SUMMARYWhat is known and objective: The off-label use of medicines is widespread in several diseases. This type of prescribing practice is particularly more acute in oncology. However, the suitability of anticancer medications for off-label use remains an issue of controversy, due to uncertainty around the clinical benefits and potential toxicities, limited evidence to support clinical decisionmaking, increased out-of-pocket costs for patients and ethical concerns around the lack of informed consent. Currently, data pertaining to the global prevalence of off-label use in cancer therapy are lacking. The aim of this review was to provide an overview of off-label drug use prevalence in oncology. Methods: A systematic literature search was performed in PubMed as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines from 1975 to 2016. Studies assessing the prevalence of off-label use of anticancer drugs were included. Data synthesis: Of the 199 eligible papers retrieved, 23 studies were included in this systematic literature review. Off-label drug use in inpatients ranged from 18% to 41%. Among adult patients with cancer, 13%-71% received a minimum of one offlabel chemotherapy. The main reasons for off-label drug use were 'drug unapproved for specific tumour' and 'modified drug applications'. Among adults, metastatic cancers and palliative care patients received the most off-label drugs. The off-label drug use unsupported by standard treatment guidelines or drug compendia was in the range of 7%-31%. Conclusion: Off-label drug use in cancer therapy is commonly practised but outcomes could vary significantly. Hence, greater scrutiny and robust clinical guidance is needed to establish the favourable benefit-risk ratio for patients at the time of prescribing at each level of oncology care to facilitate rational off-label prescribing. WHAT IS KNOWN AND OBJECTIVEOff-label drug use refers to prescribing medicines in a manner that is inconsistent with prescribing information published by regulatory authorities. Off-label drug use can be classified into different categories, such as unapproved indication, use in a special population, through an unapproved route of administration or with a dose not specified in the FDA-approved label.1 Off-label drug use based on little or no scientific evidence is termed as off- 3 Off-label drug use is further differentiated from unlicensed drug use, which refers to the use of a therapeutic entity which has never received any regulatory approval for clinical use in either paediatrics or adult population (Table 1).1 Off-label prescribing is prevalent across different diseases and healthcare settings; however, it is more frequently reported in paediatrics, psychiatry and oncology. [4][5][6] Physicians are generally allowed to prescribe the drug in an offlabel manner in most regions in the world except in countries such as India where it is illegal. 7 The off-label status of a drug could also vary among different countries due to different marketing authorization ...
This systematic review provides a chronological overview of how mhealth research has evolved with changes in mobile technologies. The review involved a PubMed search complemented by manual searching of all issues of the Journal of Medical Internet Research and Telemedicine Journal and eHealth, from inception to January 2015. Articles reporting the evaluation of mhealth interventions in any patient group for any health-related outcomes were analysed without restrictions on the study design. A total of 3476 publications were obtained from the PubMed search and manual searching of eHealth journals. Analysis was based on an abstract review of 515 (14.8%) original research articles, which fulfilled preset inclusion criteria. Three distinct time periods were identified on the basis of mobile devices used in mhealth research. Personal digital assistants (PDAs) dominated mhealth research in the years before 2007 (17 of 33 articles, 51.5%). Basic and feature phones were the main methods of mhealth intervention from 2007 to 2012 (95 of 193 articles, 49.2%). After 2012, smart devices (smartphones, tablet PCs and iPod touches) were highly used in mhealth research (173 of 289 articles, 59.9%). Despite a growing focus on infectious diseases and maternal and child health in the most recent years, non-communicable conditions continued to overshadow the trend of mhealth research. Overall, mHealth research has evolved over the past decade in terms of the mobile devices employed, health conditions addressed and its purpose. While chronic medical conditions have clearly been the focus of mhealth research, a shift in trends is expected as the application of mhealth interventions spreads to other under-studied areas. Future research should continue to leverage on the advancements and ubiquitous nature of mobile devices to make healthcare accessible to all.
MTM is an important platform in identifying and managing DRPs. Patients are generally satisfied with MTM services.
There is a need for a systematic approach to manage these cutaneous reactions. Oncology trained pharmacists play vital roles in assessing, managing, documenting and patient education.
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