouped into the category ‘others’ (6.8%). The most common types of intervention were ‘dose modification due to an adverse event (AE)’ (34%) and ‘resolution of consultations regarding prescription/medication administration’ (18%). The next types of interventions by frequency were ‘treatment recommendations’ (9.1%) and dose adjustments based on renal function’ (6.81%). Less common intervention types (4.5%) were: ‘changes in prescription’, ‘dose adjustments based on an AE’, ‘dose adjustments based on pharmacotherapeutic recommendations’, ‘changes in route of administration’ and ‘changes in dosing schedule’. Finally, type of interventions such as ‘changes in the regimen of administration’, ‘treatment interruption’ or ‘pharmaceutical compounding’ were reported in 2.3% of cases.ConclusionOncology pharmacist participation in the patient care multidisciplinary team is essential, as is clear from the high rate of acceptance of our interventions. One of the most important aspects of pharmaceutical validation is to identify errors in the prescription and medication administration process, as well as participation in the individualisation of patient therapy through pharmacotherapeutic recommendations, ensuring the effectiveness and safety of the treatment.No conflict of interest.
Background Erlotinib, gefitinib and crizotinib are tyrosine kinase inhibitors (TKIs) used in the treatment of non-small cell lung cancer (NSCLC). Their hepatic metabolism involves several cytochrome p450 isoenzymes, making them susceptible to potential interactions. Purpose To identify and analyse potential interactions between TKI and the patients’ home treatment, and to determine the degree of acceptance of recommendations by the clinician. Materials and methods In our prospective study, we selected all patients with NSCLC treated with TKIs using the Pharmacy Landtools software, monitoring them over a period of six months. Sociodemographic, clinical and home treatment (HT) data were obtained through electronic medical histories. HT was confirmed by interviewing patients. The interactions were consulted in the SPC, the Micromedex and Lexicomp databases and related scientific articles. Results 19 patients were studied (31.58% men and 68.42% women) with a median age of 71 years (aged 46–83). 11 patients were treated with gefitinib, 5 with erlotinib and 3 with crizotinib. 18 potential interactions were detected, distributed as follows: 44.44% gefitinib and 27.78% erlotinib and crizotinib, respectively. 75% were due to the use of proton pump inhibitors. Of these interactions, only those considered relevant were reported (72.22%). 92.31% recommendations were accepted, resulting in substitution (83.33%) or withdrawal (16.67%) of the drug. During our intervention period, no side effects related to a drug-drug interaction were detected. Conclusions Although TKI interactions are described in the literature, they are not always detected by the clinician. It is essential to detect, report and improve patients’ drug treatment, preventing these potential interactions which may result in adverse effects or in lack of effectiveness of the antitumor treatment. No conflict of interest.
it emerged that the impact on budget was greater for nivolumab which had a higher survival value than pembrolizumab. This analysis was a first step in assessing the impact of introducing a significant new class of treatments, immunotherapy, comparing two drugs that have totally changed the prognosis of NSCLC patients.
BackgroundOral chemotherapy is increasingly used in Oncology. It has important advantages, such as patient comfort, but it also brings new challenges which did not exist with the intravenous treatment. Some of these drugs have interactions with food, leading to changes in their bioavailability. As they are drugs with a narrow therapeutic margin, this can lead to alterations in their efficacy and/or toxicity.PurposeA. To assess the level of knowledge on the administration of oral cytostatics that present restrictions with meals (drugs that have to be taken with/without food) among the outpatients of a third level hospital. B. To minimise the incorrect administration and the risk of food-drug interactions, providing patients with information as to how and when drugs have to be administered.Material and methodsOnce the oral cytostatics with food restrictions were identified, we asked the patients in treatment about the information they had received from the doctor and the way they were taking the medicine. We provided those who were taking the drug incorrectly with the right information. In the following visit, it was confirmed if the patients who had previously been taking the cytostatic incorrectly, were now taking them correctly (intervention accepted/not accepted).Results97 patients were interviewed (54% men, 46% women). 40% of them were used to taking the drug incorrectly. Of this percentage, 77% correspond to patients treated with capecitabine, 8% with lapatinib, another 8% with temozolomide, and finally 3% with abiraterone, erlotinib and pazopanib, respectively. We detected a great diversity depending on the drug dispensed. 95% of the 39 interventions made were accepted.ConclusionThe data obtained suggest the need to reinforce the information that the patient receives. It is important to make sure that the patient understands how and when the oral cytostatic should be administered.ReferenceCharity D. Drug interactions in cancer therapy. Nature Rev Cancer 2006;6:546–58No conflict of interest.
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