Objective: Major depressive disorder (MDD) and adjustment disorder (AD) are common psychiatric disorders in cancer patients but are often overlooked in clinical oncology settings. We introduced a clinical screening program utilizing the Distress and Impact Thermometer (DIT) to identify MDD and AD in cancer outpatients receiving chemotherapy. This study assessed the usefulness of the screening program.Methods: Pharmacists administered the DIT to consecutive patients undergoing chemotherapy at an outpatient clinic. Psychiatric treatment was recommended to all the patients with positive screening results. The proportion of patients referred to the Psychiatric Service during the program period was then compared with that during a usual care period.Results: Of the 520 patients who started chemotherapy during the 6-month program period, 5.0% (26/520) were referred to the Psychiatric Service and 2.7% (15/520) were diagnosed as having MDD or AD. No statistically significant difference in the referral rates was observed between the two periods (2.7 vs 1.0%, p 5 0.46). However, the period from the first chemotherapy treatment until the visit to the Psychiatric Service was significantly shorter during the program period than during the period of usual care (12.9713.2 days vs 55.6717.6 days, po0.001).Conclusions: The proportion of patients referred to the Psychiatric Service for the treatment of MDD or AD during the program period was not different from that during the usual care period. However, the program was useful for introducing psychiatric treatment at an earlier stage. Further modifications to the program to improve the referral rate are necessary.
Prophylactic minocycline appears to be useful for the management of erlotinib-related acneiform rash and xerosis during chemotherapy in patients with advanced pancreatic cancer.
The systematic management program for delirium decreased the incidence of delirium and improved several clinical outcomes. These data suggest that this simple cost-effective program is feasible and implementable as routine care in busy wards.
Hand-foot skin reaction (HFSR) is one of the major adverse effects of sorafenib necessitating discontinuation of the drug, however, no standard interventions for HFSR have been established yet. At our hospital, we are using a ureacontaining cream prophylactically for HFSR associated with sorafenib. We carried out this study in 74 hepatocellular carcinoma patients receiving treatment with sorafenib at our hospital between June 2009 and January 2011 to assess the benefit of prophylactic use of urea-containing cream against sorafenib-induced HFSR. Patients with a history of previous use of tyrosine kinase inhibitors or insufficient data in respect of the dose of urea-containing cream were excluded. The patients were divided into a high-dose group (38 patients) and a low-dose group (36 patients) according to the median dose (2.9 g per day) of urea-containing cream used within the first 2 weeks after the start of sorafenib treatment. The frequency of grade 2 or 3 HFSR was 42.1% in the high-dose group and 61.1% in the low-dose group (P = 0.105). The relative dose intensity of sorafenib was 71.1% in the high-dose group and 59.6% in the low-dose group (P = 0.043). No significant difference was observed in the response rate or time to progression between the two groups. In conclusion, prophylactic use of a urea-containing cream might enhance the relative dose intensity of sorafenib, but further prospective studies are warranted to elucidate its usefulness.
近年,がん治療を始めとする各分野で治療の合併症, 有害事象を減らす医療の最適化の試みが進められている. そのためには患者を合併症の評価や多剤併用の把握等の 複数の視点から評価する包括的アセスメントが必要とさ れており,中でも入院患者の持参薬管理は薬剤師が関与 する有用性が報告 1, 2) され,求められている役割である. 塩谷らの報告 3) では,入院患者の 8 割が持参薬を有してい た中の半分で何らかの問題点があったと指摘し,松原ら は薬剤師が持参薬をチェックしたことで 4.3% の問題が回 避できたことを報告 4) している.そのことからも特にがん 治療を行う患者の併用薬の把握は,プレアボイド(薬剤師 が薬物療法に直接関与し,薬学的患者ケアを実践して副 作用,相互作用,治療効果不十分等の患者の不利益を回 避あるいは軽減すること)への貢献はもちろん,潜在的な 薬物有害事象,薬物間相互作用,服薬アドヒアランス, 医療経済等の観点から重要である 2, 57) . がん専門病院において担がん患者で精神科的対応が必 要な患者が 2040% とされ,向精神薬による治療が必要 とされており,薬剤師による併用薬の把握は,服薬アド ヒアランスの向上,薬剤性せん妄等の有害事象のリスク 評価,相互作用の問題がある薬剤の事前抽出等に大きく 貢献する可能性がある.特に持参薬業務の利点は早期に チェックができるという点であるとされている 2) .がん医 療は抗がん剤や多くのハイリスク薬,医療用麻薬,向精 神薬等を用いる頻度が高いため,特に緩和ケアの分野で どのような薬剤が使用され,何に気をつけるべきかにつ いて事前に把握する必要がある.また,使用される薬剤 がどの様な変遷をしているかについての情報を把握する ことは,状況に合わせた薬剤業務を実施するために重要 医療薬学 37(7) 437 - 441 (2011) Few studies have been done on the use of opioids or psychotropic drugs by cancer patients in Japan. In view of this, we investigated patient records for a total of 2,044 patients, brought by themselves to our pharmacy between September 2009 and March 2010. Their median age was 67 (range 16 -93) yrs, and there were 1,402 males (68.5%). The median number of prescriptions they brought with them was 4 (range: 0 -23, median number of maintenance drugs = 3, median number of temporary acute therapy drugs = 0). One hundred and eighty seven patients (9.1%) had narcotic analgesic drugs other than codeine phosphate hydrate, and their median morphine-equivalent daily dose was 25mg (range 3.8 -265). Six hundred and thirty four patients (31.0%) had psychotropic drugs. Among these drugs, hypnotics accounted for 17.6% (359/2044), anxiolytics 11.0% (224/2044), antipsychotics 7.4% (151/2044), antiepileptics 3.0% (61/2044), and antidepressants 2.3% (47/2044). Our survey revealed that approximately 10% of cancer patients brought in narcotic analgesic drugs and approximately 30% of them had several psychotropics to be used as supportive medication in cancer treatment.
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