Oral anticancer medication: Does the patient understand?

Abstract

219 Background: Oral anti-cancer medication (OAM) prescribing is increasing. Safety and adherence issues surrounding OAM are causing a shift in the traditional roles and responsibilities of oncologists, nurses and pharmacists. This study aims to investigate patients’ perception of education and safety surrounding OAM use. Methods: Over a 6-month period an anonymous cross-sectional survey was offered to all patients (pts) attending for cancer treatment with OAM at Irish hospitals with cancer services in the South-West region. Data was prospectively analysed using standard statistical tools for non-parametric data. Results: A total of 172 surveys were distributed and 101 pts responded (59%). Of these, 53 (54%) were female. Median age was 62 (range 29-80 yrs). Diagnosis was colorectal cancer in 49 pts (48%), breast cancer in 13 (13%) and brain tumour in 12 (12%). Of treatments used, 85% were oral chemotherapy and 15% oral biological therapy. The most commonly used agent was capecitabine (61%). When commencing OAM, 17% of respondents felt they did not understand it. Understanding was improved by pt education by a doctor (p=0.03) or hospital-based nurse (p=0.04) and provision of information booklets (p=0.04). Pts were unaware of interactions in 30% of cases and 20% were not aware of any safety issues. Pts who had been given information leaflets were significantly more aware of safety including careful handling (p<0.001), storage conditions (p=0.02) and safe disposal (p<0.001). Pts attending nurse-led oral chemotherapy clinics (NOCC) were significantly more aware of safety issues (p=0.04). Of respondents, 1% reported taking too many tablets and 15% had forgotten to take OAM on ≥1 occasion. NOCC improved adherence (p=0.03). Conclusions: OAM, when indicated, is an option for selected pts who are compliant and educated about complications. This study highlights issues with pt education and safety awareness. To our knowledge the factors influencing this have not been previously explored. A significant proportion of our pts were sub-optimally educated regarding medication interactions, storage needs, handling and disposal precautions. Educational tools to aid healthcare professionals in pt instruction and NOCC significantly improve patient understanding.

Manejo e descarte dos medicamentos antineoplásicos orais e seus impactos ambientais

“…Foram identificados nas bases de dados 791 estudos, os quais passaram por um processo de triagem detalhado na Figura selecionados para compor a revisão 12 artigos 11,18-28 e dois resumos de anais de evento [29][30] . Os três estudos captados por buscas prévias que auxiliaram na consolidação da temática, foram adicionados ao escopo, sendo eles um resumo de anais de evento 31 , uma dissertação 6 e um trabalho de conclusão de curso 8 .…”

“…Apesar No que diz respeito ao manejo e ao descarte de antineoplásicos orais, 63% (12) dos estudos focaram em sua importância 11,[20][21][23][24][26][27][28][29][30][31]33 , 42% (8) tiveram como objetivo a identificação das práticas de manejo dos antineoplásicos orais 11,[20][21]26,[29][30][31]33 , 32% (6) buscaram identificar as estratégias educacionais para o manuseio seguro, através da correlação das práticas realizadas com as publicações das diretrizes baseadas em evidências sobre padrões de segurança da terapia antineoplásica oral 18,[22][23]25,28,32 tratamento oncológico 19,27 , e 21% (4) estudos 6,8,23-24 , destacaram os riscos e impactos dos medicamentos oncológicos como contaminantes do meio ambiente.…”

“…Dentre os profissionais envolvidos na terapia oncológica, 68% (14) estudos evidenciaram a importância dos profissionais de saúde como médicos, enfermeiros e farmacêuticos como orientadores do manejo seguro dos antineoplásicos orais 6,8,[18][19][22][23][24][25][26][27][28][29][30]33 ; 21% (4) focaram no papel do farmacêutico como o profissional capacitado para fornecer as orientações específicas quanto aos cuidados de manejo, armazenamento, administração e descarte dos medicamentos oncológicos [23][24][25]27 . Além disso, 16% (3) artigos avaliaram os riscos de toxicidade inerentes aos medicamentos oncológicos orais no ambiente domiciliar e a importância da ação do profissional farmacêutico na mitigação desses efeitos 6,8,28 .…”

“…• Desconhecimento dos riscos destes medicamentos e a inexistência de qualquer problema em relação à segurança [20][21]26,[29][30]33 ;…”

Reply to: Gilligan T. Is There Such a Thing as Cancer Treatment That Isn't Worth Its Cost? The Oncologist 2012;17:3–4

“…Gilligan emphasizes the potential role of guidelines in the appropriate use of expensive anticancer therapies. We also observed the importance of nurse specialists in adherence to anticancer therapy in a survey of patients receiving these agents [5]. Dispensing these expensive agents in weekly rather than monthly aliquots would also reduce waste.…”