Impact of outpatient pharmacy interventions on management of thyroid patients receiving lenvatinib

Abstract

Objectives: Medical oncologists and pharmacists at our institution established an integrated support program aimed at preventing unnecessary treatment interruption or dose reduction during oral targeted therapy with lenvatinib. Here, we evaluated the benefits of this program in managing patients with thyroid cancer receiving lenvatinib. Methods: We retrospectively evaluated thyroid cancer patients who received lenvatinib between May 2015 and March 2017. This descriptive study collected records in which pharmacists contributed to changing doctors’ prescriptions and categorized the interventions. Results: During the study period, 24 thyroid cancer patients were treated with lenvatinib. Among patients, the incidence of temporary interruption and dose reduction of lenvatinib due to adverse drug reactions was 100% (n = 24) and 83.3% (n = 20), respectively. There were 193 temporary interruptions of lenvatinib due to adverse drug reactions. A total of 501 outpatient pharmacy services were conducted by pharmacists in collaboration with oncologists, of which 125 were interventions (24.9%). In addition, pharmacists conducted 156 telephone follow-up services; 18 (11.5%) of these were to consult an oncologist about a patient’s confirmed problems and resulted in the decision to continue observation with no medical intervention while 41 (26.2%) resulted in the oncologist deciding to temporarily interrupt lenvatinib treatment after the report of an adverse drug reaction from the pharmacist. Conclusion: Pharmacist interventions in collaboration with medical oncologists improved lenvatinib therapy. Interventions for outpatients were conducted not only in outpatient clinics but also by telephone follow-up, clarifying the importance of continuous management for patients at risk of adverse reactions and misuse of oral medicine.

Use of Telepharmacy To Support Patients Using Oral Antineoplastic Agents: A Pilot Study

“…As for the type of medication related to intervention, only 25% of these were related to the study's antineoplastic agent. This result is consistent with one in which 86.3% of the pharmacist's interventions were not associated with cancer drugs [30], but lower than that of others studies [4], [20].…”

“…This study corroborates this view since most of the interventions carried out referred to medication use. Another aspect that draws attention is that practically one-third of the interventions performed were corrective, a result similar to another study (25 %) [20].…”

“…However, when asked about the form of use, some inadequate reports were identi ed, as in another study [20], although patients believed they were adopting the correct procedure. This fact indirectly demonstrates the importance of the multi-professional team in providing patient care.…”

“…Other topics were also addressed in the population studied, such as adherence (14%) and empowerment (13%), among others. Other studies describe other themes of the interventions performed, such as the need for additional drug therapy, non-adherence, inappropriate use of the drug [20], ADR, medication adherence, drug interactions, medication errors, and symptom management [4]. Contrary to other reports in the literature [4][5], not many interventions have been performed on adverse effects.…”

“…The tool suggested in this work can be applied in different scenarios of pharmaceutical care. Among possibilities of pharmacist teleconsultation's applications, we can mention the identi cation of inappropriate medication use [20], ADR identi cation [4], [20], [21], the detection of drug-related problems [4], [20], and improved adherence [4]; often with positive feedbacks from patients and professionals about the telemedicine use [12], including phone calls [22].…”