The risk of infection with Pneumocystis jirovecii pneumonia (PCP) in patients undergoing chemotherapy is closely related to the intensity of corticosteroid exposure. PCP is uncommon with classical (3-weekly) R-CHOP, but the risk may be higher with biweekly R-CHOP (R-CHOP-14) due to the increased frequency of prednisolone pulses. Among 47 consecutive patients treated with R-CHOP-14 at our institution, five (11%) developed microbiologically proven PCP, with a further two (4%) having classical clinical and radiological features of PCP, but without microbiological confirmation. None of these patients were HIV-positive or had additional risk factors for PCP. Our experience suggests that PCP prophylaxis should be considered in institutions using R-CHOP-14 for the treatment of patients with aggressive lymphomas.

Background Patients with cancer are managed across the whole healthcare spectrum. This complex system of interdependencies has high potential for errors to occur. This is a focus area for pharmacists, who possess the skillset to optimise cancer care across the health care system, identifying errors and other medication‐related problems (MRP). Aim The aim of this study was to identify and describe the impact of the pharmacist’s contribution in reducing cancer therapy‐related errors. Methods A search of English‐language publications in Embase, Medline and CINAHL was conducted. Databases were searched from 1 January 2010 until 29 September 2020 to identify all quantitative studies of a descriptive, observational or experimental design. Articles describing pharmacist‐led interventions in adults receiving one or more cancer therapies including oral chemotherapy, intravenous chemotherapy or immunotherapy compared to no intervention, usual care or a service delivered by another healthcare professional were included. Researchers screened articles to identify eligible studies, and then data were extracted using a standardised data collection sheet. Quality assessment was undertaken using the modified Cochrane and the Newcastle Ottawa risk of bias tools. Data were reported as number or percentage. Results Of 2292 papers identified, nine studies were eligible for inclusion in this review. Pharmacist interventions consistently showed an increased identification of medication errors and medication‐related problems. Pharmacist contributions in many of the included studies comprised medication reviews and monitoring, laboratory monitoring, adverse drug reaction and drug–drug interaction management, adherence monitoring and medication counselling. All studies showed pharmacist intervention in cancer care resulted in fewer errors compared to control arms. Error minimisation was described for parenteral and oral cancer therapies and also for supportive medications such as antiemetics. Conclusion Pharmacists reduce errors and potential patient harm in practice settings where cancer patients are treated. Pharmacists are an integral component of cancer care teams.

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Response, action, and adaptation of the way health services are delivered will impact our ability to provide optimized and continuity of care while acting within resource constraints imposed by COVID-19. Care for patients with cancer is particularly important given increased infection rates and worse outcomes from COVID-19 in this patient population, as well as potential adverse outcomes if treatment pathways need to be compromised. In this commentary, we provide a global oncology pharmacy perspective (including both developed and developing nations) on how COVID-19 has impacted access to and delivery of cancer therapies. This perspective was prepared by the International Society of Oncology Pharmacy Practitioners, with input from national and regional oncology pharmacy practice groups (42 practice leaders from 28 countries and regions) who contributed to a snapshot survey between 10 and 22 April 2020. Specifically, we highlight challenges related to safe handling of hazardous drugs and maintaining high-quality medication safety standards that have impacted various stakeholders.

With the development of innovative cancer treatments over recent decades, the cost of cancer care has risen exponentially, limiting patient access to patented originator biotherapeutics in many countries. The introduction of biosimilars to the market has created new opportunities as well the need for changes in practice within healthcare institutions. A ‘biosimilar’ is a biotherapeutic product which is highly similar in terms of quality, safety and efficacy to an already licensed originator product. Although biosimilars lack clinically meaningful differences in therapeutic activity as compared to the originator product, these complex biological molecules are not considered identical chemical copies, unlike generics, and minor differences in molecular structure and inactive compounds may exist. A thorough understanding of these differences and their clinical implications is necessary for optimising medicines-use practices involving biosimilars. This position statement, developed by the International Society of Oncology Pharmacy Practitioners Biosimilars Taskforce, aims to provide the global oncology pharmacy community with guidance to support decisions around biosimilar use. The 11 statements cover the regulation and evaluation of biosimilars, practical issues around local implementation, the education of healthcare staff and patients, and the requirement for ongoing pharmacovigilance and outcome monitoring.

Introduction The coronavirus of 2019 pandemic has necessitated vast and rapid changes in the way oncology pharmacy services are delivered around the world. Methods/aims An international survey of oncology pharmacists and technicians was conducted via the International Society of Oncology Pharmacy Practitioners and collaborating global pharmacy organisations to determine the impact that the coronavirus of 2019 has had on pharmacy service delivery, pharmacy practitioners and oncology practice. Results The survey received 862 responses from 40 different countries from September to October 2020. The majority of respondents were pharmacists ( n = 841, 97.6%), with 24% involved in the direct care of patients with the coronavirus of 2019. Of the survey participants, 55% increased their time working remotely, with remote activities including dispensing, patient assessment/follow-up and attending multi-disciplinary rounds. Respondents reported a 72% increase in the use of technology to perform remote patient interaction activities and that participation in educational meetings and quality improvement projects was reduced by 68% and 44%, respectively. Workforce impacts included altered working hours (50%), cancelled leave (48%) and forced leave/furloughing (30%). During the pandemic, respondents reported reduced access to intensive care (19%) and anti-cancer (15%) medications. In addition, 39% of respondents reported reduced access to personal protective equipment, including N95 masks for chemotherapy compounding. Almost half of respondents (49%) reported that cancer treatments were delayed or intervals were altered for patients being treated with curative intent. A third of practitioners (30%) believed that patient outcomes would be adversely impacted by changes to pharmacy services. Sixty-five percent of respondents reported impacts on their mental health, with 12% utilising support services. Conclusion The coronavirus of 2019 pandemic has altered the way oncology pharmacy services are delivered. These results demonstrate the adaptability of the oncology pharmacy profession and highlight the importance of formal evaluation of the varied practice models to determine the evidence-based practices that enhance pharmacy services and, thus, should be reinstated as soon as practical and reasonable.

Objective Off-protocol prescribing of systemic anti-cancer therapy (SACT) can lead to concerns about effectiveness of patient care. To identify variations in practice, a toolkit was developed for health services to address patient safety and the risk of sub-optimal outcomes for patients. Data sources Following significant incidents with SACT in South Australia and New South Wales, the Department of Health and Human Services, Victoria (the department) conducted an assessment of Victorian public health services to understand current practice regarding SACT protocol governance. A literature review examining SACT auditing was also undertaken to guide improvements. A department supported Chemotherapy Audit Toolkit (CAT) was created for implementation at public hospitals in Victoria. A post-implementation survey was done on uptake and issue identification. Data summary An initial assessment showed that 27% of Victorian public health services were undertaking retrospective review of SACT dosing, which was targeted for improvement. The literature review identified little guidance, however an audit of current sector practices found several audit methodologies. A process that involved audits by health services assessing their own practice was adopted. The toolkit was developed and piloted with health services. A post-implementation survey showed that 20% of services were using the toolkit, 35% were implementing the toolkit and 45% did not use the toolkit. Conclusions The VicTAG CAT has been adopted by more than half of Victorian public health services and is being used to influence prescribing. Implementation of the toolkit has been affected by resource reallocation due to the COVID-19 pandemic. The CAT is available online.

Background: Worldwide, demand for health care services far outpaces the availability of staff. The use of robots in healthcare has advanced in recent years as robots are seen as a viable solution to address the shortage of healthcare staff. We propose the use of a humanoid robot to provide basic nutritional education to patients with diabetes in the waiting room, hence freeing up time for dieticians to address more complex issues. We hypothesize that use of this intervention will be more effective than the current standard of care i.e. A leaflet, in educating and empowering patients with diabetes. Methods: We conducted a single-centre, randomized controlled trial to determine whether a humanoid robot would improve patient’s knowledge of nutrition. The primary outcome of the trial is improvement in patient knowledge score based on 36 items from a validated nutrition questionnaire. Each patient’s prior knowledge of nutrition was assessed by a validated questionnaire prior to the intervention. Patients were randomized to current standard of care i.e. physician-led education plus a leaflet (n=40) or standard of care plus Droid Audio Visual Educator (n=40). Following the trial, both groups had their knowledge of nutrition reassessed using the same validated questionnaire. The performance of patients in each group was compared and effectiveness of the intervention in improving education objectively determined. Results: A total of 90 patients underwent randomization. 10 withdrew before completion. The mean age was 53.7 years. The change in score in the intervention group was 3.2 of 36 points higher than control group on average (95% confidence interval [CI] 0.9 to 5.4; P= 0.006). Conclusions: This trial suggests there is potential for humanoid robots to deliver basic nutritional education Disclosure S.O'connor: None. J.Ong: None. B.Lim: None. S.Coleman: None. H.Worlikar: None. C.Connolly: None. S.E.Mcgarel: None. T.O'brien: None. D.T.O'keeffe: None. Funding Health Services Executive, Intern Network Academic Track