Clinical pattern and drug-related problems among colorectal cancer patients at oncology center in Ethiopia: A hospital-based study

Abstract

Objective: Despite the fact that cancer patients are highly susceptible to drug-related problems due to the effects of cytotoxic agents, data are limited due to a lack of studies on those patients. Hence, we aimed to investigate drug-related problems among patients diagnosed with colorectal cancer. Method: A registry-based cross-sectional study was conducted on colorectal cancer patients at the Felege Hiwot Comprehensive Specialized Hospital. Socio-demographic and disease-related characteristics, treatment regimens, and drug-related problems were recorded by reviewing medical records. Standard guidelines, protocols, and databases were used to evaluate the occurrence of drug-related problems and the severity of adverse drug reactions. For the analysis, Stata version 16/MP for Windows was used. Logistic regression analysis was employed to investigate the potential-associated factors of drug-related problems. A p-value ⩽ 0.05 was used to declare the statistical significance of each independent variable. Results: A total of 150 colorectal cancer patients were included, with a mean age of 51.4 ± 13.8 years. About 30% and 41.3% had stage II and stage III cancers, respectively. About three-quarters (73.8%) of the patients were given 5-fluorouracil-based combination regimens. The prevalence of drug-related problems was found to be 48.7%, with a mean of 2.12 ± 0.93 drug-related problems. In the Felege Hiwot Comprehensive Specialized Hospital, drug–drug interactions and adverse drug reactions were the most prevalent drug-related problems, which accounted for 50 (32.7%) and 49 (32%) cases, respectively. Being elderly (>50 years old) ( p = 0.013), having co-morbidity ( p = 0.001), and being on five or more medications ( p = 0.002) were independent predictors of drug-related problems. Conclusion: Fluorouracil-based chemotherapy was the most frequently used treatment regimen. Almost, half of the colorectal cancer patients had one or more drug-related problems. About one-third of patients had adverse drug reactions and drug–drug interactions. Furthermore, age, co-morbidity status, and the number of medications used were significantly associated with drug-related problems. Clinical pharmacy services should be implemented to optimize drug therapy because the majority of colorectal cancer patients have one or more drug-related problems.

Drug-related problems among esophageal, gastric and colorectal cancer patients at the National and referral hospital in Kenya

“…Drug–drug interactions, adverse drug reactions and the need for additional drug therapy were the most common DRPs among colorectal cancer patients. 41 Likewise, adverse drug reactions, the need for additional drug therapy, and dosing problems were the predominant categories of DRPs among colorectal cancer patients in our study setting. This high prevalence of adverse drug reactions in colorectal cancer patients could probably be related to the frequent use of chemotherapy-based regimens in managing this condition.…”

“…24,[38][39][40] In contrast to the study conducted in Ethiopia, we found a significantly higher prevalence of DRPs in our patients with colorectal cancer. 41 However, a Turkish study revealed a similar prevalence of DRPs among colorectal cancer patients after the first course of chemotherapy. 42 This could probably be linked to the frequent use of chemotherapy in colorectal cancer patients.…”

“…A similar study in Ethiopia revealed older age, comorbidity and polypharmacy (≥ five medications) were significant predictors of DRPs in colorectal cancer patients. 41 Another study also reported the stage of cancer and comorbidity are significant determinants of DRPs in cervical cancer patients. 40 In other cancers, comorbidity was significantly associated with DRPs.…”

“…Similarly, various studies found a higher incidence of chemotherapy-induced DRPs in cancer patients. 41,47,48 Therefore, preventive strategies with the active involvement of clinical pharmacists are indispensable to curb this high burden of DRPs in chemotherapy-treated gastrointestinal cancer patients.…”

“…In contrast, a previous study showed 58% significant and 4% severe levels of drug–drug interaction in colorectal cancer patients. 41 A Chinese study reported a 97.02% severity level of drug–drug interactions in cancer patients. 51 In addition, 67% severe and 26.9% moderate drug–drug interactions were observed among cancer patients undergoing chemotherapy.…”