Safe Handling of Oral Chemotherapeutic Agents in Clinical Practice: Recommendations From an International Pharmacy Panel

Abstract

Although there has been a significant increase in the availability and use of oral chemotherapeutic agents, the guidelines around their safe handling are still evolving. Although oral chemotherapy is associated with ease of administration, it has the same exposure risks to health care practitioners, patients, and their caregivers as intravenous formulations, and because it is administered in the home, to the families of patients. However, the general misconception appears to be that exposure risk is low and therefore oral chemotherapeutic agents present little risk and are safer to handle. In a series of three roundtable meetings, a team of international pharmacists from North America and Europe reviewed existing guidelines and identified gaps in recommendations that we believe are important for safe handling. The present article is a compilation of these gaps, especially applicable to manufacturers and distributors, storage and handling, and patient education regarding safe handling. These recommendations, on the basis of our experience and of best practices, provide an international perspective and can be adapted by institutions and practices for development of standardized procedures specific to their needs for the safe handling of oral chemotherapeutic agents.

Key Element in Oral Chemotherapy: Patient Adherence

“…İlk faktör, oral kemoterapiye ilişkin eğitim uygulamasında eğitim alacak hasta ve bakım verenler; ikincisi, eğitim ortamı (hastane ve ev ortamı); üçüncüsü, kullanılacak olan eğitim metodu ve görsel/işitsel materyaller dördüncüsü, eğitim verecek sağlık profesyonelleridir. İlk faktör olarak hasta veya bakım verenlere ilişkin yaş, eğitim durumu, görsel yada işitsel herhangi bir sağlık sorunun varlığı, mental iyilik hali, eğitim almak için hazır olma durumu ve eğitim gereksinimlerinin değerlendirilmesi gereklidir (13)(14)(15). İkinci olarak değerlendirilmesi gereken, oral kemoterapi alacak hastaya eğitim verilen ortamdır.…”

“…Bu ortam ev yada hastane olabilir. Önemli olan hasta, ailesi ve sağlık profesyoneli için rahat ve güvenli bir ortamın oluşturulmasıdır (13)(14)(15)…”

“…Otomatik ses yanıt sistemi ise bilgisayar destekli olarak hastaların ihtiyaç duydukları konulara istedikleri zaman yanıt aldıkları bir sistemdir. Bu gibi eğitim yönteminin ve kullanılacak eğitim materyalinin oral kemoterapi alan hasta ve ailesine uygunluğuna karar veren, eğitim içeriğinin değerlendirilmesinde ve eğitim gereksinimlerinin belirlenmesinde sorumlulukları olan dördüncü faktör sağlık personelidir (13)(14)(15). Sağlık personelinin yeterli donanımda olması önemlidir.…”

Medication Therapy Management for Patients Receiving Oral Chemotherapy Agents at a Community Oncology Center: A Pilot Study

“…Interventions performed by the pharmacist included oral chemotherapy education, safe handling techniques for hazardous drugs, oral chemotherapy dosage adjustments, medication interaction mitigation recommendations, immunization recommendations, and a multitude of accepted recommendations impacting medication therapy and/or patient safety. 24 All MTM encounters were documented by the pharmacist and forwarded to the primary oncologist and the patient's primary care physician, as well as other providers as needed. The patient was mailed a typed copy of the updated medication list, a medication action plan, and a 10-question survey about the MTM process.…”

Risks for Workers Handling Solid Oral Doses: Development of a Tool to Improve Personal Protection

“…We initially listed 17 documents and retained 10 of them for complete analysis Among these 10 documents, three deal with hazardous drugs in general [9][10][11] and seven deal with cytotoxics only [12][13][14][15][16][17][18]. One is written in French, the remaining nine are written in English.…”